Future Development through the Past: Pathology of the Financing Dimension of Iran’s Health Transformation Plan

Abstract

Introduction: In Iran, during the years, the budgeting model used for healthcare funding is affected by factors such as global oil prices and fluctuation in the exchange rates, so developing or continuing to implement a plan in the health system depends on the current and future global and local economic trends. This study aimed to analyze the future of the recent significant reform called Health Transformation Plan (HTP), started on 15 Jun 2014 in light of potential financial barriers and challenges.Methods: Face to face interviews were conducted with health policymakers at different levels of the health system, health researchers, health insurance officers, and faculty members. Also, published and unpublished documents about HTP in the country and worldwide were reviewed. Data analysis was done using a qualitative inductive content analysis approach and assisted by qualitative data management software.Findings: Instability of financial resources and allocation of Gross Domestic Product (GDP) to the HTP in the traditional way is a challenge in continuing this policy reform. Also, the bureaucratic procedures in allocation and distribution of funds, discrepancy between health insurance funds and affiliated units of Ministry of Health and Medical Education (MoHME) especially Medical Sciences Universities (MSU), the lack of purchaser–provider split, inappropriate payments and compensation mechanisms, and dependence of MSU on especial revenues are the main challenges that threaten the future of HTP in Iran.Conclusion: Given the current situation, where the country's funding resources are often unpredictable, it seems that such funding challenges will lead to poor HTP results. Therefore, the continuance of such high cost-based plan requires the strategies and policies to ensure raising additional funds through various types of innovative financing to overcome challenges.

Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

“…For example, the self-employed continued to lack reliable and sustainable coverage; health insurance coverage remained voluntary for those with no stable and regular income; there was no redistribution of cross-subsidies among health insurance funds; inequality in benefit package among different groups of the population was high; no real strategic purchasing existed. Meanwhile, OOP health care expenditure was increasing [45,46]. As the general performance of health insurance system in the country was not satisfactory, over the time, along with the large basic health insurance funds, 17 smaller well-off institutional funds (such as banks, the Tehran Municipality, the National Broadcasting Organization, private insurance companies, the Petroleum Industry Health Organization) started to provide generous health insurance coverage for their employees independently.…”

“…According to the National Health Accounts, informal payments formed 14% out of 53% OOP expenditures [50]. The percentage of households facing catastrophic health expenditure varied from 8.3 to 22% [45,51].…”

“…To overhaul the health system and also address the health financing challenges (e.g., high OOP and catastrophic health expenditure), a series of policy interventions called Health Transformation Plan (HTP) was implemented in May 2014 mainly by increasing the share of public budget for the health sector [45,46]. The Plan's purpose was to reduce OOP payments and financial burden in the public health sector (HTP generally does not provide financial support for patients getting health services from private health sector), by lowering coinsurance rates in the public sector and the provision of free-of-charge health insurance coverage (government paid the whole premium on behalf of the uninsured population).…”

“…In deprived areas of Iran, many more hospitals and health facilities were built, and others were renovated. In the remote areas, the number of hospital beds and health care staff (physicians, nurses and midwives) was increased [55]. These improvements, alongside updating medical tariffs, led to a big increase in health care expenditures and higher costs for health insurance organisations.…”

The analysis of National Health Accounts and financial communications network in Iran health insurance ecosystem

“…According to the definition provided by the World Health Organization (WHO), the ultimate goal of health systems is to maintain and promote the health of individuals in societies, to meet their expectations in a justice-oriented manner, and protect them from harm and the financial burden of disease [1]. Financing is an essential component of health systems, but spending more resources in the health sector does not necessarily mean achieving better results and providing effective, efficient, and equitable health care for people in the health sector [2,3]. Providing financial resources as one of the main tasks of a health system includes three main functions: revenue collection and financial resources, accumulation and management of revenues (risk accumulation), and allocation of resources to meet the health needs of individuals and society (service purchase) [4].…”