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) 

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

Health in the news: 18 million illegal use of the SSIO's health insurance plan in one year

The executive director of the Social Security Insurance Organization (SSIO) , Mr Davoud Madadi, annouced that while we have issued 28 million health insurance plans, 40 million people used SSIO insurance plans in the last year (1384=2004,5). Mr. Madadi believes that electronic medical record is an effective measure to prevent from the illegal utlization of health insurances. Evaluations show that 86% of patients only need a medical/health consultation at the time of visit and over-administration of medicines by physicians just to satisfy patitients is a problem of our medical society he said.

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!

Mr. Shahriari, a member of the Health Commission of the Parliament says that claiming that the poor pay 10 times more than the better-off for health has not been proved by any evidence. He added that those with lower income usually utilize public health services and cannot afford private health facilities. According to the law uninsured people receive a compulsory health insurance plan at the point of hospitalization and are able to use their policy right after the first encounter Shahriari reiterated. Some doctors/centers even waive the co- payments for poor patients he continued.
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

"Next year, per capita health expenditure share of the government will face a 2-percent negative growth" said the vice chairman of the Health Commission of the Parliament, Mr. Baghbanian. This may cause people to pay more out of their pocket to balance the total health expenditures.
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

Health in the news: Establishment of electronic registry network of health insurance plans cuts the costs by 30%

The Health and Treatment Commission correspondent of the Parliament, Dr. Avaz Heidarpour Shahrezaei, rolled out that 80 million insurance plans does not match up with 70 million population of the country [Taking into account a great proportion of uninsured population, there would exist a considerable portion of the over-insured population in the country]. Consequently, it has been decided to employ a software to register all the insured . This way we may bring the problem of over-insurance under control and as a result we can expect an estimated 30% cut in the expenses he said.

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

Health in the news: With 120 billion dollars annual income Iran should not be viewed as a poor coutnry

The Ministry of Welfare (Refah in Persian) , Mr. Mesri, made it clear that 2 million vulnerable individuals in the country should be cprotected by a health insurance plan. We are now in the second year of the fourth five year development plan (2005-2009) in which health promotion and equity has been considered as the most important focus of national development he said. Mr. Mesri declared that the country has 120 million dollars annual revenue from selling oil and oil products. A reason for high unemployment rate is that Iranians handed over tons of job opportunities to Afghan labor force he stated. Mr. Mesri reiterated that 97 percent of the total population will benefit from one kind of health insurance in the next year.

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: Health insurance organizations are not able to cover all health needs of the population

Dr. Bagheri Lankarani, the Minister of Health remarked: Health inequality and lack of an comprehensive and uniform health insurance plan is the salient health problem in Iran. He added that without the establishment of an uniform, comprehensive public health insurance plan the Ministry of Health cannot help the system be more equitable. He admired the insurance organizations ,however, for increasing the public health insurance coverage from 75% to almost 90% in recent years.
Source: No: 1977, Jan 3, 2007 Aftab newspaper, http://www.aftabyazd.com/

My comment: I think this is quite understandable. We have at least 4 huge health insurance companies in Iran:Social Security Organization, Medical Treatment Insurance Organization, Imdad (relief) Committee Health Insurance for poor people, and Military Service Health Organization. Private insurance's coverage is around 1% . Many have double and even triple coverage while some (approximately 25% according to 2002 Household Healthcare Utilization Survey ) lack any. People who are working with a number of prestigious public, or private organizations benefit from a special coverage provided by complementary health insurance policy. Many attempts have failed so far in order to integrate the plans and build up a unified one. This remains, I believe, to be a major problem until the system makes an effective and simple policy to have one integrated health insurance plan for the entire population or alternatively implement a HMO-type policy.
Code:7N