achievements and challenges of social security health insurance: the experience of the islamic...

Achievements and Challenges of Social Achievements and Challenges of Social Security Health Insurance: Security Health Insurance:

The Experience of the Islamic Republic of IranThe Experience of the Islamic Republic of Iran

Achievements and Challenges of Social Achievements and Challenges of Social Security Health Insurance: Security Health Insurance:

The Experience of the Islamic Republic of IranThe Experience of the Islamic Republic of Iran

Current Challenges in Delivering Social Security Health Insurance

Meeting of Directors of Social

Security Organizations in Asia and the Pacific

Seoul, Korea

9 - 11 November 2005

Social SecurityOrganization

HealthHealth

• Definition: Health is a state of

complete physical, mental and social well-being and not merely the absence of disease or infirmity.

WHO

Dimensions of Health PlanningDimensions of Health Planning

• All Ages

• Both Sexes

• Comprehensive

• Integrated

Biological FactorsSocial FactorsPsychological FactorsSpiritual Factors

Preventive CareTherapeutic CareRehabilitative Care

IRAN in PerspectiveIRAN in Perspective

• Area: ………………………………… 1/648/000 sq. km• Population: ………………………… 68 millions• Labor Force: ………………………. 15.4 millions• Labor Structure: …………………... 23% Agriculture, 32% Industry, 45% Service Sector• 42.28% of Population Under Age 15

IRAN in PerspectiveIRAN in Perspective

• 23 Million Students in School• 2.1 Million Students in University• Iran Has the 4th Largest Oil Reserves of the World• Iran Has the 2nd Largest Gas Reserves of the World• Iran Has the 2nd Largest Copper Reserves of the

World• GDP: 108.2 billion US$ (2002)• GDP Growth for 2003: 6.4%• GDP Per Capita:

7,217 US$ PPP (2002)

National Health Indicators:National Health Indicators:Health Investment: GDP/ Health6%

Life Expectancy at Birth (M/F)70.3 Yr (68.6 / 72)

Infant Mortality Rate (Per, 1000 live births) 26

Under-five Mortality Rate (Per, 1000 live Births)42

Maternal Mortality Rate (Per, 100,000 live Births)37.4

Annual population growth rate (%), 1993 to 2003 1.3

Number of Physicians70,000

Number of Hospitals & Day Clinics (public & private)

850 with 104,000 beds

Number of Public Health &Treatment Clinics4900

Number of Rural Health Houses16,800

Access to Primary Health Care (PHC) 100 %-Urban / 95%-Rural

Health Care Insurance Coverage94%

• To benefit from social security with respect to retirement, unemployment, old age, disability, absence of a guardian, and benefits relating to being stranded, accidents, health services, and medical care and treatment, provided through Insurance or other means, is accepted as a universal right. The government must provide the foregoing services and financial support for every individual citizen by drawing, in accordance with the law, on the national revenues and funds obtained through public contributions.

Social Protection ProgramsSocial Protection Programs• The right to social security is embedded in

the Constitution:

Art

icle

29

Social Protection ProgramsSocial Protection Programs

• The social protection programs in Iran are legislated by the Ministry of Welfare and Social Security and are carried out by several organizations, the largest of which is the Social Security Organization (SSO).

• Unemployment and injury benefits existed in 2500 years ago in the construction of “Persepolis Palaces”.

Social Protection ProgramsHistorical Backgrounds

Social Protection ProgramsHistorical Backgrounds

Social Protection ProgramsContemporary Era

Social Protection ProgramsContemporary Era

• 1931 Railway Workers Provident Fund• 1952 SS Legal Bill Ratified• 1975 Modern SSO was born

SSO NationalHeadquarters

Social Security OrganizationSocial Security Organization

Defined Benefit

Scheme

This MeansThis Means 43%43% of the wholeof the whole PopulationPopulation

and and 62%62% of the of the Urban PopulationUrban Population

Total number of insured under the SSO scheme:

