title: Analysis of equality in Iranian household healthcare payments during Iran's fourth development program.
abstract: BACKGROUND
  Today, the provision of healthcare should be efficient and equitable to achieve the health system's goals. The aim of this study was to survey equality in healthcare expenditures and its effects on income redistribution.
  
  
  METHODS
  This study was a descriptive-analysis, cross-sectional study that was conducted with data obtained from the Statistical Center of Iran (SCI) during 2006 and 2011. The source population and study population were the urban and rural residents of Iran and their households' income and expenditures on health. The analysis was based on annually aggregated data from all provinces relative to their share of the total population. The data were collected using a pre-tested checklist consisting of two sections. The first section was used to retrieve data about total gross non-food expenditures of households. The second section retrieved out-of-pocket payments for healthcare. The data that were collected were analyzed using a Microsoft Excel spreadsheet. The Kakwani index was used to measure the extent of the deviation from equity. The redistributive effect of healthcare costs was considered as the impact of healthcare payments on households' income distribution.
  
  
  RESULTS
  The overall Kakwani index during the fourth development program for urban households was progressive (OKI = 0.013), but it was regressive for rural households (OKI = -0.012). Healthcare payments had a negative effect on income redistribution in urban areas during the entire period of the study, and they had a positive effect in rural areas, except for the years 2010 and 2011, for which the effects were negative and non-existent, respectively.
  
  
  CONCLUSIONS
  By regarding the regressive Kakwani index and the negative effect of healthcare expenditures on income redistribution in some years, the government can use health grants, such as increasing health facilities and supplementary insurance, to increase the ability of households to deal with the cost of developing a remedy and reducing health inequalities.
authors.affiliation: Department of health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Pourasghari
authors.affiliation: Department of health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran; Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Jafari
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Bakhtiari
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Iman
authors.initials: I
authors.lastname: Keliddar
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Afifeh
authors.initials: A
authors.lastname: Irani
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Afshari
keywords: Development program; Gini index; Healthcare; Households; Kakwani index