The Comparison of Out of Pocket Payments for Coronary Artery Bypass Graft Surgery Before and After the Health Sector Evolution Plan in the South of Iran

Background: One of the goals of the Health Sector Evolution Plan (HSEP) in Iran was to increase the fairness of the household’s financial contribution in health systems with the aim of reducing out of pocket (OOP) payment. Objectives: The study was aimed to measure patients’ OOP payment for coronary artery bypass grafting (CABG) surgery before and after the implementation of HSEP in the south of Iran. Methods: This cross-sectional study was conducted as descriptive-analytic in Shiraz as the center of medical tourism in the south of Iran in 2017. The study population consisted of patients admitted to Namazi Hospital from which 316 patients were selected before and after implementation of HSPE according to census. Data was collected through a checklist and analyzed using descriptive statistics, t-test and One-way ANOVA in SPSS 23. Results: The study results showed that the average of total cost has increased significantly from 1198.59$ to 3260.36$ after the plan (P < 0.001). The percentage of patients’ contribution to the total cost decreased significantly from 17.78% to 7.46% after the plan. The ratio of patients’ OOP payment has been reduced significantly after adding the plan’s share in the patients’ bill. The percentage of OOP payment to total cost has decreased for different insurance organizations from 5% in social security insurance to 13% in rural insurance. Conclusions: The ratio of patients’ OOP payment has been reduced for CABG surgery after implementation of HSEP, which can be an indication of the effectiveness of the out-of-pocket reduction instructions. However, the average of patients’ OOP payment has increased.