27/000/000

Coverage includes:1- Formal Blue-collar workers

2- Self-employed3- Voluntary insured persons

PLUStheir dependants

1979……….17%2004………43%

SSO SchemeSSO SchemeSSO SchemeSSO Scheme

Extension of Coverage Slide1of 2 Extension of Coverage Slide1of 2

1979……….9%2004………21%

Other SchemesOther Schemes

Whole Package

of SS Benefits

64%

27,000

22,250

6,800

4,200

2,750

1000

4,000

SSO

RPHI

MSIO

IKRF

AF MSIO

Others

Without Coverage

Extension of Coverage Slide 2 of 2 Extension of Coverage Slide 2 of 2 Health Care Coverage

X1000

94%

30% of the Payroll

Rate of ContributionRate of Contribution

20% Employer

Employee 7%

Government 3%

SSO BenefitsSSO Benefits

Lump sumcompensatio

nOld age pension

Unemployment pension

Payment of allowance to the

women as head of the family

Sickness benefit

Maternitybenefit

Work related total and partial

disability

Funeral grant

Survivor’s pension

Accommodation and travel expenses

of patients

Housing allowance

Marriage grant

Benefit in kind for pensioners

Health care

Family allowance

Expenses of prosthesis &

orthos

An Iranian ProverbAn Iranian Proverb

Sound wisdoms dwell

only in healthy bodies.

SSO Medical Services Slide1of 2SSO Medical Services Slide1of 2

Preventive, Curative, and Rehabilitative CarePreventive, Curative, and Rehabilitative Care

• Out-patient & In-patient Medical Services

• All Types of Surgeries• Emergency Medical Services• Dental Care• Medical Imaging and Laboratory

Services• All Types of Medications • Child and Maternity Care • Rehabilitation Services• Providing and Replacing Orthos &

Prosthetic Appliances

SSO Medical Services Slide2 of 2SSO Medical Services Slide2 of 2

Preventive, Curative, and Rehabilitative CarePreventive, Curative, and Rehabilitative Care

• Daily allowances during temporary incapacity

• Transfer to a hospital in another area or district for treatment and care, if necessary

• Periodical Examination of Workers who Deal with Hazardous Substances

• Medical Examination of Workers upon Recruitment and Annually During Employment

SSO’s Health Care NetworksSSO’s Health Care Networks

SSOHealth

Direct Health Network (DHN) Indirect Health Network (IHN)

Direct Health Network (DHN)Direct Health Network (DHN)

• 76 Modern Hospitals

• 11,000 Beds (8,981 Active)

• 270 Clinics and Polyclinics

• 49 Centers for Occupational Medicine

• 112 Medical Commissions

• 34,000 Staff (6000 Physicians)

Indirect Health Network (IHN)Indirect Health Network (IHN)• SSO Have Contracts With 95% of All Providers

of Health Care in Iran: - Independent Physicians and

. Dentists………………...............28,417 - Hospitals………………………..772 - Private Clinics…………………750 - Public Clinics………………….4,102 - Drugstores……………………..6,461 - Medical Labs…………………..1,752 - Imaging Centers……………....1,286 - Independent Hemodialysis & Lithotripsy Centers……………199 - Independent Physiotherapy….970 - Miscellaneous…………………..70 Total……………………………..44,779

Administration of DHN & IHNAdministration of DHN & IHN

SSO Board

SSO Chairman

Health Deputy

31 Provincial Hlth. Management Offices

32 Medical Documents Offices

SSO’s Health CareSSO’s Health Care

Achievements Challenges

1-Comprehensive and Diverse Services 1-Comprehensive and Diverse ServicesA

chie

vem

ents

DHN2004No. of Hospital Admissions

689,663

No. of Surgeries431,291

Patient Length of Stay

3.2

Bed Occupancy Rate

73.13%

Case Flow80.37

No. of Outpatient visits

41,941,648

IHN2004No. of Hospital Admissions

1,484,987

No. of Outpatient visits

182,762,519

2-Full Geographic Coverage 2-Full Geographic Coverage

• The Direct and Indirect Health Networks of the SSO cover the entire country, including the rural and remote areas in all 31 provinces.

