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Healthcare in the Islamic Republic of Iran

Guiding Principle

Iran has a well-structured healthcare system. Basic healthcare is available to the entire population and guaranteed by the Iranian Constitution. Details are governed by a number of Laws including e.g. the Labor Law and the Health Insurance Law. However, the more sophisticated services are not available for everyone. Especially the health services of the Private Sector remain the benefit to the middle and upper classes. 

The Iranian healthcare system is highly centralized; most decisions are directly made by the Ministry of Health and Medical Education (MOHME). Nevertheless, several different laws apply to the different sectors of the healthcare system; some were implemented by the Ministry of Labour and Social Affairs.

I.    Rules and Regulations related to Healthcare

There are many laws and regulations generally or specifically related to the healthcare inIran, the most important ones are:

1.   The Constitution of the Islamic Republicof Iran

The Iranian Constitution was adopted by a referendum on October 24, 1979, and went into force on December 3 1979, replacing the Constitution of 1906. It has since been amended on July 28, 1989. Article 29 of the Iranian Constitution entitles Iranians to basic health care. It reads as follows:

“The right to benefit from social security with respect to retirement, unemployment, old age, disability, and destitution benefits, as well as benefits relating to being stranded and emergencies, health services, medicine, and medical care,provided through insurance or other means, is a universal right.

The government must assure the foregoing rights and financialprotection by drawing on the national income, in accordance with the law, and on income derived from the participation of the people.”

2.   Medical Equipment By-Law

The by-law was approved in March 2009, in order to establish a harmonized system for the process ofproduction, importation, exportation, distribution, supply, installation, operating and after sale services for consumable and semi-consumable items, devices, diagnostic, surgical, laboratory (medical diagnostic), treatment, cure, dentistry, rehabilitation, and for medical equipment.

3.   The Law of the Ministry of Health for Medical Cure and Education (MOHME)

The Law was ratified by Islamic Consulting Parliament in 1985.

4.   The Law of the Organization Chart and Duties of Ministry of Health, Medical Cure and Medical Education

This Law was passed in 1988 by Islamic Consulting Parliament.

5.   The Law on Medical Affairs, Pharmaceutical, Eatable and Beverage Items

This Law comprises regulations for medical, pharmaceutical, eatable and beverage items and was passed in 1955.

6.   Labour Law

The Iranian Labour Law got into force on November 20, 1990. The Ministry of Labour and Social Affairsprovides general supervision for observing the above law. The Labour Law provides regulations on working conditions for women, pregnant women and their entitlement to maternity leave. The law also sets specific conditions for employment of any person who is between 15 and 18 years of age. He/she shall undergo a medical examination by the Social Security Organization prior to commencing employment and at least once a year after commencing employment.

Furthermore, the Labour Lawprovides, that all workplaces, employers, workers, and trainees shall observe the instructions as drawn up by the Ministry of Health and Medical Education with regard to the prevention of occupational diseases and the maintenance of occupational health and workers’ health and the work environment. All workplaces, whose personnel are, because of the nature of their work, exposed to occupational diseases shall keep medical records on all the workers concerned and require them to undergo the necessary tests and examinations at the health and therapeutic centers at least once a year.

7.   Healthcare Insurance Law

Healthcare insurance is regulated by the Social Security Law of June 24, 1975. The Social Security Organizationprovides general supervision for observing the above law. The Social Security Law covers those persons who, under any title or description are engaged in work against receipt of wages or salary, and those who receive pensions for retirement, incapacity or death. Those who are insured under the Social Security Law and their family members may make use of medical services in case they are injured by accidents or suffer from a disease. Medical services include all medical services such as outpatient and hospitalization services, supply of medicines, diagnostic testing etc.

8.   The Law for the Protection of the Staff Employees against the Effects of Old Age, Disability and Disease

The above Law was ratified by the Parliament on 28.02.1971. The Ministry of Labour and Social Affairs is charged with the execution of this Law. According to this Law, all the employees of every workplace areprotected by the scheme of obligatory insurance against the effects of old age and disability.

9.   Regulation Governing Voluntary Social Insurance (Retirement & Death Benefits)

This Regulation, comprising five articles, was approved by the High Council in a meeting held on 11.9.1960. The regulation provides that for those who are covered by Iranian Social Security Law, medical aids shall be rendered by the Social Security Organization or its affiliated physicians except in the following cases:

1. The Social Security Organization’s physician considers that the patient’s referral to outside physicians or his treatment outside has been absolutely necessary,

2. the patient has had no access to the Social Security Organization’s medical services, and

3. if the patient notifies the Social Security Organization within 48 hours of his first referral to an outside physicians or hospitalization.

