Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

Abstract

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011)(2012)(2013)(2014)(2015)(2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016)(2017)(2018)(2019)(2020)(2021).

The Effects of Health Transformation Plan Implementation on the Performance Indicators of Public Hospitals

“…In accordance with its general duties, missions, and upstream documents, especially the 20-year vision document, health legislation in the 5th development plan and the 11th government program, the Ministry of Health and Medical Education, as the main custodian of the country's health system, initiated the HSRP, in cial protection of individuals, access to health services and improved quality of services (10)(11)(12). In spite of the short lifetime of this plan, several studies have investigated it from different perspectives.…”

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

“…Another reason could lie in the increase in an tariffs for medical services as a result of the publication of a new book of relative value units of healthcare services in September 29, 2014 with the aim of making the tariffs closer to the actual final prices; accordingly, the tariffs for medical services increased, particularly in private sector. 22 According to the results of the study, certain variables increase the chances of exposure to CHE. One of the most important determinants of facing CHE is the household economic status so that the higher the economic status of a household, the lower the chance of exposure to such expenditures.…”

“…The budget for the plan is provided from 10% of revenues coming from the targeted subsidy plan and a 1% increase in the rate of value-added tax. 22 After more than one year since the start of this plan, three phases have been implemented. The first phase of HSEP was carried out in hospitals affiliated with MoHME and consisted of eight executive packages (started on May 5, 2014).…”

“…The ultimate objectives of HSEP include increasing the responsiveness of the health system, reducing OOP payments, reducing the percentage of households facing CHE and increasing the rate of child natural delivery. 22,23 Along with the expansion of the health system reform plan in different domains, various aspects of the plan should also be monitored and evaluated. Timely monitoring and evaluation of reforms can provide evidence for (re)directing the implementation of the reforms.…”

Designing a Framework for “Iranian Pay for Performance” Program for Non-Medical Workforce in Hospitals

“…The ministry of health and medical education executed the Iranian pay for performance model in the public teaching hospitals in 2015 in line with the emphasis of the Iran's laws to deploy the structures of the PFP program (13)(14)(15) and health system reform (16).…”