Iran's health system
I created this blog to share with you my concerns about healthcare system in Iran as an example of a developing country. I would like you to feedback on the major challenges of the healthcare system in Iran. Healthcare disparity, quality, and status of healthcare are among subjects I am very interested to write about. I hope this blog makes researchers and policymakers in the field more familiar with the healthcare system of this country.
Wednesday, April 8, 2015
Myocardial infarction and Stroke account for 75% of causes of death In Iran
Sunday, October 6, 2013
Medical costs brings 7 percent of Iranian population down to poverty level every year
Monday, August 19, 2013
Health in the news: 75,000 new annual cancer cases in Iran
Source: www.aftabeyazd.com , No: 2005, Feb, 10 2007
Code: 24N
Sunday, August 18, 2013
Priorities of the Ministry of Health for the next four years
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
Wednesday, August 7, 2013
150 pulmonologist (lung diseases subspecialist) for 77 million Iranians
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
Saturday, July 27, 2013
Health insurances do not afford coverage for prescribed medicines anymore
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
Thursday, August 18, 2011
7000 patients with diabetes registered at the Center for Control and Prevention of Diabetes in Iran
The center is in Mashad, northeast of Iran. The CEO of the center Javad Jahani Mehr says that this center was established in 2005 with the mission to provide care to patients with diabetes and control the disease. He emphasizes that such infrastructure will be coming along soon in other major cities of Iran. He stressed the point that more than half of patients with diabetes in Iran are not aware of their high blood sugar. On the other hand 99 percent of those who know they have diabetes are under poor blood sugar control he added. The major policy intervention to be implemented is to educate people how to deal with the condition , which is the core policy intervention devised for such clinical centers , he said.
My comment: It’s very promising that targeted interventions for high-cost /high mortality diseases and risk factors are getting attention by Iranians. It would be great if the clinical effects of such interventions could be measured and compared with traditional care being received by the rest of patients with diabetes.
Link to the news: http://www.irna.ir/NewsShow.aspx?NID=30525826
Source: Irna, online, Accessed on August 18,2011. News Code: 30525826
Wednesday, August 17, 2011
Inadequate insurance and shortage in providers to support patients with burn
Saturday, March 19, 2011
High utilization of pharmaceutical in Iran
Saturday, February 12, 2011
Family Physician Plan starts today Feb 12, 2011
Thursday, January 13, 2011
'Health Houses' in Iran is getting attraction!
http://www.fic.nih.gov/news/publications/global_health_matters/2009/1209_health-house.htm
Monday, April 26, 2010
Cesarian Section in Iran is 4 times world's standard
Source: Khabar Online, News Code: 57202
Accessed on Monday, April 26, 2010 at http://www.khabaronline.ir/news-57202.aspx
My comments: 1. To make this worse I would say that the majority of cesarian section operations are being performed under general anesthesia. Local (subdural) anesthesia that has a lower risk of complications is not the dominant mode of anesthesia in obstetrics in Iran 2. Based on a cross sectional study in Tehran , in private hospitals about 80% of all deliveries are done through cesarian section. Also, the results of this study show that the main reason to select cesarian section over normal vaginal delivery is pregnant mother's/ her husband's request for cesarian delivery.
Reference for the second tip: Garmaroudi G. et al. Cesarean section prevalence in Tehran, Iran. Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2003; 19: abstract no. 16. Accessed on Monday, April 26, 2010 at http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102275934.html
Tuesday, February 24, 2009
ISNA: 80 Percent of Patients in Iran Ask for Complementary Curing
"ISNA - Tehran
Service: Health
Tehran, Feb.19 (ISNA)-Experts' researches of Iranian Academic Center for Education, Culture and Research (ACECR) shows that 35 percent of patients affected by cancer use various methods of complementary curing.
"35 percent of patients affected by cancer use complementary curing methods that includes 81 percent supplication and 9 percent energy curing," said one of ACERC researchers.
According to the researches, 80 percent of patients ask physicians for complementary curing and 90 percent of them are satisfied by this method.
Among those who have used this method, 38 percent has used one curing method and 11 percent of them have used two methods of complementary method.
Complementary method consists of a collection of behaviors and believes that are used by patients for prevention and curing the disease and also betterment of health level.
End Item"
5 cancers get free treatment
My comment:
1.There has been a long debate in the country if cancers should be financially treated as long lasting disabling ill conditions such as chronic renal failure and thalssemia. The latter illnesses are called "bimari haye khas" which means 'exceptional diseases' and receive huge governmental subsidies. Patients with 'execeptional diseases" geneally utilize healthcare for these illnesses free of charge.
2. According to the literature stomach cancer ranks first among all type of cancers in Iran and I have no idea why this cancer is not included in the 'free treatment plan for cancers'.
Source: Gooya news quoted from ISNA news agency , http://news.gooya.com/technology/archives/084296.php, Feb 24, 2009
Saturday, February 24, 2007
Health in the news: Some facts on pharamaceutical usage in Iran
2-Total items of medicines sold in 2005 amounted to 16.5 billions (monetary equivalence: 11,526,602,000 Rials).
3-Average item prescribed per encounter was 3.5 in 2005 (3.6 in 1997).
4-Probable reasons for irrational drug utilization: Lack of systematized structure for pharmaceutical usage, absence of adequate control over drug utilization, unrealistic medical tariffs, inefficiency of medical insurers, adverse interests of pharmaceutical companies, and high financial benefits of drug distributors.
5-Mr. Davood Madadi, CEO of the Social Security Organization adds to the above list the tendency of people to visit doctors prescribing more than standard drug items.
6- Patients generally expect doctors to prescribe parenteral forms of medicines. They don't put believe in physicians who do not satisfy these expectations, a bitter fact of our health system.
7-Dr Mojdehi Azar stresses that low income of physicians in Iran encourage them to follow patients requests instead of concentrating on what the real needs of patients are.
8- Dr. Hassan Hovida, director of the General Physicians Association in Iran, says that patients are the main inducers of over-prescription of medicines in Iran.
[Extracted from a report by Ali Akhavan Behbahani]
Source: Jamejamonline, www.jamejamonline.ir, Feb 21, 2007
Code: 27N
Friday, February 16, 2007
Possible rise of out-of-pocket health expenditures in 2007-8
Sources:
1-http://pezeshkan.ir/ .Feb 3, 2007 (original reference: Mehr News interview with Dr. Bijan Shahbazkhani, and Dr. Jahanbakhsh Aminia , members of the Health Commission of the Parliament)
2-http://pezeshkan.ir .Feb 4, 2007 (original reference: Mehr News interview with Dr. Ahmad Reza Jamshidi, the Vice Chairman of the I.R.Iran's Medical Council)
3-http://pezeshkan.ir . Feb 3, 2007 (original reference: Fars News interview with Dr. Mohammad Hossein Tarighat, the Vice Chaiman of the Welfare Ministry)
Code:5A
Sunday, February 11, 2007
Health in the news: Last updates on the number of medical human resources in Iran
70,000 General Practitioners(completed 7-year medical school)
25,000 Medical Specialists and Subspecialists
20,000 Dentists (General and specialist)
13,000 pharmacists
3500 Laboratory Medicine Specialists (either 7-8 year and 10-11 year educational programs)
40,000 Midwifes (all has a formal 4-year university education).
Total: 170,000
My comment: This total does not include nurses and theyare I guess all members of the IMC and should be counted in.
Source: http://aftabnews.ir/vdciw3at1wa35.html , http://www.aftabnews.ir/ August 13, 2006
Code:26N
Health in the news: establishing provincial hemophilia clinics
Source: www.aftab-yazd.com , No: 2002, Feb, 6 2007
Code: 25N
Health in the news: 75,000 new annual cancer cases in Iran
Source: www.aftabeyazd.com , No: 2005, Feb, 10 2007
Code: 24N
Health in the news: If approved, people won't pay for expensive medicines
Source: www.jamejamonline.ir , Feb, 7 2007
Code: 23N
Saturday, January 27, 2007
Health in the news: 18 million illegal use of the SSIO's health insurance plan in one year
Source: www.baztab.ir, Aug 31,2006
Code:22N
Health in the news: It's not true to say the poor pay 10 times more than the better-off for health!
Source: www. aftabyazd.com, Jan 7, 2007 ; No: 1980
My Comment: I agree with Mr. Shahriari that this number (10 times) cannot be true (You can find the estimated values from the National Statistical Center) but I believe that in general the poor receive services of lower qualities. Residents of hard to reach areas, those who reside in ghettos, and pensioners have a poor access to quality healthcare.
Code: 21N
Health in the news: Possible negative growth rate for per capita public health expenditure
According to the fourth National Development Plan (2005-2009) per capita health expenditure share of the government was determined to be 7000 Toman (approximately 7.5 USD) while the real allocated share of the government for the coming year is 3660 Toman (3.2 USD) for residents of urban areas and 1660 Toman (1.2 USD) for the rural dwellers he added.
Mr Baghbanian says that residents of rural areas cannot use their health plans to utilize urban health facilities.
