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Achievements and Challenges of Social Security Health Insurance: The Experience of the Islamic Republic of Iran

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Title: Achievements and Challenges of Social Security Health Insurance: The Experience of the Islamic Republic of Iran


1
Achievements 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
2
Health
  • Definition Health is a state of complete
    physical, mental and social well-being and not
    merely the absence of disease or infirmity.

WHO
3
Dimensions of Health Planning
  • All Ages
  • Both Sexes
  • Comprehensive
  • Integrated

Biological Factors Social Factors Psychological
Factors Spiritual Factors
Preventive Care Therapeutic Care Rehabilitative
Care
4
IRAN 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

5
IRAN 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)

6
National 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
7
Social 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
8
Social 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).

9
Social Protection Programs Historical Backgrounds
  • Unemployment and injury benefits existed in 2500
    years ago in the construction of Persepolis
    Palaces.

10
Social Protection Programs Contemporary Era
  • 1931 Railway Workers Provident Fund
  • 1952 SS Legal Bill Ratified
  • 1975 Modern SSO was born

SSO National Headquarters
11
Social 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
12
Extension of Coverage Slide1of 2
Whole Package of SS Benefits
1979.17 200443
1979.9 200421
SSO Scheme
Other Schemes
64
13
Extension of Coverage Slide 2 of 2
Health Care Coverage
X1000
94
14
Rate of Contribution
  • 30 of the Payroll

20 Employer
Government 3
Employee 7
15
SSO 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
16
An Iranian Proverb
Sound wisdoms dwell only in healthy bodies.
17
SSO 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

18
SSO 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

19
SSOs Health Care Networks
SSO Health
Direct Health Network (DHN)
Indirect Health Network (IHN)
20
Direct 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)

21
Indirect 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

22
Administration of DHN IHN
23
SSOs Health Care
Challenges
Achievements
24
1-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
25
2-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
26
DHN
27
3-Continuous Quality Improvement
TQM
Achievements
Improves the Quality of Care
Enhances Customer Satisfaction
Increases Productivity
28
3-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
29
3-Continuous Quality Improvement
Integrated Management System
ISO 9001 2000
SA 8000
Achievements
ISO 14000
ISO 18000
30
4-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
31
5-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
32
1-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
33
1-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
34
2-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
35
3-Absence of a Requisite Medical Culture in the
Society
Provider
Challenges
Regulator
Consumer
36
3-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
37
4-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
38
Demographic Indicators World and Asia
Source WWW.UN.Org
39
4-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

40
4-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
41
5-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
42
Social Security Welfare and Social Justice for
All
Thank you
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