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

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