Measuring Progress toward Universal Health Coverage in Iran: Two Years after the Implementation of the Health Transformation Plan

Introduction: One of the most important 2015-post agendas of countries’ health systems is achieving Universal Health Coverage (UHC), so countries should monitor the activities carried out. The present study aimed to investigate the UHC status two years after Health Transformation Plan (HTP) in Iran. Methods: This is a secondary analysis of the national household income and expenditure survey (with close 40,000 households as the survey sample). The survey was used to estimate financial protection indicators (out-of-pocket payment, catastrophic and impoverishment health expenditure) in 2016. Estimation for service coverage index provided by international databases was applied at the country level. Indicators of financial protection and service coverage were evaluated in relation to each other using the World Health Organization joint levels assessment method, which indicates UHC attainment in terms of a plot with four zones. The relationship was estimated for the entire population, first quintile, and fifth quintile in 2000, 2017, and 2030. Results: The average per capita of OOP annually was 1,940,613 Rials (162.415 PPP int $). About 15.85% of households endured catastrophic health expenditures at the 10% threshold. The impoverishment health expenditure is about 0.6. Accordingly, Iran is on the border between zones 1 and 2 in 2017 in terms of achieving UHC and will move to zone 1 in 2030 with the current trend. Conclusion: According to the results of this study, universal health coverage has not been achieved even despite the implementation of the HTP. Even with improved service coverage, achieving UHC by 2030 may seem impossible with the current trends.