Health Scope

Published by: Kowsar

Measuring Financial Protection in Hospitalized Patients after the Health Sector Evolution Plan in Iran

Soheyla Reshadat 1 , Farid Najafi 2 , Behzad Karami-Matin 3 , Moslem Soofi 4 , * , Eshagh Barfar 5 , Nader Rajabi-Gilan 6 and Seyed-Ramin Ghasemi 7
Authors Information
1 Associate Professor of Pediatrician, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
2 Professor of Epidemiology, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
3 Associate Professor of Health Management, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
4 PhD Student of Health Economics, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
5 PhD Student of Health Economics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
6 M.Sc. of Social Research, Social Development and Health Promotion Research Center Kermanshah University of Medical Sciences, Kermanshah, IR Iran
7 M.Sc. of Social Welfare, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
Article information
  • Health Scope: November 2017, 6 (4); e63163
  • Published Online: November 6, 2017
  • Article Type: Research Article
  • Received: September 8, 2016
  • Revised: January 7, 2017
  • Accepted: February 23, 2017
  • DOI: 10.5812/jhealthscope.63163

To Cite: Reshadat S, Najafi F, Karami-Matin B, Soofi M, Barfar E, et al. Measuring Financial Protection in Hospitalized Patients after the Health Sector Evolution Plan in Iran, Health Scope. 2017 ; 6(4):e63163. doi: 10.5812/jhealthscope.63163.

