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Flagship Course on:Health Financing & Provider
Payment
Iran Health Financing
May 12-15, 2005
Khoramabad - Lorestan
Dr hamidreza Jamshidi
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Iran Health Financing
Iran is a lower middle income country with a 2002 GDP US$ 108.2 billion (US$ 438.5 billion PPP)
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Iran Health Financing
2002 GDP Per Capita equal to US$ 6690 PPP.
Government revenues are 25 Percent of GDP
54% from oil and gas
24% from taxes
The remainder from other Sources
Iran Health Financing
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Iran Health Financing
Public health expenditure as % of GDP = 2.8% (2001)
Private health expenditure as % of GDP = 3.6%(2001)
Out of Pocket Payment = 56%
Iran Health Financing
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Iran Spent an estimated 6.4% of its GDP on health US$ 422 Per Ca Pita in PPP.
Health Spending accounts for some 10% of Government spending and 5.5 percent of house hold spending.
Iran Health Financing
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Iran Health Financing
Population with Sustainable
access to improved Sanitation
(%)
1990
)-(
2000 (%83)
Population with Sustainable
access to an improved water
Source: (%)
1990
)-(
2000 (%92)
Under nourished People: (% Total
Population) 1990/92
(%5)1991/2001
(5)
Children under weight for age: (% under s year)1990-2002
%11
Iran Health Financing
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Children under height for age1990-2002 :%15
Infants with low birth weight)%( 1998-2002 : %17
Life expectancy at birth (years)1970-75 “55.3 years”
2000-05 “70.3 years”
Infant mortality rate (Per, 1000
live births)
1970
“ 122”
2002
“35”
Under-five mortality rate (Per,
1000 live Births)
1970
“ 191”
2002
“ 24”
Iran Health Financing
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Poverty Safety Netin IR. IRAN
Social Security Structure
Expansion of the Equal Opportunities
& Empowerment
Development the
Infrastructures
High Education
Public Education
HousingJob
CreationHealth-Health Insurance
-Social Insurance-Rehabilitation-Social protection system:
Through establishing:1- Imam Khomeini Emdad Committee
Establish the Ministry of
Welfare Since 2004
PHC system
Providing human resources for
deprived areas
Health insurance
system
Infrastructure
Capacity Building
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Iran Health Financing In formal sector 30% of income paid
for social security benefits (24 million population). Nearly one third of this (9%) amount allocate to health insurance fund.
Government employees pay a monthly fix amount Per Capita and armed forced personnel pays the same amount. Nearly two third of premium paid by Government, just as an employer.
Iran Health Financing
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Iran Health Financing
Rural Population premium Paid by Government as a fixed amount equal to 40% of civil Servant Premium.
New incoming rural insurance is established by the parliament. Almost totally financed by GOV (5% by people)
Workers Contribution Pooled by Social Security organization fund.
Iran Health Financing
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Iran Health Financing
Medical Services insurance organization manage Contributions related to civil Servants, Rural Population , Self employed, and other groups.
Armed forced organization provide insurance Services for military Personnel.
Iran Health Financing
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Iran Health Financing
Poor people is financed partly through charity which Pooled by “Imam khomeini foundation” fund.
Government pay & compensate for poor people premium.
Iran Health Financing
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Iran Health Financing
Other Social groups (Students, clergies, etc): 80% of their Premium Paid by Government.
Banks, Oil Company and municipality have Own insurance fund.
Self-employed Pay the full amount of their premium.
Iran Health Financing
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Primary Health Care (PHC) services is delivered by the GOV through widespread health network.
PHC (fully financed through government budget) account for 20% of Government health expenditure.
Iran Health FinancingIran Health Financing
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Health insurance sharing in health expenditure = 23%
Health insurance expenditure (Resource Allocation):
Hospitals : 40-45%
Drug : 25-28%
Physicians : 25-22%
Para clinics : 15-18%
Iran Health FinancingIran Health Financing
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Medical Insurance System Covered groups ) 2003 (
GroupPopulation
(Millions)
Percent)%(
Basis of CoverageFinancing
Method
Total AmountsInsurance
Provider BillionRail
Billion $
(ppp)
Outpatient
Inpatient
Labors2436.6√ √ %7 of salary by employee 21% by employer3% by the Gov.
70003.5Social Security Organization
(SSO)
GovernmentEmployees
6.810.4√√Per capita 200,000 Rls.Per year 80% by Gov.
30% by employee
13600.68Medical Services Insurance
Organization
( MSIO)
Villagers1929√Coverage Via PHC-(
_
Per capita, 50,000Provided by Gov.
9000.45MSIO
Poor people under social protection coverage
4.26.4√√ Via
referralsystem
Per capita, 120,0004820.24Imam Khomeini Emdad Committee
Self- employed,&
Special patients
.55.84√√Per capita, 250,000110.055MSIO
Poor self employees first
level of services
61√─Per capita, 66,000Provided by Gov.
4000.2MSIO
Others (students, war injured, etc)
.851.3√√Per capita, 200,000Rails per year
170.085MSIO
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Iran Health Financing
1 .Revenue sources are complex
2 .Risk pooling limitation
3 .No cost-effectiveness analysis of benefit package
4 .Regressive method of financing
5 .Multiple insurance funds
6 .Mixed financing and provision
Iran Health Financing
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Iran Health Financing
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Iran Health Financing
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Iran Health Financing