Iranian Health Transformation Plan in Physiotherapy Services: Comparison of Household Based Financial Outcomes

Abstract

Background: Physiotherapy services are important because they help disabled patients to return to work and other social activities. High out-of-pocket payments of physiotherapy services are one of the major barriers to the utilization of these services. In 2014 a reform named the Health Transformation Plan (HTP) was implemented in Iran aimed at improving Universal Health Coverage of Iranians. This paper researched the effects of HTP on the financial outcomes of physiotherapy services. Method: Data of the Iranian Household Income and Expenditures Survey (IHIES) before and after HTP was used in this study. Out of Pocket payments, utilization of physiotherapy services, and facing catastrophic expenditures were compared using a propensity score matching estimator. Inequity indices were compared using concentration indices and curves. Result: Out-of-pocket payments did not change significantly after the plan, however, utilization of physiotherapy services decreased significantly (coefficient ¼ ¡0.00188, P-value ¼ 0.032). Inequity in out-of-pocket payments improved significantly after HTP (P-value ¼ 0.000), however, inequity in the utilization of services become worse in favor of the rich (P-value ¼ 0.000) and the percentage of households facing catastrophic health expenditures did not change significantly (P-value ¼ 0.407). Conclusion: The health transformation plan, one year after its implementation, did not achieve its goals in terms of utilization and out-of-pocket payments and their inequity in physiotherapy services.