title: Inequity in household's capacity to pay and health payments in Tehran-Iran-2013.
abstract: BACKGROUND
  Health inequality monitoring especially in Health care financing field is very important. Hence, this study tends to assess the inequality in household's capacity to pay and out-of-pocket health carepaymentsin Tehran metropolis.
  
  
  METHODS
  This cross-sectional study was performed in 2013.Thestudy population was selected by stratified cluster sampling, and they constitute the typical households living in Tehran (2200 households). The required data were collected through questionnaires and analyzed using Excel and Stata v.11. Concentration Index on inequality was used for measuring inequality status in capacity to pay and household payments for health care expenses; and also the concentration index for out-of-pocket payments and capacity to pay was used to determine the extent of inequality. The recall period for inpatient care was one year and 1 month for outpatient.
  
  
  RESULTS
  The average of out-of-pocket payments for receiving the outpatient services was determined to be 44.33US$ and for each inpatient1861.11 US$. Concentration index for household's outof- pocket payments for inpatient health care, out-of-pocket payments for outpatient health care and health prepayments were calculated 0.13, -0.10 and -0.11, respectively. Also, concentration index in household's capacity to pay was estimated to be 0.11whichindicatedinequality to the benefit of the rich. The households used financing strategies like savings, borrowing or lending to pay their health care expenditures.
  
  
  CONCLUSIONS
  According to this study, the poor spend a greater portion of their capacity to pay for outpatient and inpatient health care costs and prepayment, in comparison to the rich. Thus, supporting the vulnerable groups of the society to decrease out-of-pocket payments and increasing the household's capacity to pay through government support in order to improve the household economic potential, must be considered very important.
authors.affiliation: PhD, Department of Health Economics, School of Health Management and information Sciences& Health management and Economics Research Center &Center of Excellence in Health Management and Economics, Iran University of Medical Sciences. Tehran, Iran. rezapour_a57@yahoo.com.
authors.forename: Aziz
authors.initials: A
authors.lastname: Rezapour
authors.affiliation: PhD, Department of Health Education and promotion, School of Health &Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. dr.febadi@yahoo.com.
authors.forename: Farbod
authors.initials: F
authors.lastname: Ebadifard Azar
authors.affiliation: PhD Candidate in Health Policy, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. saberazami@yahoo.com.
authors.forename: Saber
authors.initials: S
authors.lastname: Azami Aghdash
authors.affiliation: PhD, Department of Microbiology, Faculty of Medical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran. tanomanda@yahoo.com.
authors.forename: Asghar
authors.initials: A
authors.lastname: Tanoomand
authors.affiliation: MA Management Systems and Efficiency, the Deputy of Health in Social Affairs, Management and Planning Organization, Tehran, Iran. nahalmadzadeh@yahoo.com.
authors.forename: Nahal
authors.initials: N
authors.lastname: Ahmadzadeh
authors.affiliation: MSc in Public Administration, Health Management and Economics Research Center, Iran university of Medical Sciences, Tehran, Iran. sarabi.a@iums.ac.ir.
authors.forename: Ali
authors.initials: A
authors.lastname: Sarabi Asiabar
keywords: Capacity to pay; Health inequality; Healthcare financing; Out-of-pocket payment