Previous experiences, current challenges, and future strategies

The healthcare system in Iran is mainly based on an established insurance system, which has a significant impact on the Iranian healthcare system.

In 1947, the Iranian Tobacco Company insured its employees for health expenses and medical services. The first social insurance law was passed in 1952, when the Social Insurance Organization (Social Security) became an official part of the Ministry of Labor and Social Services. In 1974, the Ministry of Welfare was established to coordinate various previous activities in the field of social welfare. The Social Security Act expanded the support services provided by insurance companies and in 1975, it made it mandatory for all workers to be insured by the Social Security Organization.

In 1979, the Iranian parliament merged the Ministry of Social Welfare with the Ministry of Health and renamed it the Ministry of Health and Welfare. The Social Security Organization was placed under the management of this new ministry. In 1980, the organization was renamed as the Social Security Insurance Organization to emphasize the importance of insurance for medical services. Currently, this organization provides coverage for over 27 million people (36% of Iran’s population) across the country. Almost all of its customers are private sector workers and employees, for whom insurance coverage is mandatory. There are two distinct features that set this organization apart from other insurance organizations. First, its financial system is heavily dependent on the government, which allows for more freedom in resources and services. Second, the organization has two branches that work together. The health branch acts as both a provider and a consumer of medical services. As a provider, it offers services in health centers and hospitals that are free for those covered by social security insurance. As a

The Health Insurance Committee of the Relief Committee is a charitable health insurance program that was established shortly after the 1979 Revolution to provide basic insurance coverage for citizens who cannot afford the membership fees of any insurance. Approximately 20% of the organization’s income comes from charity, and the rest is paid by the government. Currently, this organization covers around 5.4 million impoverished individuals.

The Universal Health Insurance Law in 1994 aimed to cover approximately 60% of the uninsured population in Iran. The Medical Services Insurance Organization was established in October 1994 based on this law to provide coverage for a wide range of individuals over a period of 5 years. These individuals included government employees and all members of society with varying social and economic levels who were not eligible for insurance through other organizations. Since the establishment of this organization, the proportion of the population covered by health insurance has increased from 40% in 1991 to approximately 90% in 2010. This was when the country’s population had reached 7.57 million to 7.74 million. This increase mainly occurred in rural areas, where there is a lower likelihood of being able to afford insurance compared to urban areas. However, the goal of providing complete coverage for the population has not yet been achieved. Today, the Medical Services Insurance Organization is the largest health insurance organization in Iran, covering approximately

The Armed Forces Medical Services Insurance Organization covers approximately four million members of the armed forces and their families. Its services and policies are very similar to those of the Medical Services Insurance Organization, but it is directly established by the Ministry of Defense.

The current situation of the health insurance system in Iran is facing two types of challenges; one is internal challenges directly caused by policies and regulations of the health insurance system in Iran, and the other is problems arising from external factors.

The first problem is the rise in medical expenses. The reasons for this increase are new and expensive medical techniques and tools that have become prevalent in treatment procedures. Medical expenses in Iran have greatly increased in the past decade. This rapid increase in expenses has put immense pressure on insurance systems and healthcare providers.

The second problem is the lack of systematic evaluation of health technology. Although new technologies have continuously entered Iran in recent years, there is no systematic method for evaluating and guiding the optimal use of these expensive and innovative technologies.

The third issue is limited financial resources. It seems that there is an obvious imbalance between the expenses and income of health insurance organizations, indicating a serious financial shortage that prevents these organizations from meeting the expectations of patients in terms of financial capabilities. One of the reasons for this financial shortage is the increase in medical expenses. Another factor is that the per capita health care costs are higher than what the government approves. The per capita costs for health insurance organizations have grown significantly in recent years. These factors have made it difficult for health insurance organizations to timely pay the necessary funds to healthcare providers. This transfers the problem to healthcare providers such as hospitals, to the point where they sometimes cannot pay their bills.

The fourth problem is a problem in management and decision-making. Each of the health insurance organizations in Iran has its own structure and board of directors. This method has caused key problems such as providing coverage for only a portion of the country’s population.

The difficulty of data collection and the duration of the decision-making process have had a significant impact on health insurance activities.

The fifth problem is the uninsured population. Uninsured population is a prominent concern in Iran. This concern is especially for those who are unable to be covered by any insurance. Currently, there is no accurate statistics on the number of people covered by health insurance services. It is estimated that between 10-15% of the Iranian population is not covered by any health insurance, while it was planned for all of the Iranian population to be covered by health insurance organizations by 1999.