How health transformation plan was designed and implemented in the Islamic Republic of Iran?

Iraj Harirchi, Mohammad Hajiaghajani, Aliakbar Sayari, Rassoul Dinarvand, Haniye Sadat Sajadi, Mahdi Mahdavi, Elham Ahmadnezhad, Alireza Olyaeemanesh, Reza Majdzadeh

Abstract


Following his inauguration in late 2013, President Rouhani aimed to boost quality and equity in the
health care delivery system. To fulfill this aim, a set of interventions, called Health Transformation
Plan (HTP), were implemented. So far, it has been a heated debate whether HTP breathes a spirit
of a new reform. HTP has targeted long‑standing historical deficits of the Iranian health system
as well as urgent problems, both of which have been, to some extent, resolved. To decrease
Out‑Of‑Pocket (OOP) health expenditures, HTP has presented new financing mechanisms to expand
a safety net to Iranian citizens fundamentally. HTP also encompassed interventions to overcome
problems in the provision of health care by recruitment of health workforces, establishing new
health facilities, and expanding primary health care to urban and peri‑urban areas. Furthermore,
performance indicators including access, quality, and patient satisfaction have been affected. Given
these changes, HTP is entitled to be a health system reform. However, a new agenda within HTP is
required so that the Iranian health system can obtain better value for money that is to be spending
on it.

Keywords


Health care reform; health system; health system strengthening; Universal health coverage

Full Text:

PDF

References


Kutzin J, Sparkes SP. Health systems strengthening, universal

health coverage, health security and resilience. Bull World

Health Organ 2016;94:2.

Tamara H, Jeremy S. The emergence of global attention to health

systems strengthening. Health Policy Plan 2013;28:41‑50.

Sajadi HS, Majdzadeh R. From primary health care to universal

health coverage in the Islamic Republic of Iran: A journey of

four decades. Arch Iran Med 2019;22:262‑8.

Heshmati B, Joulaei H. Iran’s health‑care system in transition.

Lancet 2016;387:29‑30.

Mousavi SM, Sadeghifar J. Universal health coverage in Iran.

Lancet Glob Health 2016;4:e305‑6.

Moradi‑Lakeh M, Vosoogh‑Moghaddam A. Health sector

evolution plan in Iran; equity and sustainability concerns. Int J

Health Policy Manag 2015;4:637‑40.

Hajizadeh M, Nghiem HS. Out‑of‑pocket expenditures for

hospital care in Iran: Who is at risk of incurring catastrophic

payments? Int J Health Care Finance Econ 2011;11:267‑85.

Namazi S. Sanctions and medical supply shortages in Iran.

Available from: http://gozaresh‑nakhande.ir/ref/3/27/sanctions_

medical_supply_shortages_in_iran.pdf. [Last accessed on 2020

Jun 31].

Kingdon JW. Agendas, Alternatives and Public Policies. 2nd ed.

New York; 1997.

Roberts M, Hsiao W, Berman P, Reich M. Getting Health

Reform Right: A Guide to Improving Performance and Equity.

New York: Oxford University Press; 2008.

Bengtsson M. How to plan and perform a qualitative study using

content analysis. Nurs Plus Open 2016;2:8‑14.

Lankarani KB, Alavian SM, Peymani P. Health in the Islamic

Republic of Iran, challenges and progresses. Med J Islam Repub

Iran 2013;27:42‑9.

Vosoogh Moghaddam A, Damari B, Alikhani S, Salarianzedeh M,

Rostamigooran N, Delavari A, et al. Health in the 5th 5‑years

development plan of Iran: Main challenges, general policies and

strategies. Iran J Public Health 2013;42:42‑9.

Damari B, Vosoogh‑Moghaddam A, Delavari A. How does the

Ministry of Health and Medical Education of Iran protect the

public benefits? Analysis of stewardship function and the way

forward. Hakim Health Sys Res 2015;18:94‑104.

Rajabi F, Esmailzadeh H, Rostamigooran N, Majdzadeh R,

Doshmangir L. Future of health care delivery in

Iran, opportunities and threats. Iran J Public Health

;42(Suppl 1):23‑30.

Bazyar M, Rashidian A, Jahanmehr N, Behzadi F, Moghri J,

Doshmangir L. Prohibiting physicians’ dual practice in Iran:

Policy options for implementation. Int J Health Plann Manage

;33:e711‑20.

Ibrahimipour H, Maleki MR, Brown R, Gohari M, Karimi I,

Dehnavieh R. A qualitative study of the difficulties in reaching

sustainable universal health insurance coverage in Iran. Health

Policy Plann 2011;26:485‑95.

Rashidian A, Khosravi A, Khabiri R, Khodayari‑Moez E,

Elahi E, Arab M, et al. Islamic Republic of Iran’s Multiple

Indicator Demograpphic and Healh Survey (IrMIDHS) 2010.