Ach

ieve

men

ts Equitable Access

DHN

3- Continuous QualityImprovement

3-Continuous Quality Improvement

Ach

ieve

men

ts TQM

Improves the Quality of

Care

Increases Productivity

Enhances Customer

Satisfaction

Ach

ieve

men

ts

ISO 9001:2000

Centers

Status

Ho

sp

itals

Clin

ics

Provincial Health

Management Offices

Medical Documents

Offices

Occupational Health

Centers

Medical Commissions

Certified26183642

In

Process

20291493

3- Continuous QualityImprovement

3-Continuous Quality Improvement

Ach

ieve

men

ts

IntegratedManagement

System

ISO 9001:2000

ISO 14000 ISO 18000

SA 8000

3- Continuous QualityImprovement

3-Continuous Quality Improvement

Ach

ieve

men

ts4-E-health 4-E-health

• Phase 1: Hospitals & Clinics• Phase 2: Medical Documents Offices• Phase 3: National SSO Health Portal• Phase 4: Smart Electronic Health Card

SSO e-health Plan

e-Care

Ach

ieve

men

ts5-Modern Therapeutic Services 5-Modern Therapeutic Services

• Non-invasive Medical Treatment Plan

• Medical Equipment Calibration Plan

• Mutual Medical Projects with France, US, Germany, South Africa, Kuwait, Tajikistan, Azerbaijan, and Malaysia.

Ch

alle

ng

es1-Steep Increase in Health Care Costs 1-Steep Increase in Health Care Costs

YearGrowth in The SSO Overall Expenses

Growth in Health Care Expenses

2000-200124 per cent 36 per cent

2001-200214 per cent 34 per cent

2002-200319 per cent30 per cent

2003-200424 per cent26 per cent

2004-200540 per cent32 per cent

Ch

alle

ng

es1-Steep Increase in Health Care Costs 1-Steep Increase in Health Care Costs

• The major factors responsible for the increase in health care cost :

• Inflation • Health care technology• Shifting trends of diseases• Sub-standard workplace environment• Yearly increase in medical tariffs and salaries • Beneficiaries’ heightened expectations • Increase in life expectancy and consequent aging of the

covered population• Increase in the number of beneficiaries (Dependency Ratio)• Simultaneous and unlimited access to both the DHN & IHN• Improper and deficient regulation of health market

Ch

alle

ng

es2-Lack of Referral System2-Lack of Referral System

• A referral system is a system where patients are first treated by a general practitioner or a family doctor and if necessary, are referred to specialists.

Referral System

Good Governance

Cost Containment

Ch

alle

ng

es3- Absence of a Requisite Medical

Culture in the Society3-Absence of a Requisite Medical

Culture in the Society

Provider

Consumer

Regulator

Ch

alle

ng

es3- Absence of a Requisite Medical

Culture in the Society3-Absence of a Requisite Medical

Culture in the Society• To overcome the problem, SSO has launched

an extensive public programme to educate the insured and their families on issues such as:

• Physical fitness • Dental care• Nutritional information and eating habits• New born care• Smoking• Blood pressure• Diabetes• Medication misuse• Breast feeding• Sexually transmitted diseases

Ch

alle

ng

es4-Population Ageing 4-Population Ageing

Improved HealthHigher Life

ExpectancyLonger Retirement

A

Health care expensesat age range of 20-30

Health care expensesat age range of 60-70

Health care expensesat age range of 80-90

3As 10As

Demographic Indicators:World and Asia

Demographic Indicators:World and Asia

Source: WWW.UN.Org

Ch

alle

ng

es4-Population Ageing 4-Population Ageing

• One SSO research shows that only 4% of the insured population in Tehran is above 65 , however, this group consumed 36% of the SSO in-patient budget of the Capital city.

• An American study indicates population over 65:

• 13% of the population• 36% of hospital stays• 49% of all hospital care• 50% of all physician work hours• 40% of healthcare dollars

Ch

alle

ng

es4-Population Ageing 4-Population Ageing

• People over 65 account for:

• The Iranian population above 60 will double in ten years and reach to more than 12 millions.

• 40% of surgical procedures

• 50% of emergency operations

• 75% of surgery-related deaths

Ch

alle

ng

es5- Political Pressure to Reduce

Contribution5-Political Pressure to Reduce

Contribution

• Macro-economic constraints have always led governments to turn to social security funds as abundant resources in solving state problems.

Awareness Activities

Thank you

Social Security: Welfare and Social Justice for All