Myocardial infarction and Stroke account for 75% of causes of death In Iran

This is what Dr. Mohammad Aghajani, the Deputy Minster of of the Ministry of Health and Medical Education revealed in a conference in Kermanshah-Iran. He said  that Iran has added 2,200 ICU beds to the existing 5,700 ICU beds in 1393 (2014-2015). He also announced that the Ministry has a plan to build 100 new Emergency Centers in the first half of the year  1394 ( 2015-2016). [As part of the new health reform] "we aimed at formulating and implementing "real" medical tariff ( the same as price of medical services) and we will complete the implementation of this policy in three years from now" he added. 

My comment: Chronic disease prevention and management is the main problem of the ministry of health in Iran. While the system is well integrated in rural areas ( some 30% of the population)  for infectious disease control ( and newly implemented chronic disease risk factor control) residents of urban areas are far from receiving a quality care for a variety of chronic diseases. 

Source: ILNA ( code: 265177) ; Link to the original news in Farsi : https://www.blogger.com/blogger.g?blogID=2999283583133896799#editor/target=post;postID=5169542610711172221

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.  

End of the post

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) 

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

Inadequate insurance and shortage in providers to support patients with burn

"Tehran Province has the highest burn-related mortality among all provinces in the country" says the officials of the Forensic Medicine Center. It is claimed that Tehran has only one hospital (Shahid Motahhari) that deals with burn cases at sub-specialty level. There are handful of other private hospitals giving care to patients with mild to moderate burns but not to severe cases. The ILNA's journalist reports that 2,690 people with burns die annually [in the country]. However, the number of beds per capita for burn cases has been going down in recent years. The CEO of the Motahhari Inpatient Burn Center (Hospital) says that insurance plans do not cover all costs of patients with significant burns and charities have to be more active to collect money to support these patients. He says that adding one Burn-ICU bed to the hospital costs some 60,000 dollars and the hospital is struggling with economic barriers to expand its facilities to provide adequate care to patients with burn.

My comment: The highest mortality may be due to the fact that cases with severe burn may be constantly referred to hospitals in Tehran.

Reference: Iranian Labor News Agency, online , accessed on August 17, 2011. News Code:202485

Link: http://www.ilna.ir/newsText.aspx?ID=202485

High utilization of pharmaceutical in Iran

According to the report of the Ministry of Health and Medical Education Iran is among the top 20 countries whose people utilize the highest amount of pharmaceuticals. Iran ranks second after China among Asian countries on pharmaceutical utilization. The report also explains that 46% of the medicines used are injection drugs while this figure for the globe is only 11%.

My note: From my practice long time ago in Iran I can tell that the figures can be all true. A dominant belief among people regarding medicine is that injection drugs are much stronger than oral medications. I have seen evidence from India and Pakistan that a large fraction of population in theses countries think the same way. I hope the Family Physician Program started a few years ago is able to change the false paradigms and help regulate the outpatient healthcare.

Source: http://techdaily.ir/?p=324 , accessed on March 19, 2011

Family Physician Plan starts today Feb 12, 2011

The plan is to be started functioning in 3 provinces Sistan & Baloochestan, Charmahal, and Khozestan as of today, Feb 12, 2011. In brief the plan focuses on a referral system involving 3 levels. General practitioner level, Specialty level, and subspecialty level. The primary level of care is given by a team that includes at least a General practitioner, a Community Health Worker (Behvarz in Farsi), and a trained nurse or obstetrics assistant (Mah-Mah in Farsi). The team is in charge of the patients' health. The plan assumes that all people registered are insured. The consultations provided by the first layer of referral is free of charge for people and the team are reimbursed by the insurance company. The distribution of the first-level services are equal such that 4 physician and 17 other medical staff provide services for every 10,000 population.

The hope is that the plan increases quality of care and reduces the costs. It is said that there are so many obstacles toward the end of the plan. One important one is that around 20 million of the country's population are uninsured and that around 20 million of the insured hold dual insurance coverage (quoted from Sadegh Mahsooli, the current Welfare Minister) .

It's worthy noting that the centers executing the plans are equipped with Electronic Health Record system.

My comment: Outpatient health services in Iran have been historically in the private sector and quite unregulated. It's really hard to put the doctors under a unique gate keeper system. Subspecialty level doctors are powerful agents. Their income is super high. Also, many of them have high political leverage. Having said that, expecting a full collaboration across different levels of the system may be achieved only based on some crude evaluations. General practitioners , on the other hand, are the weakest (both in terms of income, and the political power) among the physician population. The plan is revolutionary on many fronts and its full implementation is hard to achieve.

