Is distribution of health expenditure in Iran pro‐poor?

Background The size and distribution of households' health care expenditure indicate the financial burden on different income groups. Since the distribution of health expenditure evaluates the performance of health systems, this study aims to examine the health expenditure distribution among urban and rural households in Iran. Methods This research was conducted on the distribution of health expenditure among urban and rural households in 2014. The effects of households' health expenditure on distribution of personal incomes were measured by using Kakwani and Reynolds‐Smolensky indices. In addition, Theil T index was used to classify provinces based on inequality in health expenditure distribution. The calculations were made by using EXCEL. Results The Kakwani indices for urban and rural households were calculated around −0.572 and −0.485, respectively. Reynolds‐Smolensky indices for urban and rural households were measured as much as −0.038 and −0.031, respectively. Regardless of income distribution, Theil T index shows that urban households face with the most unequal distribution in health expenditure. Conclusion Based on calculations, the distribution of health expenditure is against the poor households. In addition, this distribution is more regressive in urban than rural households. As well, Reynolds‐Smolensky indices indicate more uneven income distribution after paying for health care, and inequality is larger among urban than rural households. To this research, the health policymaking priorities should be given to the provinces with the highest inequality, and the expenditure burden of low‐income households should be reduced through expanding insurance coverage.