Title: Achievements and Challenges of Social Security Health Insurance: The Experience of the Islamic Republic of Iran
1Achievements and Challenges of Social Security
Health Insurance The Experience of the Islamic
Republic of Iran
Current Challenges in Delivering Social Security
Health Insurance
Social Security Organization
Meeting of Directors of Social Security
Organizations in Asia and the Pacific Seoul,
Korea 9 - 11 November 2005
2Health
-
- Definition Health is a state of complete
physical, mental and social well-being and not
merely the absence of disease or infirmity.
WHO
3Dimensions of Health Planning
- All Ages
- Both Sexes
- Comprehensive
- Integrated
Biological Factors Social Factors Psychological
Factors Spiritual Factors
Preventive Care Therapeutic Care Rehabilitative
Care
4IRAN 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
5IRAN 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)
6National Health Indicators
Health Investment GDP/ Health 6
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 Physicians 70,000
Number of Hospitals Day Clinics (public private) 850 with 104,000 beds
Number of Public Health Treatment Clinics 4900
Number of Rural Health Houses 16,800
Access to Primary Health Care (PHC) 100 -Urban / 95-Rural
Health Care Insurance Coverage 94
7Social Protection Programs
- The right to social security is embedded in the
Constitution
- 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.
Article 29
8Social 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).
9Social Protection ProgramsHistorical Backgrounds
- Unemployment and injury benefits existed in 2500
years ago in the construction of Persepolis
Palaces.
10Social Protection ProgramsContemporary Era
- 1931 Railway Workers Provident Fund
- 1952 SS Legal Bill Ratified
- 1975 Modern SSO was born
SSO National Headquarters
11Social Security Organization
Defined Benefit Scheme
Coverage includes 1- Formal Blue-collar
workers 2- Self-employed 3- Voluntary insured
persons PLUS their dependants
This Means 43 of the whole Population and
62 of the Urban Population
Total number of insured under the SSO
scheme 27/000/000
12Extension of Coverage Slide1of 2
Whole Package of SS Benefits
1979.17 200443
1979.9 200421
SSO Scheme
Other Schemes
64
13Extension of Coverage Slide 2 of 2
Health Care Coverage
X1000
94
14Rate of Contribution
20 Employer
Government 3
Employee 7
15SSO Benefits
Lump sum compensation
Family allowance
Work related total and partial disability
Old age pension
Payment of allowance to the women as head of the
family
Expenses of prosthesis orthos
Unemployment pension
Survivors pension
Benefit in kind for pensioners
Health care
Sickness benefit
Funeral grant
Maternity benefit
Marriage grant
Accommodation and travel expenses of patients
Housing allowance
16An Iranian Proverb
Sound wisdoms dwell only in healthy bodies.
17SSO Medical Services Slide1of 2
- Preventive, 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
18SSO Medical Services Slide2 of 2
- Preventive, 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
19SSOs Health Care Networks
SSO Health
Direct Health Network (DHN)
Indirect Health Network (IHN)
20Direct 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)
21Indirect 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 Clinics750
- - Public Clinics.4,102
- - Drugstores..6,461
- - Medical Labs..1,752
- - Imaging Centers....1,286
- - Independent Hemodialysis
- Lithotripsy Centers199
- - Independent Physiotherapy.970
- - Miscellaneous..70
- Total..44,779
22Administration of DHN IHN
23SSOs Health Care
Challenges
Achievements
241-Comprehensive and Diverse Services
DHN 2004
No. of Hospital Admissions 689,663
No. of Surgeries 431,291
Patient Length of Stay 3.2
Bed Occupancy Rate 73.13
Case Flow 80.37
No. of Outpatient visits 41,941,648
IHN 2004
No. of Hospital Admissions 1,484,987
No. of Outpatient visits 182,762,519
Achievements
252-Full Geographic Coverage
Equitable Access
- The Direct and Indirect Health Networks of the
SSO cover the entire country, including the rural
and remote areas in all 31 provinces.
Achievements
26DHN
273-Continuous Quality Improvement
TQM
Achievements
Improves the Quality of Care
Enhances Customer Satisfaction
Increases Productivity
283-Continuous Quality Improvement
ISO 90012000
Medical Commissions Occupational Health Centers Medical Documents Offices Provincial Health Management Offices Clinics Hospitals Centers Status
2 4 6 3 18 26 Certified
3 9 14 9 2 20 In Process
Achievements
293-Continuous Quality Improvement
Integrated Management System
ISO 9001 2000
SA 8000
Achievements
ISO 14000
ISO 18000
304-E-health
SSO e-health Plan
- Phase 1 Hospitals Clinics
- Phase 2 Medical Documents Offices
- Phase 3 National SSO Health Portal
- Phase 4 Smart Electronic Health Card
Achievements
e-Care
315-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.
Achievements
321-Steep Increase in Health Care Costs
Growth in Health Care Expenses Growth in The SSO Overall Expenses Year
36 per cent 24 per cent 2000-2001
34 per cent 14 per cent 2001-2002
30 per cent 19 per cent 2002-2003
26 per cent 24 per cent 2003-2004
32 per cent 40 per cent 2004-2005
Challenges
331-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
Challenges
342-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
Challenges
Good Governance
Cost Containment
353-Absence of a Requisite Medical Culture in the
Society
Provider
Challenges
Regulator
Consumer
363-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
Challenges
374-Population Ageing
Improved Health
Higher Life Expectancy
Longer Retirement
Health care expenses at age range of 20-30
Health care expenses at age range of 60-70
Health care expenses at age range of 80-90
Challenges
A
3As
10As
38Demographic IndicatorsWorld and Asia
Source WWW.UN.Org
394-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
Challenges
- 13 of the population
- 36 of hospital stays
- 49 of all hospital care
- 50 of all physician work hours
- 40 of healthcare dollars
404-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
Challenges
415-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.
Challenges
Awareness Activities
42Social Security Welfare and Social Justice for
All
Thank you