Copyright © 2017, Journal of Health Scope. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Saksena P, Hsu J, Evans DB. Financial risk protection and universal health coverage: evidence and measurement challenges. PLoS Med. 2014;11(9). e1001701. doi: 10.1371/journal.pmed.1001701. [PubMed: 25244520].
  • 2. Shrime MG, Dare AJ, Alkire BC, O'Neill K, Meara JG. Catastrophic expenditure to pay for surgery worldwide: a modelling study. Lancet Glob Health. 2015;3 Suppl 2:S38-44. doi: 10.1016/S2214-109X(15)70085-9. [PubMed: 25926319].
  • 3. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362(9378):111-7. doi: 10.1016/s0140-6736(03)13861-5.
  • 4. Wagstaff A. Measuring financial protection in health. World Bank Publications; 2008.
  • 5. Ozgen Narci H, Sahin I, Yildirim HH. Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey. Eur J Health Econ. 2015;16(3):255-70. doi: 10.1007/s10198-014-0570-z. [PubMed: 24566703].
  • 6. Arsenijevic J, Pavlova M, Groot W. Measuring the catastrophic and impoverishing effect of household health care spending in Serbia. Soc Sci Med. 2013;78:17-25. doi: 10.1016/j.socscimed.2012.11.014. [PubMed: 23267776].
  • 7. Tomini SM, Packard TG, Tomini F. Catastrophic and impoverishing effects of out-of-pocket payments for health care in Albania: evidence from Albania Living Standards Measurement Surveys 2002, 2005 and 2008. Health Policy Plan. 2013;28(4):419-28. doi: 10.1093/heapol/czs073. [PubMed: 22907092].
  • 8. Kim Y, Yang B. Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy. 2011;100(2-3):239-46. doi: 10.1016/j.healthpol.2010.08.008. [PubMed: 20832893].
  • 9. Wagner AK, Graves AJ, Reiss SK, Lecates R, Zhang F, Ross-Degnan D. Access to care and medicines, burden of health care expenditures, and risk protection: results from the World Health Survey. Health Policy. 2011;100(2-3):151-8. doi: 10.1016/j.healthpol.2010.08.004. [PubMed: 20828854].
  • 10. Hosseinpoor AR, Bergen N, Koller T, Prasad A, Schlotheuber A, Valentine N, et al. Equity-oriented monitoring in the context of universal health coverage. PLoS Med. 2014;11(9). e1001727. doi: 10.1371/journal.pmed.1001727. [PubMed: 25243463].
  • 11. Ghiasvand H, Abolghasem Gorji H, Maleki M, Hadian M. Catastrophic Health Expenditure Among Iranian Rural and Urban Households, 2013 - 2014. Iran Red Crescent Med J. 2015;17(9). e30974. doi: 10.5812/ircmj.30974. [PubMed: 26473081].
  • 12. Soofi M, Rashidian A, Aabolhasani F, Akbari Sari A, Bazyar M. Measuring the Exposure of Households to Catastrophic Healthcare Expenditures in Iran in 2001: the World Health Organization and the World Bank's Approach. J Hospital. 2013;12(2):39-50.
  • 13. Karami M, Najafi F, Karami Matin B. Catastrophic health expenditures in kermanshah, west of iran: magnitude and distribution. J Res Health Sci. 2009;9(2):36-40. [PubMed: 23344170].
  • 14. Kavosi Z, Keshtkaran A, Hayati R, Ravangard R, Khammarnia M. Household financial contribution to the health System in Shiraz, Iran in 2012. Int J Health Policy Manag. 2014;3(5):243-9. doi: 10.15171/ijhpm.2014.87. [PubMed: 25337598].
  • 15. Mousavi SM, Sadeghifar J. Universal health coverage in Iran. Lancet Glob Health. 2016;4(5):e305-6. doi: 10.1016/S2214-109X(16)00068-1. [PubMed: 27102193].
  • 16. Ministry of Health and Medical Education (MoHME). Health Sector Evolution Portal. 2016. Available from:
  • 17. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag. 2015;4(10):637-40. doi: 10.15171/ijhpm.2015.160. [PubMed: 26673172].
  • 18. Najafi F, Karami-Matin B, Rezaei S, Rajabi-Gilan N, Soofi M. Health system responsiveness after health sector evolution plan (HSEP): An inpatient survey in Kermanshah in 2015. Med J Islamic Republic Iran. 2016;30:387.
  • 19. Murray CJL, Xu K, Klavus J, Kawabata K, Hanvoravongchai P, Zeramdini R. Assessing the distribution of household financial contributions to the health system: concepts and empirical application. In Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva: World Health Organization; 2003. p. 513-32.
  • 20. Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour AR, et al. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan. 2012;27(7):613-23. doi: 10.1093/heapol/czs001. [PubMed: 22279081].
  • 21. Xu K. Distribution of health payments and catastrophic expenditures methodology. Genva: World Health Organization; 2005. Available from:
  • 22. Koltai PJ, Solares CA, Koempel JA, Hirose K, Abelson TI, Krakovitz PR, et al. Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children. Otolaryngol Head Neck Surg. 2003;129(5):532-8. doi: 10.1016/S0194-59980300727-7. [PubMed: 14595276].
  • 23. Ghiasvand H, Sha'baninejad H, Arab M, Rashidian A. Hospitalization and catastrophic medical payment: evidence from hospitals located in Tehran. Arch Iran Med. 2014;17(7):507-13. [PubMed: 24979565].
  • 24. Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, et al. Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2006;62(4):866-76. doi: 10.1016/j.socscimed.2005.07.004. [PubMed: 16139936].
  • 25. Piroozi B, Moradi G, Nouri B, Mohamadi Bolbanabad A, Safari H. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran. Int J Health Policy Manag. 2016;5(7):417-23. doi: 10.15171/ijhpm.2016.31. [PubMed: 27694669].
  • 26. Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bull World Health Organ. 2007;85(8):600-6. [PubMed: 17768518].
  • 27. Yardim MS, Cilingiroglu N, Yardim N. Financial protection in health in Turkey: the effects of the Health Transformation Programme. Health Policy Plan. 2014;29(2):177-92. doi: 10.1093/heapol/czt002. [PubMed: 23411120].
  • 28. Somkotra T, Lagrada LP. Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand. Soc Sci Med. 2008;67(12):2027-35. doi: 10.1016/j.socscimed.2008.09.047. [PubMed: 18952336].
  • 29. Nguyen H, Ivers R, Jan S, Pham C. Cost of surgery and catastrophic expenditure in people admitted to hospital for injuries: estimates from a cohort study in Vietnam. Lancet. 2015;385 Suppl 2. S50. doi: 10.1016/S0140-6736(15)60845-5. [PubMed: 26313100].
  • 30. Gotsadze G, Zoidze A, Rukhadze N. Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC Health Serv Res. 2009;9:69. doi: 10.1186/1472-6963-9-69. [PubMed: 19400939].
  • 31. Rashad AS, Sharaf MF. Catastrophic and impoverishing effects of out-of-pocket health expenditure: New evidence from Egypt. Am J Econ. 2015;5(5):526-33.
  • 32. Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health Aff (Millwood). 2009;28(3):w467-78. doi: 10.1377/hlthaff.28.3.w467. [PubMed: 19336470].
  • 33. Rahman MM, Gilmour S, Saito E, Sultana P, Shibuya K. Health-related financial catastrophe, inequality and chronic illness in Bangladesh. PLoS One. 2013;8(2). e56873. doi: 10.1371/journal.pone.0056873. [PubMed: 23451102].
  • 34. Sun J, Liabsuetrakul T, Fan Y, McNeil E. Protecting patients with cardiovascular diseases from catastrophic health expenditure and impoverishment by health finance reform. Trop Med Int Health. 2015;20(12):1846-54. doi: 10.1111/tmi.12611. [PubMed: 26426679].
  • 35. Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2010;94(1):26-33. doi: 10.1016/j.healthpol.2009.08.006. [PubMed: 19735960].
  • 36. Lee JE, Shin HI, Do YK, Yang EJ. Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel. J Korean Med Sci. 2016;31(3):336-44. doi: 10.3346/jkms.2016.31.3.336. [PubMed: 26955233].

Featured Image:

Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments