Medical costs brings 7 percent of Iranian population down to poverty level every year

This is a direct quote from Dr. Hassan G. Hashemi  ,the new Minister of Health in President Rohani’s government, in his visit to Kermanshah , a major city in west of Iran on October 4, 2013. Recently people have faced a sharp increase in the price of the prescription drugs (up to 46%) he mentioned. Dr. Hashemi reiterated that the new price control policy for drugs will focus on reducing the price of prescription drugs for special need patients (e.g. chronic kidney disease, and cancer).

The Minister of Health stressed that in the current budget 13,600 billion Toman has been allocated to the  Ministry of Health and Medical Education, however,  only 2,600 billion Toman of the total has been secured so far. To afford their life expenses fifteen thousands of Iranian physicians are in a job other than health services he said. This is despite the fact that country is in need for 2000 physicians. Between 200 and 250 thousand nursing staff are required to fulfill the country’s healthcare system needs.

Dr. Hashemi is optimistic toward a better future for the healthcare system with the new government’s approach to solve international relations and removing the sanctions.  

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My comment: With the largest portion of the outpatient healthcare delivery in private sector (at least 90%), it is hard to regulate the price for physician visits and pharmaceuticals. Many hospitals ask patients to provide some of the equipment  and medicine they need to provide care. The global budget deficit is a main problem. With many unpredictable factors around it is hard to predict if improvement in medicine supply and service delivery is a myth or a fact. 

Source: www.dw.de , 10/04/2013,available from http:/dw/de/p/19tqR

Health in the news: 75,000 new annual cancer cases in Iran

Dr Mohagheghi, the chief of Tehran University Institute of Cancer, said that 200,000 patients with cancer live in the currently and each year 75,000 new cases are diagnosed as having a type of cancer. 30,000 cancer patients die in Iran each year he added.
Source: www.aftabeyazd.com , No: 2005, Feb, 10 2007
Code: 24N

Priorities of the Ministry of Health for the next four years

Seyed Hassan Hashemi , MD, and the new minster of health explained the priorities of the Ministry of Health (MOH) for the next five years. Meeting the needs for [essential] pharmaceuticals is the first and the foremost first task of the MOH he stated. He acknowledged the unmet needs of patients with hard-to-treat conditions. Establishing a single payer system is what MOH will accomplish as its most important mission in the coming four-year term according to him. Improving and expanding the family physician network was what Dr. Hashemi described as a parallel important plan for the MOH.

My comment: It seems that essential drug supply is the right immediate mission for the MOH. Single payer system helps integrate the medical care in Iran. This is doable because less than 2% of the health insurance coverage is provided by private medical insurances. Family physician network is essential as well but is a rather difficult task to accomplish. With more than 90% of outpatient care being in private sector enforcing the referral guidelines and managing the provider payment system is quite challenging.

Source: It's an interview in Farsi posted on youtube :

http://www.youtube.com/watch?feature=c4-overview&v=5AEgpDjaoOw&list=UUI01l6WXUWeKEpaNJD3x6fQ&desktop_uri=/watch?v=5AEgpDjaoOw&feature=c4-overview&list=UUI01l6WXUWeKEpaNJD3x6fQ&nomobile=1

150 pulmonologist (lung diseases subspecialist) for 77 million Iranians

Dr. Katayoun Najafi Zadeh MD, the chair of Organ Donation Center of Shahid Beheshti Medical University in Tehran-Iran,  says we should increase this number to 1500 in order to meet the needs of our population. Najafi Zadeh believes that if number of pulmonologists in Sweden was the right benchmark we would already train around 4000 of these specialists.

My comment: There are two problems here: 1) the distribution , and 2) the absolute low number. Medical specialists in developing countries tend to provide services in big cities. This is very true about Iran as well. The low number of pulmonologists regardless of where they practice seems to be a serious issue. However, it seems like Iran has to have its own health service provision map rather than looking at western benchmarks. Training more sub-specialist physicians cannot be an optimal solution in a system with disintegrated care for chronic conditions. In fact, more sub-specialist does not guarantee more efficient ( high quality at lower cost) medical care.

Source: Tasnim News, Tasnim News ID: 112574 ; URL: http://www.tasnimnews.com/Home/Single/112574 accessed August 7, 2013

Health insurances do not afford coverage for prescribed medicines anymore

With the recent sanctions against the country and skyrocketing  market inflation health insurance companies have problems with reimbursing  prescribed medicines. 

Reported by Tasnim News Agency Ahmad Ariayei Nezhad , a member of the Health Commission of the   Parliament of the Islamic Consultative Assembly, announced that insurance companies pay pharmacies according to old contracts in which the price of drugs is about one third of the current rates.

He seriously warned that if insurance firms do not receive enough premiums/governmental source of money they will soon go bankrupt.  

Source: http://www.tabnak.ir/fa/news 
News code: 334650 (In Farsi) 
Accessed: July 27, 2013 

My comment:  Health insurance companies in Iran for the most part receive their monetary input from the government. Only a fraction of the money come from premiums. Pharmacies have two main sources  of monetary input for prescribed drugs : Purchaser's out of pocket money (either co-payment or  entire payment), and reimbursements mae by the insurance companies. Recently, many people have to pay hundreds of dollars out of their pocket to buy expensive medicines they need to treat specialized conditions such as various cancers and multiple sclerosis. Lately, US government removed the ban from exporting  life-saving drugs to Iran. The sanctions have created an alarming  problem for Iranians seeking for a variety kinds of medical treatments.

(see http://www.guardian.co.uk/world/2013/jan/13/iran-lifesaving-drugs-international-sanctions)