Source: www.aftabyazd. com, Jan 25, 2007 No:1995
Code: 20N
Wednesday, January 24, 2007
Six principles of Iranian Health System
"1)priority of preventive care as a long-term asset, 2) priority of rural and underprivileged areas, with special attention to high-risk groups,3) priority of general practice over specialized medical care, 4) priority of outpatient over inpatient care, 5) maximum feasible integration of preventive and curative services,6) and decentralization, aimed at forming self-sufficient regional and local facilities."
Source: Shadpour K. Primary healthcare networks in the Islamic Republic of Iran. Eastern Mediterranean Health Journal.2000;6(4):822-825
My comment: I think the Ministry of Health has gone to a great length to make these happen but what we see now after almost 3 decades are somewhat different from the principles. I can see that the government has great achievements in fulfilling the first, the second , and the fifth principles but could not pave the way for the sixth principle. Iranian PHC system is a unique one and has contributed a lot in rapid decline of child and maternal mortality in spite of progressive drop of the economy for many years after the revolution. However, the system failed in decentralization of the services. The fourth principle remained untackled until the introduction of a national program to set up a family medicine network in recent years. I don't know what to say about the fourth principle but to me is not as important as the others. I know that the outpatient care consumes the most part of people's out-of-pocket payments for healthcare and more than 90% of the outpatient care is in private sector. I don't know for sure how the fourth principle facilitated the emergence of the poorly supervised outpatient care market.
Code: 4A
Sunday, January 21, 2007
Health in the news: Establishment of electronic registry network of health insurance plans cuts the costs by 30%
Source: www.pezeshkan.ir, Jan 8,2007
My comment: I did not understand what kind of expenses might be cut following this intervention. E-registry sounds like an effective intervention though. In Iran less than one percent of the health insurances are private. So, the government has a good opportunity to put all the public information on health insurance plans together and make one huge data base. Over-insurance is a real problem. I used to see many people presenting more than one or even more than one insurance plans to doctors at the time of visit. Seems to me people tend to keep more than one insurance plans just to receive a better protection. Notwithstanding double and triple insurance , people are not protected by either of their plans in some occasions.
Code:19N
Saturday, January 20, 2007
Health in the news: With 120 billion dollars annual income Iran should not be viewed as a poor coutnry
Source: www.aftabyazd.com, Jan 17,2007 No:1988
My comment: In addition to insurance coverage one would think of the efficiency of the health insurance plans. Healthcare Utilization Survey 2003 showed a 75% self reported health insurance coverage in the country which differs from the official reports.
Code: 18N
Health in the news: Iran needs 500 more medical diagnostic laboratories
Source: http://pezeshkan.ir , Jan 19 , 2007
Code: 17N
Health in the news: Some facts on Road Traffic Accidents in Iran
1-Annual number of road traffic victims is 330,000.
2-Each year, 30,000 death are registered due to RTI.
3-Most accidents take place within 30 kilometers of urban areas.
4-Total length of roads is 180,000 kilometers from which only 31,000 km is either highway or main road(rahe asli in Persian). The remainder are 44,000 km of hazardous side roads (rahe far'ee in Persian) and 100,000 km rural roads.
5-Unexpectedly, the police patrol only 23,000 km(13%) of the entire roads.
6- 90% of travels travel through the ground while rail and air travels comprise 7% and 3% of the grand total respectively.
7-14 million out of 65 million daily travels happen in the capital (Tehran).
8- In Tehran 45% of travelers use public transportation. The remnant use their own private vehicle.
9- With a growth rate of 17%, two million four-wheeler vehicles and motor bikes per year (one million each) are being produced in the country while the growth rate for the road network is only 2%.
10-The government needs 1000 billion Toman (more than a billion dollar) to fix 1500 unsafe points already made known by the experts.
11-20 billion Toman per day (more than 20 million dollars) are spent on RTI.
12-70% of RTI deaths in the country are attributed to violation of the rules by drivers.
13-Nearly all the cars have not equipped with airbag or ABS (Anti-lock Braking System) which are reported as a safe measure to prevent fatal events in RTIs.
Source: www.baztab.ir , Jan 18, 2007, Code: 58295
My comment: I have no insight into the cost of RTI. It sometimes happens that an inadvertently placed extra zero in the reported numbers makes a huge difference. You need to use caution when you want to cite the above mentioned numbers. They may give us a sense of what the problems are but in my opinion the numbers need to be checked over. For example I am not certain about the extent to which the roads are patrolled by the police.
Code:16N
Monday, January 15, 2007
Health in the news: Per capita insurance premium for diabetics
Source: www.jamejamonline.ir, Jan 12 , 2007
Code: 15N
Sunday, January 14, 2007
Health in the news: Total Health Expenditure as a percent of GDP in Iran is less than that of comparable countries
Source: http://www.aftabyazd.com/ , Jan 13, 2007 No: 1984
Code:14N