Iranian Journal of

Knowing the population size of rare diseases or special subpopulations like injection drug users (IDUs) is one of the most important challenges in public health and health surveillance systems but it is difficult to estimate these groups. During the last few years, new methods have been suggested to estimate hidden or hard-to-reach populations, one of which is the network scale-up method (NSUM). The NSUM itself includes measuring the personal network size and estimating the prevalence of hidden and hard-to-count populations. In this paper, we basically discussed the indirect methods of calculating the population size, and the history of NSUM and its concepts, and then addressed the estimation of hidden populations with NSUM and the applicable notes for such populations.

Background and Objectives: Out-of-pocket (OOP) expenditure is one of the main indicators in health financing, indicating risk pooling and risk spreading. This study aimed to calculate the total health expenditure (THE), the THE per capita and share of OOP in each province from 2008 to 2014.

Methods: The present cross-sectional study was done by collecting provincial health expenditure data from public and private organizations during 2008-2014. The data were approved by board of trustees or board of directors in each organization. The relevant data on household health expenditures were collected from the Statistical Centre of Iran, as well.

Results: Even though the absolute monetary value (IRR) of OOP in the study years showed an increase, it decreased from 51.9% in 2008 to 40.6% in 2014 in terms of share. The absolute monetary value (IRR) of THE and THE per capita increased about 3.5 times in all provinces. So, during the study years, Tehran and Sistan and Baluchistan Provinces had the highest and lowest absolute monetary values (IRR) in THE per capita and this difference increased from 2.12 million Rials in 2008 to 10.56 million Rials in 2014.

Conclusion: Although the share of OOP decreased in all provinces in the country during the study years, it is still far from the objective of the national development plans (30% OOP). In order to improve the study indices and reduce the provincial inequity, it is suggested to put more emphasis on prepaid-based mechanisms, insurance system improvement, and equitable distribution of financial resources should be compatible with the deprivation of the area and its infrastructures.