Financial protection of Iran's healthcare system during the COVID-19 pandemic and strategies for improvement.

Purpose: The conclusion of the COVID-19 pandemic provides an opportune moment to assess the performance of health systems in financial protection. This study aims to analyze the state of financial protection within Iran's healthcare system during the COVID-19 pandemic and propose practical solutions to enhance the system's financial protection.

Design/methodology/approach: This study, conducted in three stages, first assessed financial protection among 24,170 COVID-19 patients in three major Tehran hospitals, categorized by insurance status. We used dispersion indices to depict cost distribution and the Kruskal-Wallis test to analyze variations in out-of-pocket payments. In the second phase, ordinary least squares regression identified key factors affecting out-of-pocket payments. The third stage involved deriving strategies to improve health system financial protection using the Delphi technique and prioritizing them with the TOPSIS approach.

Findings: The average patient hospitalization cost was 512.41 US$, with patients covering 29.60% of total expenses while insurers handled 70.39%. Among Iran's basic health insurances, armed forces insurance exhibited the highest financial protection, with over 90% for insurers and less than 10% for the insured. The study highlights the significance of factors like prevention, equitable access, healthcare cost structuring and economic efficiency in enhancing financial protection. Priority for strengthening financial protection is given to promoting disease prevention and structuring demand through family doctor mechanisms and referral systems.

Originality/value: Enhancing financial protection requires attention to a wide range of measures, including health promotion and prevention, organizing healthcare demand, improving access structures, leveraging technological advancements and optimizing economic efficiency within the healthcare system.