Iran is a country in the Middle East with a population of over 83 million. Iran’s health care system includes both public and private organizations. The Constitution of the Islamic Republic of Iran, established following the 1979 Revolution, includes a constitutional mandate to provide health for all. To help achieve this the Primary Health Care (PHC) program was implemented in the 1980s. Before, the rural population faced a severe lack of health infrastructure and access. The Ministry of Health and Medical Education (MOHME) finances and delivers the PHC, while secondary and tertiary care is increasingly financed through compulsory public sector and private insurance schemes. Now, infant and maternal mortality rates have fallen significantly and life expectancy is up. Also, in 2016 Iran’s healthcare system was ranked the 30th in the world. In May 2014, healthcare in Iran entered a major reconstruction period as the MOHME began implementing its new Heath Transformation Plan (HTP).
The main access point for rural residents for health services is through health houses. A health house is a small medical facility that provides basic health services to the surrounding rural community. Most facilities include at least two medical personnel, common pharmaceuticals and basic medical equipment. There are over 17,000 health houses in Iran, or approximately one for every 1,200 residents. Health houses have behvarz, or trained medical workers, that care for the residents in the area. Behvarz usually handle vaccinations, family planning services, maternal health care and child health care.
Each health house has at least one male and one female behvarz. They are chosen by the members of the community and therefore are well acquainted with the people and local customs. The behvarz are trained at the district level, with tuition covered by the government in return for at least four years of service at their respective health house. The government also provides financial support to students training to be behvarz. More complex health issues are referred to rural health centers. There is approximately one rural health center for every 7,000 residents, which are staffed by physicians, health technicians and administrators.
Urban areas have a similar structure with health posts providing basic healthcare and health centers handling more complex health issues. Nearly 75% of Iranians live in urban areas which means there is a higher density of health care personnel than rural areas. Although the government has worked hard to eliminate the disparities in coverage between urban and rural areas, urban areas still have better health resources. All hospitals in Iran are located primarily in cities which makes access to specialized health issues easier for urban residents. The private sector is almost completely focused in urban areas, so urban residents have the advantage of choosing between public and private facilities. However, differences like rural areas having higher infant mortality rates have been nearly eliminated. Health concerns too complex for the rural and urban health centers are referred to the district health centers.
More than 90% of the population has health insurance. The Social Security Organization provides insurance for employed citizens in urban areas and their dependents. All salaried and wage workers are covered along with the self-employed who voluntarily join. It also insures many old-age pensioners. The Medical Service Insurance Organization covers government employees, students, and inhabitants of rural areas. The Imam Khomeinei Relief Foundation provides insurance for the poor who are not covered by other insurance schemes. The Military Personnel Insurance Organization provides health insurance to members of the armed forces. There are also a number of private and semi-public insurance programs that cover the more affluent members of society. In general, health insurance covers 70% of the cost of drugs on the insurers’ coverage list and 90% of public hospital costs, with extra provision for those with rare diseases or in rural areas.
In 2014, healthcare in Iran entered reconstruction period as the MOHME began implementing its new Heath Transformation Plan (HTP). The new plan involved nine packages to reform the current healthcare system, including improved access and quality of healthcare and increasing the number of specialized doctors. These improvements have since provided healthcare to almost 10 million Iranians in marginalized areas throughout Iran. The program also rehabilitated 13,000 existing health centers and built 3,000. Iran is also the only country with a legal organ trade system. Medical tourism is on the rise in Iran with it having one of the more advanced healthcare systems in the area. Decades of healthcare reforms have made it well above the other countries in the regions. Despite progress some issues remain. Namely the quality difference between rural and urban areas.