en Health Policy پژوهشي Original article <strong>Background: </strong>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&#39;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 <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-3156.2003.01194.x">out-of-pocket (OOP</a>) payment in hospitals affiliated to Mashhad University of Medical Sciences.<br> <strong>Methods: </strong>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 SPSS₁₉was used to analyze the data.<br> <strong>Results: </strong>According to the research findings, the total <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-3156.2003.01194.x">OOP</a> payment percentage fell from about 20 % to 8 % at the end of the year. The percentage of the patient&#39;s spending on consumer use declined from 60 % to 6 %, for drugs from 30 % to 5.5 %, for services from 12 % to 4 %.<br> <strong>Conclusion: </strong>Increasing people&#39;s financial access to health care will improve the health of the community, which is expected to improve community health indicators by lowering their <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-3156.2003.01194.x">OOP</a> payments. The continuation of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-3156.2003.01194.x">OOP</a> payments reduces the need for macroeconomic policies and sustainable budgets. Health Services, Out-of-Pocket payment, Health Care Costs 259 265 http://jebhpme.ssu.ac.ir/browse.php?a_code=A-10-155-1&slc_lang=en&sid=1 Amin Adel adela3@mums.ac.ir 0000-0002-6438-4176 No Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Akbar Javan Biparva akbarjavan4@gmail.com 0000-0003-3565-9721 No Iranian Center of Excellence in Health Management ,Student Research Committee ,School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Hosein Ebrahimipour hcmiran@gmail.com 0000-0002-1811-372X No Research Center for Social Factors Affecting Health, Mashhad University of Medical Sciences, Mashhad, Iran Shapour Badiee Aval hcmiran@yahoo.com 0000-0003-4724-518X No Department of Chinese Medicine, School of Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Elaheh Askarzadeh elaheaskarzade@gmail.com 0000-0002-7998-6671 Yes Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran