ABSTRACT
BACKGROUND: Forecasting the future trend of health expenditures is an important step toward sustainable financing of health-care systems. This study aims to develop a conceptual framework for forecasting Iran health spending growth. MATERIALS AND METHODS: At first, we concentrated on the general model and conceptual framework of health expenditure projection by reference to a broad literature review and smart classifications of the origins of health spending and indicators. At the second step, we developed a time series modeling for econometric estimation and forecasting national health expenditure without restrictive assumptions except for current laws and regulatory environment. In the third step, we tested the accuracy of model by forecasting Iran real per capita health expenditures (2017-2025). RESULTS: The results of the literature review represented a distinct classification of the origins of health spending and indicators, applicable to any health system and health spending projection model. Furthermore, the model of expenditure forecasting shows the power of certainty of no spurious estimation, assessment of the normal state of a health system, and test of the accuracy of forecasting results. The projection by the Iranian health system database showed that the real per capita health spending will grow 43 percent till 2025 in the absence of any unforeseen disturbance in the future. CONCLUSIONS: The presented model provides estimates that are compatible with actual trends of health spending and can be applied to forecast health expenditure in the near future. The forecasted image of Iran's health spending growth implies that health authorities need to concentrate more on the growth rate of the health budget and its fiscal space in the near future.
ABSTRACT
BACKGROUND: Health reform in Iran began in 2014, aimed at improving financing pattern of health services. We assessed the reform by changes in variables representing distribution of health payments and catastrophic expenditures. METHODS: Using data from households' income-expenditure survey, this study computed the financial variables, representing poverty line and households at poor state, household's catastrophic health expenditure, fairness in financial contribution (FFC) index, and household's impoverishment state, in the years 2010-2016, in urban and rural areas. The variables were computed by special software designed for this study, based on C-Sharp(C#) programming language, with yearly data on more than 38000 households, each with 1072 information sources. RESULTS: The food share-based poverty line after sharp rise in 2010-2013, in 2014-2016 raised slowly, and the average percent of households facing catastrophic health expenditure, after sharp rise in 2011-2013, left at 3.25 in 2014-2015 and raised to 3.45 in 2016. The average FFC index remained at 0.839 to 0.837 in 2013-2016. However, interestingly, the average percent of households impoverished after out-of-pocket payments improved from 1.36 to 0.912 in 2013-2016. CONCLUSION: In three years of health reform, the major impact of reform was considerable improvements in the rate of the impoverished after out-of-pocket payments. The reform had limited impacts on the rates of households facing catastrophic health expenditure, and on FFC indexes, for the rural and urban residents.
ABSTRACT
CONTEXT: During different planning periods, human resources factor has been considerably increased in the health-care sector. AIMS: The main goal is to determine economic planning conditions and equilibrium growth for services level and specialized workforce resources in health-care sector and also to determine the gap between levels of health-care services and specialized workforce resources in the equilibrium growth conditions and their available levels during the periods of the first to fourth development plansin Iran. MATERIALS AND METHODS: In the study after data collection, econometric methods and EViews version 8.0 were used for data processing. The used model was based on neoclassical economic growth model. RESULTS: The results indicated that during the former planning periods, although specialized workforce has been increased significantly in health-care sector, lack of attention to equilibrium growth conditions caused imbalance conditions for product level and specialized workforce in health-care sector. CONCLUSIONS: In the past development plans for health services, equilibrium conditions based on the full employment in the capital stock, and specialized labor are not considered. The government could act by choosing policies determined by the growth model to achieve equilibrium level in the field of human resources and services during the next planning periods.
