Sohrabi, Mohammad-Reza

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Mohammad-Reza Sohrabi

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Decreasing Out of pocket payment Social Determinants of Health, Vol.1, No.2, Apr2015      47  Editorial Article Decreasing Out of Pocket Payment: Direct or Indirect Mohammad-Reza Sohrabi MD, MPH, MSc Author’s affiliations(Corresponding author): Social Determinants of Health Research Center and Department of Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.  Email: m.sohrabi@sbmu.ac.ir Accepted for publication: 04 Aug 2015  Cite this article as: Sohrabi M.R. Decreasing out of pocket payment: direct or indirect. SDH, 1(2), 2015: 47. ne of the determinants of health system function is the rate of out of pocket payment (OPP). When it increases to more than 40 percent of non-food expenditure, it is named catastrophic cost; it can destroy family and push it under poverty line (1).  In Iran, in developing 4th national development plan OPP was considered and one of the goals of the program set for it. By the end of the program, OPP for health should be decreased from 60% to 30%. The program did not achieve to this goal and again in 5th national developmental program it was focused. In the last years of the 5th program, the Ministry of health and medical education focused on a reform program in which decreasing OPP was the main goal of the first phase. In this reform program direct support of Ministry of health and insurance companies decreased OPP in governmental hospitals. On the other hand the Ministry revised payments to the physicians and tried to omit under-table payments to the physicians in private sector. After one year, OPP for outpatient was 6% and for inpatient reported 3% in governmental sector.   This revision made a financial burden on the Ministry and insurance companies which affect the maintenance of the program in long term. Some experts believe that it was better to consume this huge amount of money for building a health infrastructure that could be more cost effective. For example, in urban area especially in metropolitans, the health care providing system has not defined in a cost effective way; it is based on a free market in private sector in which physicians can prescribe any medicine and diagnostic imaging or lab tests; this can increase OPP and total health expenditure. To manage this problem we need guidelines and a cost effective care providing system like family physician program; although this program was developed in last 10 years, but the main basic principals were missed in this program: this system is most effective when per-capita payment is considered and defined protocols are used by the physicians; referral criteria should be well defined. There is no need for family physicians to be a specialist! Family physician should be a position for general practitioners. Health care should be provided by the least education that can provide the care effectively (2,3). Authorities of health should decide that spend the money as subsidy to care provision system and directly decrease the OOP or building infrastructures to improve health system and decrease OOP indirectly. Research may help them to assess the effectiveness and length of effectiveness.  References 1. Wagstaff A, van Doorslaer E. Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993‑1998. Health Econ 2003;12:921‑34. 2. Sohrabi MR, Saadat S, Haji-Hashemi  Z. Family medicine Residency Program: Is it Worth to Establish? . Teb va Tazkieh. 2004;55:66-74. 3. Rudmik L, Wranik D, Rudisill-Michaelsen C. Physician payment methods: a focus on quality and cost control. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2014 Aug 3;43(1):34. PubMed PMID: 25219382. Epub 2014/09/16. Eng.  O 

Decreasing Out of Pocket Payment: Direct or Indirect

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