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

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