Health system profile - Islamic Republic of Iran - What is GIS - World ...

Health Systems Profile- Islamic Republic of Iran Regional Health Systems Observatory- EMRO
Trends in insurance coverage
There are four government-controlled health insurance schemes. Public Health Insurance
Scheme-Social Health Insurance Scheme Military Health Insurance Scheme. All come
under the jurisdiction of the High Council for Health Insurance, made up of Ministers
from seven ministries and headed by the Minister of Health. The High council is
responsible for making changes to the social insurance provisions of each scheme, and
sets the fee schedule for payment of providers. All health insurance schemes use the
same fee schedule.
Medical Services Insurance Organization (MSIO)
The Public Health Insurance Law of 1995 attempted to correct the imbalance in
coverage of the population, and made provisions for government employees (excluding
the military), villagers or the rural population, the self – employed and low income
groups. Persons in these groups are eligible to join the funds, though participation is not
compulsory. Villagers are automatically insured and their premiums are paid by the
Government. This leads to a large government subsidies to finance the deficit of the
Public Health Insurance Scheme.
The MSIO provides coverage of all those services not covered by the primary Health care
network i.e. diagnostic services and treatment of illness and disease either at ambulatory
level or hospital level. Patients are eligible for benefits immediately after joining the
scheme. However these services are not, as a rule, provided free of charge for persons
with this type of insurance. (Razavi, 2003)
Social Security Organization (SSO)
The social security organization was established by the social security law of 1975 to
provide health care benefits as well as a range of financing benefits to its insured. It is
compulsory for all those in employment, with the exception of government employees
and the military (for whom there exist separate schemes). It has 26 million beneficiaries.
Wives of employees are automatically covered (though if the wife is employed and the
husband is not, the husband does not have coverage). The first three children also have
coverage; any further children are not entitled to coverage (not even through payment
of further contributions).
The SSO Scheme, in addition to health care benefits, provides for retirement pensions,
disability, survivors, work-injury, marriage grant, unemployment maternity, and other
benefits, under the 1989 Health Care Obligation Law, the Social security organization is
required to provide its own health care facilities. It now owns 27 hospitals with 10000
beds and more than 260 clinics, polyclinics and day facilities. These facilities provide
about one-third of health care services to its beneficiaries, with the remaining two-thirds
being provided through contracts with hospitals in the State's curative sector. Care which
is offered in the organization’s own facilities is free of charge to the patient; care offered
in the State's health network through a contractual arrangement requires a patient
contribution of 10% for inpatient care and 20% for a clinic visit. An insured patient using
a private hospital which does not have a contractual agreement with the organization
must meet all costs but can subsequently claim reimbursement of a portion of the fees.
(Hasanzadeh, 2003)
Voluntary insurance programs:
The statutory public Health Insurance Scheme established by the public Health
Insurance Law, is actually non-compulsory, and only employed persons and military
personnel are covered by quasi-mandatory health insurance. This voluntary character of
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