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

Health Systems Profile- Islamic Republic of Iran Regional Health Systems Observatory- EMRO
Banking
Systems ( 7
major banks)
Armed Forces
Medical
Service
Organization.
covered. contribution by employers. MO health services network.
All employees and their
dependent are
Covered.
All members of armed
forces and their
dependent are covered.
Employees pay1000 Rails
every month for each
individual covered .The
banks pay 12% of salary
and benefits.
Comprehensive curative
services are provided through
own facilities and contracting
providers. The copayment for
outpatient care varies between
zero to 20 percent and for
inpatient care varies between
zero and thirty five percent
based on fees set by the banks.
Government Armed Forces Health care
network
Private insurance programs: trends, eligibility, benefits, contributions
Private insurance schemes are relatively underdeveloped in Iran given the high coverage
provided by the social insurance schemes. Private insurance schemes are usually used
by foreign expatriates and their families but locals may purchase it as a supplementary
plan.
6.4 Out-of-Pocket Payments
High out-of-pocket (oop) expenditure that puts financial burden on the households is
one of the major problems of health financing in Iran. As seen in figure below from 1980
to 2001, oop expenditure has soared from 48% to 58% of the total health expenditure.
As a result, according to other estimates, 2% of households face catastrophic health
care spending (National Health Account Study, 2002).
70
60
50
40
30
20
10
0
50.5
40.5
Source of funding for health financing (1980-2001)
9 6.4
36.3
57.3 59.8 58.3
13.9
26.3 26.2
15.5
1980 1990 2000 2001
Health
Insurance
Government
Out-of-Pocket
Payment
The widely practiced balance billing and informal payment contribute to the high out-ofpocket
expenditure. The informal or under the table payment is due primarily to the
public sector doctors owning and running private practices (not accurate). Sometime
patients have to pay to the doctors to obtain consultancies and surgeries in public
facilities. The high co-payment for services is another reason for high oop expenditure.
Further, retrospective payment mechanisms, especially fee-for-service have since
incentives to induce demand for health care which leads to increased co-payment adding
to oop expenses.
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