Download Financing

Flagship Course on:
Health Financing & Provider Payment
Iran Health Financing
May 12-15, 2005
Khoramabad - Lorestan
Dr hamidreza Jamshidi
Iran Health Financing
Iran is a lower middle
income country with a
2002 GDP US$ 108.2 billion
(US$ 438.5 billion PPP)
Iran
Health
Financing
Iran
Health
Financing
 2002 GDP Per Capita equal to
US$ 6690 PPP.
 Government revenues are 25
Percent of GDP
 54% from oil and gas
 24% from taxes
 The remainder from other Sources
Iran
Health
Financing
Iran
Health
Financing

Public health expenditure as %
of GDP = 2.8% (2001)

Private health expenditure as %
of GDP = 3.6%(2001)

Out of Pocket Payment = 56%
Iran Health Financing
 Iran Spent an estimated 6.4% of
its GDP on health US$ 422 Per Ca
Pita in PPP.
 Health Spending accounts for
some 10% of Government
spending and 5.5 percent of
house hold spending.
IranHealth
Health Financing
Iran
Financing
Population with Sustainable
access to improved Sanitation
(%)
Population with Sustainable
access to an improved water
Source: (%)
Under nourished People: (%
Total
Population)
Children under weight for age:
(% under s
year)
1990
(-)
2000
(%83)
1990
(-)
2000
(%92)
1990/92 1991/20
(%5)
01 (5)
19902002
%11
Iran Health Financing
Children under height for age
1990-2002:
%15
Infants with low birth weight
(%)
1998-2002
: %17
2000-05
“70.3
years”
Life expectancy at birth (years)
1970-75
“55.3
years”
Infant mortality rate (Per, 1000
1970
“122”
2002
“35”
1970
“191”
2002
“24”
live births)
Under-five mortality rate (Per,
1000 live Births)
Poverty Safety Net
in IR. IRAN
Social
Security
Structure
-Health Insurance
-Social Insurance
-Rehabilitation
-Social protection
system:
Through
establishing:
1- Imam Khomeini
Emdad Committee
High
Education
Infrastructure
Capacity
Building
Development
the
Infrastructures
Expansion of the
Equal Opportunities
& Empowerment
Public
Education
Housing
Job
Creation
Health
Establish the
PHC
system
Ministry of
Welfare
Since 2004
Health
insurance
system
Providing human
resources for
deprived areas
Iran
Financing
IranHealth
Health
Financing
 In formal sector 30% of income paid
for social security benefits (24 million
population). Nearly one third of this
(9%) amount allocate to health
insurance fund.
 Government employees pay a monthly
fix amount Per Capita and armed
forced personnel pays the same
amount. Nearly two third of premium
paid by Government, just as an
employer.
Iran
Health
Financing
Iran
Health
Financing
 Rural Population premium Paid by
Government as a fixed amount equal to
40% of civil Servant Premium.
 New incoming rural insurance is
established by the parliament. Almost
totally financed by GOV (5% by people)
 Workers Contribution Pooled by Social
Security organization fund.
Iran
Financing
IranHealth
Health
Financing
 Medical Services insurance
organization manage Contributions
related to civil Servants, Rural
Population , Self employed, and
other groups.
 Armed forced organization provide
insurance Services for military
Personnel.
Iran
Health
Financing
Iran
Health
Financing
 Poor people is financed partly
through charity which Pooled by
“Imam khomeini foundation” fund.
 Government pay & compensate for
poor people premium.
Iran
Financing
IranHealth
Health
Financing
 Other Social groups (Students,
clergies, etc): 80% of their
Premium Paid by Government.
 Banks, Oil Company and
municipality have Own
insurance fund.
 Self-employed Pay the full
amount of their premium.
Iran Health Financing
Iran Health Financing
 Primary Health Care (PHC)
services is delivered by the
GOV through widespread
health network.
 PHC (fully financed through
government budget) account
for 20% of Government health
expenditure.
Iran Health Financing
Iran Health Financing
 Health insurance sharing in health
expenditure = 23%
 Health insurance expenditure
(Resource Allocation):
Hospitals : 40-45%
Drug : 25-28%
Physicians : 25-22%
Para clinics : 15-18%
Medical Insurance System Covered groups ( 2003 )
Group
Populatio
n
(Millio
ns)
Percent
(%)
Basis of
Coverage
Outpatient
Labors
Government
Employees
24
6.8
36.6
10.4
√
√
Financing
Method
Total
Amounts
Billion
Rail
Inpatient
√
√
Billion
$
(
ppp)
%7 of salary by
employee
21% by employer
3% by the Gov.
700
0
3.5
Per capita 200,000 Rls.
Per year 80% by Gov.
30% by employee
136
0
0.6
8
Insurance
Provider
Social Security
Organization
(SSO)
Medical Services
Insurance
Organization
(MSIO)
Villagers
19
29
√
Coverage
Via PHC
(-_
Per capita, 50,000
Provided by Gov.
900
0.4
5
MSIO
Poor people
under social
protection
coverage
4.2
6.4
√
√
Per capita, 120,000
482
0.2
4
Imam Khomeini
Emdad Committee
Self- employed,
&
Special
patients
.55
.84
√
√
Per capita, 250,000
110
.05
5
MSIO
Poor self
employees first
level of
services
6
1
√
─
Per capita, 66,000
Provided by Gov.
400
0.2
MSIO
Others
(students, war
injured, etc)
.85
1.3
√
√
Per capita, 200,000
Rails per year
170
.08
5
MSIO
Via
referral
system
IranHealth
Health
Financing
Iran
Financing
1. Revenue sources are complex
2. Risk pooling limitation
3. No cost-effectiveness analysis of
benefit package
4. Regressive method of financing
5. Multiple insurance funds
6. Mixed financing and provision
Iran Health Financing
Iran Health Financing
Iran Health Financing