Assessing the catastrophic health expenditure and impoverishment in Iran in 2012 and 2015 (before and after the implementation of HSEP in Iran)


1 Assistant Professor of Health Services Management, Department of Health Services Management, Tehran North Branch, Islamic Azad University, Tehran, IR Iran.

2 Department of Economic, Alzahra University, Tehran, IR Iran.


Healthcare in many developing countries is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care. Although, Iran has made great achievements in Health Sector and health financing after the implementation of Health Sector Evolution Plan, there are still some provinces and expenditure groups which suffered from health payments and pushed them under poverty line. This study aimed to compare the rates of households with CHE and the effect of health spending on national poverty estimates before and after the implementation of HSEP in Iran. To do that, statistical data were acquired from two surveys conducted by Iran statistic Centre (2012 and 2015). Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national poverty line is used.It is necessary to mention that,about 10.476 and 3.122 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure in 2012 and 2015, respectively. At the threshold of 40 % of capacity to pay, 1.249 (2012) and 0.283 % (2015) of the total household incurred catastrophic health expenditures. About 611 and 5895 households were forced into poverty due to paying for health care in 2012 and 2015, respectively. Despite the high achievements of HSEP in Iran, a significant proportion of the population was forced into poverty due to out-of-pocket payments for health care. The Iranian government should pay more attention to the actual conditions in different provinces, further to make policy decisions according to the local knowledge.