Korean J Fam Med 2017; 38(5): 296-302  https://doi.org/10.4082/kjfm.2017.38.5.296
Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran
Enayatollah Homaie Rad1, Sajad Delavari2, Afsoon Aeenparast3,*, Abolhassan Afkar4, Faranak Farzadi3, Farzaneh Maftoon3
1Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
2Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
3Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Iran
4School of Health, Guilan University of Medical Sciences, Rasht, Iran
Afsoon Aeenparast Tel: +98-9128191800, Fax: +98-2166951876, E-mail: aeenparast.af@gmail.com
Received: January 12, 2017; Revised: February 11, 2017; Accepted: February 17, 2017; Published online: September 20, 2017.
© Korean Academy of Family Medicine. All rights reserved.

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Abstract
Background: The main aim of this study was to evaluate the achievements of some important goals of Iran’s urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program.
Methods: We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined.
Results: No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform.
Conclusion: The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
Keywords: Family Physician; Out-of-Pocket Expenditure; Inequality; Economic Condition


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