Reference: http://www.bbc.co.uk/persian/iran/2011/02/110212_l19_dastjerdi_mahsoli_doctor_family.shtml

'Health Houses' in Iran is getting attraction!

It's not long ago that Mississippi has decided to plan for establishing health houses model to serve its medically undeserved areas. They picked the Iranian model and I would say it was just a right pick. Iran started its primary preventive health care network more than 40 years back. The plan has shown a high degree of success. Although the model and its implementation has not been fully presented through international publications and media , the Mississippi's collaboration with Iranian health officials on building its counterpart in the US may help the plan get international recognition. Below is a link to a website through which you can find useful information on this collaborative effort.
http://www.fic.nih.gov/news/publications/global_health_matters/2009/1209_health-house.htm

Cesarian Section in Iran is 4 times world's standard

According to a report published in Khabar Online, Iran scores second in the world in terms of number of cesarian section and cosmetic nose surgical operations. The report says that in many provinces the administrative statistics show that between 30 and 50 percent of deliveries are completed through cesarian section operation.

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

ISNA: 80 Percent of Patients in Iran Ask for Complementary Curing

"FROM OTHER WEBSITES":

"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

The Minister of Health , Dr. Bagher Lankarani, stated that breast cancer, prostate cancer, blood and lymphatic malignancies, and colon cancer will no longer pose any financial charges on people with these conditions. " Last year we allocated 75 billion Toman (roughly 75 million dollars) to the treatment of these malignancies. We continue this year with 50 billion Toman" he iterated.

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

Health in the news: Some facts on pharamaceutical usage in Iran

1-In 2005 (1384 Solar Calendar) pharmaceutical products average usage in Iran was 386 items per each Iranian (monetary value of the total usage: 169.4 Rials not taken into account the direct and indirect subsidies and the share of the pharmacist per prescription(Haghe Fanni in Persian)).
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

Possible rise of out-of-pocket health expenditures in 2007-8

A number of health officials in Iran forecast a sharp rise in out-of-pocket health expenditures (OOP) in the coming year (2007-8). They all say that pre-decided 4300 Toman (approximately 5 dollars) per capita healthcare share of the government (Saraneye darman in Farsi) for the year 2007-8 may cause a sharp 15% increase of the OOP payments. Then people will have to pay up to 70% (even 80%) of medical care expenses out of their pocket. They all concern about the bankruptcy of the private hospitals as a direct consequence of high OOP payments. Their suggestion is to increase the per capita share of the government to 7000-8000 Toman (8.5 -9 dollars) so that people directly pay much less than what they currently pay for healthcare services . Currently, OOP payments constitute 55% to 60% of total health expenditures in Iran. Private sector is the main provider of the outpatient health care. Inpatient care is provided chiefly by the government in most parts of the country. However, in big cities like Tehran, Isfahan, Tabriz, Shiraz, and Mashad, private hospitals are providing an important portion of the population's needs to inpatient care.
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

Health in the news: Last updates on the number of medical human resources in Iran

Dr. Shahab Al-din Sadr, director of Iranian Medical Council (IMC), gives an update on the number of medical human resources (all are a member of the IMC)in Iran as follows:

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

For about 6,000 hemophilia cases in Iran need to get required health services provided by especial medical centers in the province in which hemophiliacs live Dr. Alavian, the Deputy of Health of the Ministry of Health(MOH), says. To prevent the patients from going to Tehran to receive their needed medical services we are going to establish in each province a center providing especial care for these patients he added. Five billion Toman (900 Toman is equal to one dollar) subsidy has been allocated for hemophilia care by the MOH.
Source: www.aftab-yazd.com , No: 2002, Feb, 6 2007
Code: 25N

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

Health in the news: If approved, people won't pay for expensive medicines

The medical care deputy of the Social Security Organization (SSO), Mr. Ali Fattahi, said that if the Supreme Insurance Concil (Shoraye Ali Bimeh) approves a suggested official plan to financially protect the cost of treatment for patients undergoing hemodialysis, hemophiliacs, and thalassemia patients (so called privileged medical conditions or Bimari-haye Khas in Farsi), these patients will not have to pay for expensive medicines. The SSO now pays the total cost of medicines for 8,153 of such payments he added. The plan says that patients should pay a co-payment for cheaper drugs while the insurers pay 100% of costs of expensive medicines. The SSO covers 85% of costs of medicines for patients with cancers although cancers have not been listed as so called privileged medical conditions , Mr. Fattahi said. 3,562 patients with multiple sclerosis (MS) are being financially protected by the SSO he said but he did not specify the percentage of medical cost coverage by the SSO for these patients.
Source: www.jamejamonline.ir , Feb, 7 2007
Code: 23N