in the name of god flagship course on: health financing & provider payment april 12-15, 2005...
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In the Name of God
Flagship Course on:Health Financing & Provider Payment
April 12-15, 2005
Khoramabad - Lorestan
Flagship Course on:Health Financing & Provider Payment
April 12-15, 2005 Khoramabad – Lorestan
Dr Hamidreza Jamshidi
Islamic Republic of IranIslamic Republic of Iran
• Area: 1648000 km2
Population 66,000,000 (2002)
- Rural 23000000- Urban 37000000
• Province: 30• District:280• Village: 65000 <• Average distance Between
two villages:• 25 km <• Average population• Per village:350 >• GDP:114.1 billion $(2001)
45 5570
96 100 93105
117140
158
195
236
310
351337
278
350
383
354
406
459442
335
368
396
358 354 354
9575
140166
215 221240
256
290
326
268253
265252 245
202
170 167 172
202
298283
268 266
214238
325 323
145
185
215
262
305 315
350373
440
484463
489
580603
582
480
540 550526
608
757
725
603
634610
596
679 677
0
100
200
300
400
500
600
700
800
كلهزينههايبهداشتودرمانبخشخصوصي كلهزينههايبهداشتودرمانبخشدولتي كلهزينههايبهداشتودرمان
بهميلياردريال
روند كل هزينه هاي بهداشت و درمان و هزينه هاي بهداشت و درمان در بخشهاي دولتي و خصوصي
سالهاي ) 1350 - 1378 ( - به قيمت هاي ثابت سال 1361
)1378 - حسابهاي ملي بهداشت و درمان ) 1350
Public Hospitals
SSO Hospitals
NGO’sHOS
MSIO Comp INS AF MSIOUn covered
PersonsIKF
Pharmacies
Labs
Radiology Day clinics
GP & SP Clinics
Private HOS
SSO
Who actually determines the cost ?
PhysiciansPhysicians
InstitutesInstitutes
Providers have
a major role :
.•Provider Payment Mechanism
in Iran
National Tariffs:
• A list of Health Service prices which have two parts :
- Public Institute Prices
- Private Institute Prices
Setting the National Tariffs:
• Are suggested by Health Insurance High Council (HIHC), then approved by Cabinet.
Outpatient: )Prevention(health houses 17300 rural health centers 2400health posts 300 urban health centers 1900
• Services are almost free
• Doctors & Health Staff :
• Health Houses & Centers:
SalarySalary
Line-item
budget
Line-item
budget
Outpatient : )Cure(Solo physicians about 25000Polyclinics about 900
Private Physicians: (Visit)
(Procedures)
Per case
F F S
Public Hos Clinics / H. Centers GPs Salary
Public Hos Clinics / H. Centers Specialists Salary + % F F S
SSO’s Owned Clinics GPs Salary + Per Hour Per Case . + 0-10% PC as bonus
SSO’s Owned Clinics specialists Salary + % Per case
Other GOV Clinics SSO Clinics GPs Salary
• Co-payment is %45 for GPs visit & %50 for Specialists in private sector
- %30 in public sector paid at the time of service use (OOP).
• It had been %25 before 1999 & it was %30 between 1999 till 2002.
Payment to Pharmacies:Pharmacies about 6200
• Drugs: Fee For Service - National drug list Paid by People & INS ORGs
- Insurance drug list Paid by INS ORGs
- Other drugs Paid by People
• Co-payment is 30% of each service by Patient ( Before 1999 it was %25 )
Payment to Para Clinics:Laboratories about 1700Radiology units about 1100
• Lab & Graphies: Fee For Service
• Co-payment is paid by Patient
- %30 of each service in public sector
- %50 of each service in private sector
• ( Before 2000 it was %25 )
Inpatient )1( : Public Hospitals IncomePublic Hospitals (SSO & MOH) - 600
1. Partly by Line-item budget 2. Partly by Selling services to
. Insurance ORGs & people as :
- Fee For Service (K)+ Per dium - Case Payment (100 Surgery begin in
. 1999 with 60 cases )
3. Remaining by Co-Payment 10%
Inpatient : Public Hospitals )2(
1- Payment to Physicians:
2- Payment to Health Personnel:
Salary + high % of Fee For Service or Case Payment
Salary + high % of Fee For Service or Case Payment
Salary + Extra Payment only From Hospital Income
Salary + Extra Payment only From Hospital Income
Inpatient )1( : Private Hospital Income
• Partly : Selling Services to Insurance ORGs & people as :
- Fee For Service + Per dium - Case Payment • Partly : As People Pay 10% Co-Payment and a
variable amount of under table.
• Tariffs in private sector are higher than those in public sector, but private hospitals do not conform to the tariffs and people also pay under table money.
Data are less available & have low accuracy.
Inpatient : Private Hospitals )2( 1- Payment to Physicians:• Some of them are “ Shareholders” - FFS - Also their share in institute profit
• Some of them have “ Privilege Contract” - FFS
2- Payment to Health Personnel: • Some: Salary• Some: Salary + Bonus• Some: Salary + % FFS + Bonus
Provider Payment Mechanism
Is it so complex in Iran?
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