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Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households., Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP., Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively., Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

Background: Because of the rapid aging rate, the share of health expenditure in gross domestic product rises irreversibly and increases concern among politicians and the general public. The aim of this study was to examine the accuracy of the Baumol's model of unbalanced growth in Iran over the period 1981-2010., Methods: This theoretical-analytical study was conducted in 2012 to investigate the various determinants of ongoing rise in the health expenditures. To this end, an Error Correction Model was derived from the long run cointegrating equation to inquire the veracity of Baumol's theory., Results: Estimating the short run and long run equations by using time series data shows that the rate of increase in health expenditure is aligned with the difference between wage increases in and growth of productivity in the health sector. Besides, results show that both the per capita income and the inflation rate of health care had significant effects on raising the share of health sector in domestic economy., Conclusions: According to rapid population aging and existence of Baumol's cost disease in Iranian health sector, we predict much more rise in health expenditure in a few decades.