title: Provincial health accounts in Kerman, Iran: an evidence of a "mixed" healthcare financing system.
abstract: BACKGROUND
  Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province.
  
  
  METHODS
  The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General's office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province.
  
  
  RESULTS
  During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services.
  
  
  CONCLUSIONS
  The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By emphasizing on Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare sector.
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Mehrolhassani
authors.affiliation: Research Center for Health Services Provision Management, Kerman University of Medical Sciences, General Department of Medical Insurance Services, Kerman, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jafari
authors.affiliation: Kerman Province Department of General of Medical Insurance, Kerman, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Zeinali
authors.affiliation: Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Mina
authors.initials: M
authors.lastname: Ansari
keywords: Health Expenditure Per Capita; Kerman Province; Out-of-Pocket (OOP) Payment; Provincial Health Accounts (PHA)