THE EFFECT OF HEALTH REFORM IMPLEMENTATION ON THE OUT-OF-POCKET PAYMENTS OF PATIENTS: A CASE STUDY OF IRAN

One of the important aspects of the health system reform plan is the protection of households and patients against medical expenses. They suffer from the financial burden of paying for medical expenses, as well as their illness. This study aimed to estimate the out-of-pocket payment of patients for medical expenses in Urmia in 2017.
Materials & Methods: In this descriptive-analytical study, to estimate out-of-pocket, data were collected in three stages from 400 households who were selected randomly from the four main health care centers in Urmia. Data were gathered through questionnaires and interviews with the head of the household, hospital records, insurance organizations, and medical tariffs, and were analyzed using SPSS software version 16.
Results: According to the results, the average amount of out-of-pocket direct payment was calculated to be 53.07%. Basic insurance, supplementary insurance, and self-treatment were allocated 32.79%, 11.17% and 2.94% of total treatment costs, respectively.
Conclusion: The results of the study and comparisons with pre-implementation health reform plan studies showed that this plan is very successful in the inpatient area and the OOP rate is significantly lower than the designated target; but in the outpatient area, the plan is not successful, mainly due to the high costs in the dental services sector and the lack of support by insurance organizations