Evidence Based Health Policy,

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Background: The Cancer Institute of Iran, located in Tehran (Iran’s capital city), is a national specialized center for cancer. Cancer patients from all over the country refer to it. This study compared the out-of-pocket  (OOP)  expenditures of patients from Tehran and patients from other parts of Iran who were hospitalized in this center.
Methods: This cross-sectional study included all patients over 18 years of age with head and neck or digestive system cancer who were actively undergoing primary treatment in the Cancer Institute of Iran located in Tehran (the capital city). Data was collected through a structured interview with the patients themselves and/or their companions and then analyzed using SPSS₁₆ software.
Results: Direct medical costs of patients from Tehran were much higher than those of patients from other provinces. In contrast, the average direct non-medical costs including transportation, accommodation, food, etc. of patients from other provinces were significantly higher than those of patients from Tehran, and 53% of patients borrowed money for their treatments.
Conclusion: It seems necessary to develop new supportive policies to alleviate financial costs for cancer patients and help them manage their cancers effectively. Patients from the provinces faced additional costs for travel, food, and accommodations which complicated their access to special services. Establishing and improving specialized cancer centers in other cities can reduce the burden of out-of-pocket expenditures for patients from remote areas.
 

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Background: Providing financial resources for health services is the responsibility of the government, insurers and direct payments of individuals. Considering that health services are one of the most essential people's needsand impose a high cost on individuals, and may create catastrophic health costs for poor people. Therefore, the present study was conducted with the aim of analyzing the effect of health system evolution (HSE) program on out-of-pocket (OOP) payment in hospitals affiliated to Mashhad University of Medical Sciences.
Methods: This descriptive-analytic study was conducted in 24 hospitals of Mashhad University of Medical Sciences from 2013 to 2017 in order to survey the effect of HSE Program. The sample of this study included all patients with basic insurance referring to hospitals. Data were collected based on a researcher-made checklist for urban and rural patients. The statistical analysis software SPSS₁₉ was used to analyze the data.
Results: According to the research findings, the total OOP payment percentage fell from about 20 % to 8 % at the end of the year. The percentage of the patient's spending on consumer use declined from 60 % to 6 %, for drugs from 30 % to 5.5 %, for services from 12 % to 4 %.
Conclusion: Increasing people's financial access to health care will improve the health of the community, which is expected to improve community health indicators by lowering their OOP payments. The continuation of OOP payments reduces the need for macroeconomic policies and sustainable budgets.

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Background: The Health Reform Plan was begun in 2014 as one of the most significant programs of the Ministry of Health to reduce hospitalization and out-of-pocket costs paid by people. Hence, we consider examining the economic consequences of this plan as one of the research priorities in this field. This study aimed to examine the effect of implementing the Health Reform Plan on the share of basic, supplementary insurances, franchise, and health subsidies from medical expenses in Shahid Sadoughi University of Medical Sciences in Yazd in 2013-2016.
Methods: This study is a descriptive study conducted in a quantitative and cross-sectional method. The study population included patients' bills in hospitals affiliated to Shahid Sadoughi University of Medical Sciences in Yazd. All patient's hospitalization files were examined by the census method. Information was extracted from financial documents and data in the hospital's HIS system. We referred to the basic and supplementary insurance organizations of the province to complete the data. Descriptive statistics and were used to analyze the obtained data by using SPSS₁₆ Software.
Results: Generally, it was specified that the share of basic and supplementary insurances had not changed considerably due to the doubling of the whole costs of patients 'files, and basic insurances will pay on average 76 % of patients' costs. But, the patient's share of out-of-pocket payments has declined from 21 % to 11 %, which the Ministry of Health and Medical Education will pay this 10 percentage through the health subsidy to the affiliated centers.
Conclusion: This study's results explained an increase in patient's health costs and a decrease in patient's out-of-pocket costs. Consequently, it is required to pay attention to methods to increase medical centers' efficiency to reduce health costs. Furthermore, large-scale/macro programs should be designed and implemented at the national level to reduce patient's out-of-pocket payments.

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Background: Out-of-Pocket (OOP) payment is categorized among the critical indicators of health system financing. Given the high hospitalization costs of the hospitals, the ministry of health has attempted to implement Health Transformation Plan (HTP) in Iran to reduce OOP. The purpose of this paper is to show the effects of HTP on OOP payments of the hospitalized patients in Hamedan, Iran.
Methods: This descriptive-analytical study was carried out on 587 patients in the educational hospitals of Hamedan. The data obtained before and after implementing the HTP was from 2013 to 2015. Data analysis was performed using SPSS₁₆.
Results: In this study, each patient's expenditures increased by 32.2 % in 2015, compared to before the implementation of the HTP. Therefore, the health insurance organization's coverage of OOP payments decreased to 8.3 % of the total costs by a 20.2 % reduction in 2015, compared to before the implementation of the plan.
Conclusion: According to the study, HTP and government health subsidies were adequate, but the total hospitalization costs had an upward trend in all funds.

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Background: Myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. In India, incidence of MI is rapidly increasing due to lifestyle changes, ageing and rising healthcare costs. The out-of-pocket expenditure (OOPE) for MI care in India can be substantial, as majority of healthcare costs are paid by patients or their families. However, little is known about the actual OOPE incurred by MI patients in tertiary care centres in Pondicherry, South India. This study aims at estimating the OPPE by MI patients attending the tertiary care centre in Pondicherry. The findings can inform policymakers and healthcare providers in developing interventions to reduce the financial burden of MI care in patients and their families.
Methods: This was a hospital-based, cross–sectional study conducted on patients attending Cardiology's outpatient department OPD, who had myocardial infarction in the past for about 3 months to 3 years at the time of enrolment in the study. A pre-designed and validated questionnaire was used to collect information regarding socio-demographic details and cost of health expenditures (direct medical and non-medical costs and indirect cost for both the participants and caregivers). Data analysis was done using SPSS₂₄ Software. The median and inter-quartile range was used for assessing the cost of health expenditures.
Results: Study participants underwent invasive and non-invasive procedure as part of their management. More than 93% underwent invasive, and the cost ranges from 1,694.03 USD to 2470.00 USD (1,20,000 INR to 1,75,000 INR). They spent 10.58 USD to 21.17 USD (750 INR to 1,500 INR) for their monthly medication. The travel expenses for each follow-up visit were between 5.64 USD to 70.57 USD (400 INR and 5000 INR). The majority of participants received health insurance or reimbursement of 1834 USD (1,30,000 INR) from their firm, 12.7% of the participants  lost a payment of 162 USD to 776.28 USD (11,500 INR – 55,000 INR).
Conclusion: The cost of the invasive procedure for myocardial infarction patients was 1694.03 USD to 2470.00 USD, which was the major share from the out-of-pocket expenditure compared with the other direct and indirect costs.