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Abstract Background There is limited evidence on the prevalence and socioeconomic inequality in informal payments (IP) of households in the Iranian health system. This study was conducted to investigate the prevalence of IP and related socioeconomic inequalities among Iranian households in all provinces. Method Data on Household Income and Expenditure Surveys (HIES) for 91,360 households were used to examine the prevalence and inequality in informal health sector payments in the years 2016 to 2018. The Normalized Concentration Index (NC) was used to examine inequality in these payments and the decomposition analysis by the Wagstaff approach was used to determine the share of variables affecting the measured inequality. Results Of the total households, 7,339 (7.9%) reported IP for using health services. Urban households had higher IP (10%) compared to rural ones (5.42%). Also, the proportion of households with IP in 2016 (11.69%) was higher than in 2017 (9.9%), and 2018 (4.60%). NC for the study population was 0.129, which shows that the prevalence of IP is significantly higher in well-off households. Also, NC was 0.213 (p 0.05). Decomposition analysis indicated that income, sex of head of household, and the province of residence have the highest positive contribution to measured inequality (with contributions of 156.2, 45.8, and 25.6%, respectively). Conclusion There are a significant prevalence and inequality in IP in Iran's health system and important variables have shaped it. On the whole, inequality was pro-rich. This may lead to increasing inequality in access to quality services in the country. Our findings showed that previous health policies such as regulatory tools, and the health transformation plan (HTP) have not been able to control IP in the health sector in the desired way. It seems that consumer-side policies focusing on affluent households, and high-risk provinces can play an important role in controlling this phenomenon.

Background & Aims of study: Service delivery is known as the most tangible function of the health system and hospitals are the most obvious manifestation of this function. Also, one of the most important factors in creating catastrophic health expenditures is the use of hospital services; therefore, in the present study, an attempt was made to describe the share of hospital service costs from total household health expenditures. Materials and Methods: The present descriptive study was performed retrospectively for the period of 2011 to 2015. The study was done using the Household Expenditure and Income Survey (HEIS) which is conducted annually by the Statistical Center of Iran (SCI). Based on the designed model, the share of hospital costs from household health expenditure was determined by year and type of services in urban and rural areas. Results: On average, 18.5% of households used hospital services and about 28.7% of household health expenditure had been spent on receiving health services from hospitals. The average cost of household hospital medical services was 92.4% in urban areas and 91.4% in rural areas. On average, 51% of the cost of household medical services in hospitals was related to public hospitals, and the highest cost spent by households in public hospitals was allocated to surgery. Conclusion: The share of hospital services costs and the rate of use of these services among Iranian households are significant, which may lead to poverty and catastrophic health expenditures. Therefore, it is necessary for health decision makers to design and implement evidence-based policies to manage and control this part of health costs.

Objective: Demographic and epidemiological changes in the 21st century have created new challenges such as aging and the rising trend of non-communicable diseases. The high prevalence of disability (due to the growing aging population), non-communicable diseases, and accidents have increased the demand for rehabilitation services. However, there are not enough resources to meet all current needs in many parts of the world. The purpose of this study is to investigate the inequality in the utilization of rehabilitation services between Iranian households in urban and rural areas. Materials & Methods: This is a descriptive-analytical study with a cross-sectional design using the household expenditure, income survey data from the Statistics Center of Iran in 2018. The used instrument was a questionnaire surveying the expenditure and income of urban and rural households (social characteristics of household members, place of residence and main living facilities, food/non-food expenses, and household income), which was completed through interviewing the household head or a member over 15 years of age. The study samples were 18610 households in rural areas and 20348 households in urban areas. After extracting and refining the data, 38958 households were included in the study. Factors affecting their utilization of rehabilitation services and the inequality in utilization were analyzed using the Chi-square test and the concentration index (CI), respectively. Data were extracted in MS Access 2013 and MS Excel 2013 applications and were analyzed in STATA V.14.1 software. The geographic distribution of the service utilization was plotted using ArcGIS Map V. 10 software. Results: A total of 258 households (0.77%) used rehabilitation services. Of these, 226 (87%) had a male head, and 32 (13%) had a female head. About 60% had 3-4 members, and 239 (92%) had insurance coverage, and others (8%) had no insurance coverage. Also, 173 (67%) had an employed head. Finally, 55% were living in rural areas, and 45% in urban areas. Uninsured households had less use of rehabilitation services (P

