flagship course on: health financing & provider payment

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

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.

Iran Health Financing

Iran Health Financing

Population with Sustainable

access to improved Sanitation

(%)

1990

)-(

2000 (%83)

Population with Sustainable

access to an improved water

Source: (%)

1990

)-(

2000 (%92)

Under nourished People: (% Total

Population) 1990/92

(%5)1991/2001

(5)

Children under weight for age: (% under s year)1990-2002

%11

Iran Health Financing

Children under height for age1990-2002 :%15

Infants with low birth weight)%( 1998-2002 : %17

Life expectancy at birth (years)1970-75 “55.3 years”

2000-05 “70.3 years”

Infant mortality rate (Per, 1000

live births)

1970

“ 122”

2002

“35”

Under-five mortality rate (Per,

1000 live Births)

1970

“ 191”

2002

“ 24”

Iran Health Financing

Poverty Safety Netin IR. IRAN

Social Security Structure

Expansion of the Equal Opportunities

& Empowerment

Development the

Infrastructures

High Education

Public Education

HousingJob

CreationHealth-Health Insurance

-Social Insurance-Rehabilitation-Social protection system:

Through establishing:1- Imam Khomeini Emdad Committee

Establish the Ministry of

Welfare Since 2004

PHC system

Providing human resources for

deprived areas

Health insurance

system

Infrastructure

Capacity Building

Iran 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 Health Financing

Iran 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 Health Financing

Iran 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

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 FinancingIran 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%

Iran Health FinancingIran Health Financing

Medical Insurance System Covered groups ) 2003 (

GroupPopulation

(Millions)

Percent)%(

Basis of CoverageFinancing

Method

Total AmountsInsurance

Provider BillionRail

Billion $

(ppp)

Outpatient

Inpatient

Labors2436.6√ √ %7 of salary by employee 21% by employer3% by the Gov.

70003.5Social Security Organization

(SSO)

GovernmentEmployees

6.810.4√√Per capita 200,000 Rls.Per year 80% by Gov.

30% by employee

13600.68Medical Services Insurance

Organization

( MSIO)

Villagers1929√Coverage Via PHC-(

_

Per capita, 50,000Provided by Gov.

9000.45MSIO

Poor people under social protection coverage

4.26.4√√ Via

referralsystem

Per capita, 120,0004820.24Imam Khomeini Emdad Committee

Self- employed,&

Special patients

.55.84√√Per capita, 250,000110.055MSIO

Poor self employees first

level of services

61√─Per capita, 66,000Provided by Gov.

4000.2MSIO

Others (students, war injured, etc)

.851.3√√Per capita, 200,000Rails per year

170.085MSIO

Iran Health 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

Iran Health Financing