Background: Out-of-pocket is one of the most important payment methods in Iran's health system, which has negative impacts on equity and pushes the vulnerable groups into poverty. Considering the importance of this method, as one of the key issues in health policy, the present study was conducted to identify the factors that affect the household direct payments.
Methods: This cross-sectional descriptive-analytic study was carried out based on the information obtained from Mazandaran University of Medical Sciences in four one-year periods (2013-2016). The study population included all governmental hospitals in Mazandaran province. Data collection tools included some of the hospital performance indicators. After data collection, the relevant information was entered into Eviews ₆ software and the least squared (OLS) method was used to analyze the data.
Results: Based on the research findings, 73 percent of the variations in out-of-pocket payments were explained by the independent variables. The number of specialist physicians, the total bed days, and the length of patients' stay in the hospital had a significant relationship with out-of-pocket (p>  0.05), but the relationship of active beds, bed occupancy, and bed occupancy rate with out-of-pocket payments was not significant (p > 0.05).
Conclusion: Out-of-pocket is complex and multifactorial. So, different factors should be investigated thoroughly in order to identify and control the determinants of these payments and to determine appropriate strategies.