Provincial Health Accounts in Kerman, Iran: An Evidence of a “Mixed” Healthcare Financing System

Document Type: Original Article

Authors

1 Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Assistant Professor, Kerman, Iran

2 Research Center for Health Services Provision Management, Kerman University of Medical Sciences, General Department of Medical Insurance Services, Kerman, Iran

3 Kerman Province Department of General of Medical Insurance, Kerman, Iran

4 Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background
Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province.
 
Methods
The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General’s office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province.
 
Results
During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services.
 
Conclusion
The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By performing the Family Physician Program (FPP) and emphasizing Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare sector.

Keywords

Main Subjects


1.  Iranian  Ministry  of  Health  &  Medical  Education  (IMHME). Fifth 5-year Development Program of Iran. Tehran: Ministry of Health & Medical  Education;  2009.

2.  Glenngård AH, Hjalte F. Use of National Health Accounts: the Case of Uganda. Stockholm: Sida; 2006.

3.  Nekoei  Moghadam  M,  Banshi  M,  Akbari  Javar  M,  Amiresmaili M,  Ganjavi  S.  Iranian  household  financial  protection  against catastrophic health care expenditures. Iranian J Publ Health2012; 41:  62–70.

4.  De S, Shehata I. Comparative Report of National Health Accounts (NHA): Findings from Eight Countries in the Middle East and North Africa. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc; 2001.

5.  Nandakumar  AK,  Partners  for  Health  Reformplus. Synthesis of findings from NHA studies in twenty-six countries.  Maryland: Partners  for  Health  Reformplus,  Abt  Associates;  2004.

6.  Poullier JP, Hernandez P, Kawabata K. National Health Accounts: Concepts, Data Sources and Methodology. Geneva: WHO; 2002.

7.  World  Health  Organization  (WHO). Guid to producing regional health accounts within the national health accounts framework. Geneva:  WHO;  2008.

8.  World  Health  Organization  (WHO). Guide to producing child health subaccounts within the national health accounts framework. Geneva:  WHO;  2012.

9.  World Health Organization (WHO). Iraq National Health Account 2008. Geneva: WHO; 2011.

10.  World  Health  Organization  (WHO). Guid to produceing national health accounts: with special applications for low-income and middle-income countries. Geneva:  WHO; 2003.

11.  World  Health  Organization  (WHO). Guid To Producing Reproductive Health Subaccounts Within The National Health Accounts Framework. Geneva: World Health Organization; 2009.

12.  Izazola-Licea JA, Avila-Figueroa C, Arán D, Piola S, Perdomo R, Hernandez P, et al. Country response to HIV/AIDS: national health accounts  on  HIV/AIDS  in  Brazil,  Guatemala,  Honduras,  Mexico and Uruguay. AIDS2002; 16: S66–75.

13.  Lie GSS, Ravishankar N, Benezet M, Offosse Mj, Asbu EZ, Lwanga D. Developing a resource tracking system for measuring spending on nutrition in low - and middle - income countries. Geneva: WHo; 2011.

14.  Rannan-Eliya  RP,  Nada  KH,  Kamal  AM,  Ali  AI.  Egypt  National Health Accounts  1994-95  [internet].  1997. Available  from:  http://www.healthsystems2020.org/files/1304_file_Sir3.pdf

15.  Health  Systems  20/20.  National  Health  Accounts  and  Public Expenditure  Reviews:  Redundant  or  Complementary  Tools? [internet].  2009.  Available  from:   http://www.healthsystems2020.org/files/2240_file_NHA_PER_Brief_REV.pdf

16.  Partners  For  Health  Reformplus.  Understanding  National  Health Accounts: The Methodology and Implementation Process [internet]. 2003. Available from: http://www.phrplus.org/Pubs/prim1.pdf

17.  Soyibo  A. National Health Accounts of Nigeria, 1998-2002. Geneva:  WHO;  2005.

18.  Zere  E,  Walker  O,  Kirigia  J,  Zawaira  F,  Magombo  F,  Kataika E.  Health  financing  in  Malawi:  Evidence  from  National  Health Accounts. BMC Int Health Hum Rights 2010;  10:  27. doi: 10.1186/1472-698X-10-27

19.  Lazenby HC, Levit KR, Waldo DR, Adler GS, Letsch SW, Cowan CA. National health accounts: lessons from the U.S. experience. Health Care Financ Rev1992; 13: 89–103.

20.  Patrtners  For  Health  Reformplus.  National  Health  Accounts: Trainer  Manual  [internet].  2004.  Available  from:  http://www.healthsystems2020.org/files/1781_file_Tool002_fin.pdf

21.  Glenngard AH, Hjalta F, Hjortsberg C. National Health Accounts: Demand and Use of Health Expenditure Data.Lund: The Swedish Institute for Health Economics; 2007.

22.  Khayatzadeh-Mahani A, Fotaki M, Harvey G. Priority setting and implementation  in  a  centralized  health  system:  a  case  study  of Kerman  province  in  Iran. Health Policy Plan 2013;  28:  480–94. doi: 10.1093/heapol/czs082

23.  Rannan-Eliya RP, Berman PA, Somanathan A. Health Accounting: A Comparison of the System of National Accounts and National Health Accounts Approaches. Maryland:  Partnerships  for  Health Reform;  1997.

24.  Statistical Center of Iran. [National Health Accounts: years 2002-2008]. Tehran: Statistical Center of Iran; 2011.

25.  Oliyayi  AR,  Abolhalaj  M,  Zanganeh  M,  Zakeri  MR,  Rasidian  A, Kazemian M, et al. [National Health Accounts Islamic Republic of Iran]. 1th ed. Tehran: fate makers; 2008.

26.  Kazemian  M.  Financial  indicators  in  health  care  sector. Social Security Quarterly 2006;  26:  45–8.

27.  The World Bank Group, Human Development Sector, Middle East and North Africa. Islamic Republic of Iran Health Sector Review [Internet]. 2007. Available from: http://medolympiad.behdasht.gov.ir/uploads/280_954_First_Modiriat3.pdf.

28.  Baghbanian  A.  Health  scope  in  iran:  the  way  forward. Health Scope 2012;  1:  50–1. doi: 10.5812/jhs.7253