By virtue of theprovisions of this Regulation, all expenses incurred by patients shall be reimbursed by the Social Security Organization.

II.  Healthcare in the in Day to Day Life

Iran’s healthcare system is highly centralized. Almost all related decisions are made at the central level by the MOHME. The Ministry provides healthcare services through its network, medical insurance, and supervises and regulates the healthcare system in the country. Its authority also includes policymaking,production and distribution of pharmaceuticals as well as research and development. Through its network of health establishments and medical schools, the Ministry has become the largest health care provider in the country.

Iran’s “Master Health Plan”, adopted in the 1980s accorded priority to basic curative and preventive services as opposed to sophisticated hospital-based tertiary care, and focused strictly on the population groups at highest risk, particularly in deprived areas. Moreover, as a result of the prioritization and effective delivery of quality primary health care, health outcome in rural areas are almost equal to those in urban areas. The results in terms of infant and maternal mortality are nearly identical.

Therefore,Iranhas fairly good health indicators. More than 85 per cent of the population in rural and deprived regions, for instance, has access to primary healthcare services. The infant mortality rate is 28.6 per 1,000 live births; under-five mortality rate is 34 per 1,000 and maternal mortality rate is 25 per 100,000 live births. Poliomyelitis has been reduced to the point of near-eradication and the coverage of immunization for children and pregnant women is very extensive. Access to safe drinking water has been provided for over 90 per cent ofIran’s rural and urban population, and more than 80 per cent of the population has access to sanitary facilities.

In the past three decades, the Islamic Republic of Iran has adopted a policy aimed at more strongly addressing the needs of its population, and substantial progress has been achieved both in the social and economic sectors. Since the revolution in 1979, a Primary Health Care network has been established throughout the country. In rural areas, each village or group of villages contains a Health House, staffed by trained community health workers. These Health Houses, which constitute the basic building blocks for Iran’s health network, are the health system’s first point of contact with the communities in rural areas. In addition, Rural Health Centers were put in place. They include a physician, a health technician and an administrator, and deal with more complex health problems. On average, there is oneRuralHealthCenterper 7,000 inhabitants. In urban areas, similarly distributed urban health posts and Health Centers have been established. The whole network is managed and administered through District Health Centers, which are supervised by the MOHME.

Despite having a proper and elaborate system in place,Iran, has not been able to keep pace with the rapidly changing demographic developments. Rural areas in some parts of the country are not fully covered and health centers are inadequately equipped to meet community needs.

III. Healthcare in the Public Sector

After the Iranian revolution in 1979, the Iranian government started paying particular attention to the right of health and to the accessibility of health care-services for its population. Art. 29 of the Constitution of the Islamic Republic of Iran guarantees all citizens the right to health care. The government is therefore required toprovide every citizen of the country with access to social security that covers inter-alia disability, health and medical treatment and care services. However, the healthcare generally only covers low cost basic healthcare services. Because many medical facilities outside of the urban areas cannotprovide more than basic emergency care, there has always been a demand for a more sophisticated healthcare system inIran. Since the year 2000 the MOHME has made great effort to improve the country’s healthcare system.

According to the last census that Statistical Centre of Iran undertook in 2003, Iran possesses 730 medical establishments (e.g. hospitals, clinics) with a total of 110,797 beds, of which 488 (77,300 beds) are directly affiliated and run by the MOHME and 120 (11,301 beds) owned by the private sector and the rest belong to other organizations, such as the Social Security Organization.

An extensive network of public clinics offers basic care at low cost, and general and specialty hospitals operated by the MOHME,provide higher levels of care. In most large cities, well-to-do persons use private clinics and hospitals that charge high fees.

There are many private pharmacies all over the country. There are also four major governmental pharmacies that canprovide any kind of prescribed medicine in small quantities, i.e.:

  • Red Crescent Pharmacy;
  • 13 Aban Pharmacy;
  • Martyrs Foundation Pharmacy;
  • Noor Single Prescriptions Center.

Healthcare and public health services areprovided through a nation-wide network. This network consists of a referral system, starting at primary care centers in the periphery going through secondary-level hospitals in theprovincial capital and tertiary hospitals in major cities.

