ArticleBMC health services research2022
User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 3 of them syntheses that pooled it.
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Who cites it
7 citing papers in PubMed, 3 syntheses or guidelines pooled it, 10 citations in OpenAlex.
- From fees to free: impacts of user fee removal on child health outcomes - a systematic review.International journal for equity in health · 2025Pooled it
- Unmet oral health needs and barriers to dental services among socially marginalized youth: a scoping review.Frontiers in oral health · 2025Pooled it
- Health service utilization and associated factors among fee waiver beneficiaries in Ethiopia: Systematic review and meta-analysis.PloS one · 2025Pooled it
- Improving quality of care in traumatic spinal column/spinal cord injuries (TSC/SCI) in Iran: a policy brief.Spinal cord series and cases · 2024Article
- Catastrophic Health Expenditure among Iranian Households: Evidence from the COVID-19 Era.Medical journal of the Islamic Republic of Iran · 2024Article
- Health insurance coverage and access to child and maternal health services in West Africa: a systematic scoping review.International health · 2023Article
- The impact of internet use on health status among older adults in China: The mediating role of social support.Frontiers in public health · 2023Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRemoval of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran.
methodsThis is a qualitative study carried out in 2018. The purposive sampling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software.
resultsThe most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms.
conclusionImplementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization.
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