title: The financing of the health system in the Islamic Republic of Iran: A National Health Account (NHA) approach.
abstract: BACKGROUND
  The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds?
  
  
  METHODS
  The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey; while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data.
  
  
  RESULTS
  The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial).
  
  
  CONCLUSIONS
  The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.
authors.affiliation: PhD candidate, Faculty of Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran. mrzakeriir@yahoo.com.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Zakeri
authors.affiliation: Assistant Professor, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran. olyaee@tums.ac.ir.
authors.forename: Alireza
authors.initials: A
authors.lastname: Olyaeemanesh
authors.affiliation: MSc in Health Economics, HTA, Standard and Tariff Office, Curative department, Ministry of Health & Medical Education, Tehran, Iran. m.zan1976@gmail.com.
authors.forename: Marziee
authors.initials: M
authors.lastname: Zanganeh
authors.affiliation: Assistant Professor, Department of Health Economics, Medicine Faculty, Shahed University, Tehran, Iran. kazemian@shahed.ac.ir.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Kazemian
authors.affiliation: Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Arashidian@tums.ac.ir.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Assistant Professor, Ministry of Health and Medical Education, Tehran, Iran. mohme2003@gmail.com.
authors.forename: Masoud
authors.initials: M
authors.lastname: Abouhalaj
authors.affiliation: Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran. shr_tofighi@yahoo.com.
authors.forename: Shahram
authors.initials: S
authors.lastname: Tofighi
keywords: Financing; Health System; National Health Account