Objective (s): Oral health is one of the most important factors affecting peoplechr('39')s well-being. However, there are major obstacle to accessing dental services including high medical costs, lack of financial resources and human resources. Therefore, the present study was designed and conducted to investigate the distribution of dentists in public sector and household payments for dental services in Iran. Methods: The present cross-sectional study was designed and implemented using the National Household Expenditure Survey data from 2011 to 2017. Gini coefficient was used to measure the distribution of manpower and household payment. All analyzes were performed using MS Excel 2013 software. Results: Across the country, there were 5.56 dentists per thousand. Qazvin, Hamedan, Yazd, Mazandaran and Ilam provinces had the highest average and Alborz, Lorestan, Qom, Khuzestan and Khorasan Razavi provinces had the lowest average number of dentists. The Gini coefficient of dentistschr('39') distribution in 2012 was 0.41 and with slight decrease it was 0.40 in 2017. Also, the Gini coefficient of payment for household dental costs in rural areas was 0.68 and 0.66 in urban areas in 2012 and it was 0.70 and 0.65 in rural and urban areas in 2017, respectively. Conclusion: According to the findings of the present study, inequality in distribution of dentists in public sector and household use of dental services during the study period has not changed significantly. Given the high Gini coefficient of households for dental services in rural areas compared to urban areas, it seems that covering dental services can be an effective measure to reduce this inequality. In addition, implementing appropriate programs to facilitate access to dental services for disadvantaged households can be an effective measure to reduce this inequality.

Objectives Over the past few decades, Iran has faced rapid demographic changes, including a sharp decline in birth rates and increased life expectancy. This has led to an increase in the average age of the population and an increase in the percentage of the elderly people which is called “the phenomena of aging”. The occurrence of this phenomenon in Iran is rapidly increasing, and therefore the Iranian community has limited opportunity to prepare for the aging challenges. One of the major challenges for the aging population is the rising health care costs due to the elderly's need for a variety of health services, which causes many households with elderly members to face significant economic problems. This study aims to evaluate the effect of the presence and age of elderly members on health care costs of the households in Iran. Methods & Materials This study is a secondary analysis using 2016 national household, expenditure and income survey data . Sample size was 19337 households in rural areas and 18809 households in urban areas (total= 38146) in Iran. Linear regression analysis in STATA V. 14 was used to test the effect of variables on health care costs of households with and without elderly members. Results There was a significant association between the presence of an elderly member in the household and increase in total health care expenditure and medical expenses, such that for one increase in the number of elderly members, total health care expenditure increased by 390,000 Tomans, and medical expenses increased by 195,000 Tomans. In terms of age, families with an elderly member aged 75-79 years had the highest care costs, while those with an elderly member aged 80 and more had the least cost increase. Moreover, household income, having a smoker member, having an income-earner member, living in urban areas, household head education, and health development rate of the province of residence had significant association with total health care expenditure and medical expenses of households. However, no association was found between having health insurance and medical expenses. Conclusion Since the presence of an elderly member significantly increase the household health costs, future policies should be planned to support the families with elderly members. The health care system of Iran should also be prepared to meet to the health and medical needs of future ageing population.

BACKGROUND: The study aimed to investigate the associations between life and health satisfaction with health-related quality of life (HRQoL), body mass index (BMI) and chronic disease among people who are covered by health insurance schemes in Tehran city, Iran. METHODS: A cross-sectional study was conducted in Tehran city, Iran, from May to June 2016. A total of 600 people were included in the study using a cluster sampling technique. The questionnaire that used for data collection included demographic and socioeconomic variables, questions about health variables such as chronic disease, weight, height, smoking status, and EQ-5D-3L questionnaire. Two univariate and multivariate regression models performed to examine affecting factors on life and health satisfaction. RESULTS: The univariate regression showed that on average female have 0.22 and 0.69 score lower than males with their life and health satisfaction, respectively. Explanatory variables of gender, age, level of education, and employment status were not significantly associated with life and health satisfaction in multiple regression models. However, marital status was correlated with life satisfaction. Furthermore, HRQoL, BMI and chronic disease and smoking were associated with dependent variables (P < 0.001). CONCLUSIONS: The result showed that there was a strong association between BMI, HRQoL, chronic disease, and life and health satisfaction among participants. Therefore, the Iranian policymakers need to consider these factors on life and health satisfaction of adults and design health-promoting programs to improve health outcomes of them. Further studies should assess the associations between BMI, HRQoL, chronic conditions, and life and health satisfaction among Iranian adults.