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?