The public sectorprovides primary, secondary, and tertiary health services. The emphasis of the government on primary health care over the last two decades has made the public sector the mainprovider of primary health care services across the country. Some primary health care services such as pre-natal care and vaccinations areprovided free of charge in public facilities. The public sector alsoprovides a considerable part of secondary and tertiary health services in theprovinces.

IV. Healthcare in the in Private Sector

The private sector plays a significant role in health careprovision inIran. The private sector mainly focuses on secondary and tertiary health care in urban areas. The highest quality of treatment inIranis found in the sector of private healthcare. The country has invested heavily in the education of its people, especially in the medical field. These measures have paid off, as the medical staffs are very well capable.

Due to the high prices of sophisticated services in the private sectors, they are unavailable for the majority of the Iranian population. However, the economic improvements of the late 90’s, which related to the country’s oil and gas sources, resulted in an increasingprosperous middle class. This development made the private sector healthcare affordable to a higher number of people. As another result, the medical sector has become a field of interest to investors who wished to capitalize on the nation’s new found wealth by building even better medical facilities.

There are many non-governmental organizations (NGOs) active in health issues inIran. NGOs are mainly active in special fields like children with cancer, breast cancer, diabetes, thalassemia, and so on.

V.  Health Insurance

Iran has a large socialprotection system with some 28 social insurance, social assistance, and disaster reliefprograms benefiting large segments of the population. Theseprograms include training and job-search assistance, health and unemployment insurance, disability, old-age and survivorship pensions, and in-kind transfers including subsidies (e.g., housing, food, energy), rehabilitation and other social services (e.g., long-term care services for the elderly and marriage and burial assistance).

Health insurance inIrancan be obtained by either voluntary from the private or public insurance market. According to official data, more than 90% of the Iranian people are under the coverage of at least one kind of health insurance. The main public health insurers are:

1. The Social Security Organization (SSO) is one of the largest health insurers inIran. All people who are formally employed as well as those who are self-employed and their dependents contribute to the fund and receive benefit from this organization. However, government officials and service people are not included in this scheme. The organization owns and runs many clinics and hospitals in urban areas. For policy holders, medical services in these clinics and hospitals are offered either free of charge or at very low cost.

2. The Medical Service Insurance Organizationprovides health insurance for government employees, students, and rural dwellers. Most of the health careproviders accept patients holding this kind of medical insurance. Patients are subject to co-payment at the point of service.

3. The Military Personnel Insurance Organizationprovides health insurance for military personnel and their dependents.

4. The Emdade-Emam Committeeprovides health insurance for the uninsured poor and destitute.

Only a small percentage of Iranian people are not covered by any of the health insurance organizations. In fact, some people have enrolled in at least two different health insurance plans, encouraged by a small premium. Different insurance systemsprovide different levels of service coverage, so enrollment in different plans makes it easier to shop for services at a lower cost. There are some semi-public insurance companies whose policies mainly cover co-payments for costly inpatient services. Almost 5% of the middle-class population holding any of the aforementioned insurances buy their own policy. Some of the major semi-public insurance companies are: Alborz Insurance Company, Asian Insurance Company, Dana Insurance Company and Iran Insurance Company.

VI. Health System Challenges

The health condition ofIran’s population has improved remarkably during the last decades; however, many challenges threaten the health system. Some of most important challenges are:

1.   Financial Consideration

The Iranian Development Plan set the goal for out-of-pocket payment to as low as 30% in 2008. Nonetheless, almost 55% of health spending is still paid out of pocket.

2.   Health Status

Road accidents as a major cause of death and injury have a significant impact on Iranians’ life expectancy and cause a lot of disability and impairment among people, especially young men. Parallel with the decrease in the prevalence and incidence of communicable diseases, non-communicable diseases loom large. Cardiovascular diseases, diabetes, osteoporosis, nutritional disorders, and psychological disorders are some examples of diseases that need more attention in the coming years.

3.   Lack of Information in the Health System

There is an acceptable registry system for births, deaths, cancer, and many communicable and non-communicable diseases and immunization inIran. The lack of an integrated health information system is a stumbling block on the way to conducting systematic analysis of the health system. Apart from analysis of theprocess and outcome, patients’ satisfaction is a cornerstone of health system performance. Furthermore, the lack of accurate data on patients’ satisfaction is a major impediment in the health policy-makingprocess inIran. Despite efforts to measure patients’ satisfaction, the current information system is far from optimum. The quality of services and efficiency of the health system are two major issues that need more attention.

 

January, 2010 Zahra Tahsili & Lena Brand
Meyer-Reumann & Partners – Tehran & Dubai Office
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