Introduction
Healthcare system financing background in Iran
Methods
Data collection
Category | Number | Main samples |
---|---|---|
a) Documents sources and charactristics | ||
National Report, books, thesis, dessertation | 19 | Parliament’s Research Center reports, ‘Planning and Budget’ and ‘Health and Treatment’ Standing Committees reports, reports or books published by Social Security Organization Research Institute such as Reforms in Medical tariffs and 20-year setting medical tariffs in Iran, PhD or MSc thesis such as the effect of proposed changes of relative values of different specialists medical tariffs on payment weight of specialities and health system costs |
Parliamentary Proceedings | 123 | Medical tariffs, medical services universal insurance, Hospital autonomy, hospital corporatization, Hospital self-sufficiency |
Local Organizational websites | 21 | Parliament, Vice-presidency for Strategic Planning and Supervision, Medical Council, Medical Universities, Social Security Organization Research Institute, Major Public and Private hospitals, National centre for health insurance research |
Acts, bills, proposals, bylaws and regulations, | 91 | The Organization and Duties of MoHME, Medical Services Universal Insurance, Rural Health Insurance, MoHME formation, Social Security, Public Financial Regulation, Hospital autonomy policy, First to Six Five-year Development Plans and related Acts, Reviewing system administration of hospital plan, Iran Medical Council formation, the Ministry of Welfare and Social Security, the Ministry of Cooperative, Labour and Social Welfare, Employee and contractual staff payment, Hospitals Boards of trustees, Health Transformation Plan, targeted subsidies plan |
Academic literature | 68 | Papers published by the first seminar on assessing medical tariffs by Iran Medical Council, Papers published relevant to medical tariffs and related policies and reforms, mainly published in Farsi, English papers published in international journals |
Others | 8 | Documents related to the working group as special representatives of the President on the duties of the government regarding health insurance |
b) Interviewee characteristics | ||
Senior MoHME officials, senior management and planning organization deputies and officials, SSO officials, IMC senior policy makers, academic researchers, treatment deputy members |
Data analysis
Results
Overview of changes in the Iranian tariff setting over the last half a century
Context
Period | Milestone | Provider reimbursement | Controlled by |
---|---|---|---|
< 1972 | 1956: IMC created | Public: a line-item budget | Ministry of Work and Social Services |
1972–1981 | 1972: first list of the tariffs | Public: a line item budget + tariffs-based reimbursement// Private: not clear | Ministry of Work and Social Services; SSO |
1982–1985 | 1982: K-tariffs | idem + partially implemented new same tariffs for Private and public | Ministry of Work and Social Services; SSO |
1985–1990 | 1985: MoHME created | idem + Introduced additional methods of reimbursement: K-tariffs + FFS + salary + capitation + bonus | MoHME |
1990–1994 | 1990: UMSI Act introduced | idem, but the tariff is the primary method of reimbursement and shifts towards evidence-based tariff setting | MoHME, IMC |
1995 | 1995: UMIO created | idem, tariffs are now revised annually based on total costs that are included. Return on invested capital and depreciation | MoHME |
Process
Content
Actors and stakeholders
Actor | Role in setting medical tariffs | Activity Level | Activity Area | Position | Power | Influence | Agenda setting | Formulation | Implementation | Monitoring & evaluation | Group N | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Governance Side | Parliament Health Commission | Approving macro policies such as five-year development plan and approving the basic health insurance yearly budgets for policy implementation. | National | Governmental | – | High | – | + | + | + | + | 2 |
Planning and budgetary organization | Approving proposed medical tariff revision and proposing to government, approving budget proposed by insurance organization, MoHME, and MCLSW. | National | Governmental | + | High | Moderate | ++ | + | + | + | 2 | |
MoHME | Proposing policy of relative value revision and providing its implementation infrastructure. | National | Governmental | +++ | Very high | High | +++ | +++ | +++ | ++ | 1 | |
MCLSW | Head of Insurance High Council and responsible for holding meetings and making related decisions. | National | Governmental | + | High | High | ++ | ++ | ++ | + | 2 | |
Medical Council organization | Member of Insurance High Council, attendance in the meeting. | National | Non-Governmental | +++ | Very high | Very high | +++ | +++ | +++ | + | 3 | |
Supply Side (Health care Providers) | Private hospitals and clinics/para clinic | Health care provider and implementing and executing new tariff book. | Regional/local | Private | ++ | Moderate | Very high | + | + | ++ | + | 3 |
Public hospitals and clinics/ para clinic | Health care provider and implementing and executing new tariff book. | Regional/local | Governmental | ++ | Moderate | Very high | + | + | ++ | + | 3 | |
Special Councils | Health care provider and implementing and executing new tariff book. | National/provincial | Governmental | +++ | Moderate | High | +++ | +++ | ++ | + | 3 | |
Demand Side (Health care purchasers or health caregiver) | Basic Insurance organizations | Member of Insurance High Council, attendance in meetings and executer of tariff book. | National/provincial | Governmental | + | Very high | – | ++ | ++ | ++ | ++ | 1 |
Private/ supplementary insurance organizations | Member of the secretariat of Insurance High Council, attending in meeting and executer of tariffs. | National/provincial | Governmental | – | Moderate | – | + | + | ++ | + | 4 | |
People/insured people | Health care givers and paying health care expenditures. | Regional/local | – | – | Low | – | – | – | – | + | 4 |