Abstract
Background: Iran’s Health Transformation Plan (HTP) was implemented to decrease households’ out of pocket and protect them from facing catastrophic health expenditure and impoverishment from 2014. It is needed to assess the effect of HTP; therefore, the study aimed to examine the households’ impoverishment due to health expenditure after HTP. Methods: A household survey was carried out in 2017 in Sistan and Baluchestan province in southeast Iran. About 2400 households were selected as the study sample using a multi-stage sampling technique. The household section of the World Health Survey questionnaire was used to collect data. Independent variables contained households’ characteristics, household income, chronic illness status, the use of health services, and health spending. The dependent variable was whether the household was faced with health spending impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the impoverishment using SPSS software 21. Results: About 7.5% of the households had no basic insurance and 757 (31.6) heads’ of the households were unemployment. The results showed that about 5.4% of the households impoverished due to health expenditure. The households in the furthest region were forced with impoverishment more than other regions (23.0%). Living in a rural area, unemployment, economic status, and inpatients and outpatient costs were the main determinates on impoverishment (P < 0.05). In addition, having supplementary insurance was a protective factor in facing impoverishment (P = 0.05). Conclusions: In general, despite the implementation of HTP, healthcare expenditures leading to impoverishment of high percent of the households and Iranian development goals have not been fulfilled in this region. Economic poverty of the people may also be an important factor in this regard. It is recommended that outpatient services are covered by health insurances.
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