Hospitalization Costs and Out-Of-Pocket (Oop) Payment in Lung Cancer Patients in Iran: Health Sector Evolution Plan (Hsep) Has Reduced Oop Payments and Improved Financial Protection Publisher Pubmed



Jalilian H^{1, 2} ; Heydari S² ; Javanshir E³ ; Jamebozorgi K⁴ ; Mir N^{2, 5} ; Eshraghi A⁶ ; Fehresti S⁷ Show Affiliations
Source: PLoS ONE Published:2024

Abstract

Background and objectiveIn Iran, Health Sector Evolution Plan, the most significant reform in the healthcare system in recent decades, has been launched since 2014 with the objective of achieving universal health coverage, decreasing out-of-pocket health expenditures and improving access to health services in hospitals and clinics affiliated to the Ministry of Health and Medical Education (MOHME). This study aimed to estimate the hospitalization costs of lung cancer and the impact of HSEP on hospitalization costs of lung cancer and patients’ contribution in Iran between 2010 and 2017.MethodsThis was a prevalence-based cost of illness study with a bottom-up costing approach. The sample size included 1778 lung cancer patients hospitalized in the Imam Reza hospital in Tabriz, Iran, between May 5, 2010, to May 5, 2014, and four years after the implementation of Health Sector Evolution Plan: from May 5, 2014, to May 5, 2017. The analysis was conducted from a societal perspective. Data were extracted from the electronic medical records of patients and were analyzed using SPSS V22.0, STATA V13.0 and Microsoft Excel 2016. The Interrupted Time-Series design was applied to estimate the impact of the implementation of HSEP on hospitalization costs and patient contribution rate for reimbursement of costs.ResultsThe mean hospitalization costs of lung cancer before and after the implementation of Health Sector Evolution Plan was estimated at 2860 ± 4575 and 5300 ± 8880 PPP (Current International $), respectively. Moreover, the amount of out-of-pocket payments reduced from 705 PPP (Current International$) (22.16%) before the implementation of Health Sector Evolution Plan to 480 PPP (Current International $) (10.5%) after its implementation. the hospitalization costs went up moderately before the HSEP (increased from 2320 $ in 2010 to 3025 $ in 2013). After the HSEP, it continued to rise, but with a more significant increase until 2016. Then, in 2016, it reached a peak (6395 $) before dropping in 2017 (5005 $). Regarding patient contribution, before the HSEP, the percentage of patient contributions increased from 19.45 in 2010 to 24.28 in 2013. With HSEP’s implementation, this fell dramatically to 14.47 and continued to decline, reaching 7.99% in 2016. In 2017, patient contribution increased again and reached 9.58%.ConclusionOverall, hospitalization costs experienced an upward trend over the course of study, but this trend considerably intensified further after the HSEP. The patient contribution demonstrated an upward trend before HSEP, followed by a significant decline post-HESP, and the percentage of out-of-pocket payments reduced after implementation of HSEP. Therefor this plan has been successful in achieving the goal of financial protection of patients. © 2024 Jalilian et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.