Tehran: Ministry of Health and Medical Education; 2012.

Available from: http://nihr.tums.ac.ir/UpFiles/Documents/d057

-a152-4245-acd1-ea32f0a3f3b9.pdf [Last accessed on 2020

Jun 31].

Davari M, Haycox A, Walley T. Health care financing in

iran; is privatization a good solution? Iran J Public Health

;41:14‑23.

Nekoeimoghadam M, Esfandiari A, Ramezani F, Amiresmaili M.

Informal payments in health care: A case study of Kerman

province in Iran. Int J Health Policy Manag 2013;1:157‑62.

Parsa M, Aramesh K, Nedjat S, Kandi MJ, Larijani B. Informal

payments for health care in Iran: Results of a qualitative study.

Iran J Public Health 2015;44:79‑88.

Bazyar M, Rashidian A, Kane S, Mahdavi MR, Sari AA,

Doshmangir L. Policy options to reduce fragmentation in the

pooling of health insurance funds in Iran. Int J Health Policy

Manag 2016;5:253‑8.

Available from: https://meybod.ac.ir/userfiles/financial/files/

financial_4.pdf. [Last accessed on 2020 Jun 31].

Bastani P, Doshmangir L, Samadbeik M, Dinarvand R.

Requirements and incentives for implementation of

pharmaceutical strategic purchasing in Iranian health system:

A qualitative study. Glob J Health Sci 2016;9:163‑70.

Takian A, Rashidian A, Kabir MJ. Expediency and coincidence

in re‑engineering a health system: An interpretive approach

to formation of family medicine in Iran. Health Policy Plan

;26:163‑73.

Majdzadeh R. Family physician implementation and preventive

medicine; opportunities and challenges. Int J Prev Med

;3:665‑9.

Moghadam MN, Sadeghi V, Parva S. Weaknesses and challenges

of primary health care system in Iran: A review. Int J Health

Plann Manage 2012;27:e121‑31.

Akbari Sari A, Rezaei S, Rad EH, Dehghanian N, Chavehpour Y.

Regional disparity in physical resources in the health sector in

Iran: A comparison of two time periods. Iran J Public Health

;44:848‑54.

Sefiddashti SE, Arab M, Ghazanfari S, Kazemi Z, Rezaei S,

Karyani AK. Trends of geographic inequalities in the distribution

of human resources in health care system: The case of Iran.

Electron Physician 2016;8:2607‑13.

Davari M, Haycox A, Walley T. The Iranian health insurance

system; past experiences, present challenges and future strategies.

Iran J Public Health 2012;41:1‑9.

Palesh M, Fredrikson S, Jamshidi H, Jonsson PM, Tomson G.

Diffusion of magnetic resonance imaging in Iran. Int J Technol

Assess Health Care 2007;23:278‑85.

Palesh M, Tishelman C, Fredrikson S, Jamshidi H, Tomson G,

Emami A. “We noticed that suddenly the country has become

full of MRI”. Policy makers’ views on diffusion and use of

health technologies in Iran. Health Res Policy Syst 2010;8:9.

Baradaran‑Seyed Z, Nedjat S, Yazdizadeh B, Nedjat S,

Majdzadeh R. Barriers of clinical practice guidelines

development and implementation in developing countries: A case

study in Iran. Int J Prev Med 2013;4:340‑8.

Mokdad AH, Forouzanfar MH, Daoud F, El Bcheraoui C,

Moradi‑Lakeh M, Khalil I, et al. Health in times of uncertainty

in the eastern Mediterranean region, 1990‑2013: A systematic

analysis for the Global Burden of Disease Study 2013. Lancet

Glob Health 2016;4:e704‑13.

Available from: https://vizhub.healthdata.org/gbd-compare/ [Last

accessed on 2020 Jun 31].

Farzanegan MR, Khabbazan MM, Sadeghi H. Effects of oil

sanctions on Iran’s economy and household welfare: New

evidence from a CGE model. In: Farzanegan M, Alaedini P,

editors. Economic Welfare and Inequality in Iran. New York:

Palgrave Macmillan; 2016. p. 185‑211.

Katzman K. Iran sanctions. Curr Politics Econ Middle East

;5:41.

Sajadi HS, Hosseini M, Dehghani A, Khodayari R, Zandiyan H,

Hosseini SS. The policy analysis of iran’s health transformation plan

in therapeutic services. Hakim Health Sys Res 2018;21:71-88.

Goudarzi Z, Mobinizadeh MR, Olyaeemanesh AR, Tabatabaei M,

Maanavi S. Health System Financing in Iran. In: Harirchi I,

Majdzadeh M, Ahmadnezhad E, Abdi Z, Observatory on Health

System, Tehran: National Institute for Health Res 2017:56-82.

Available from: http://nihr.tums.ac.ir/UpFiles/Documents/4baaf

-84e4-4551-89ef-10af46d2fe78.pdf [Last accessed on 2020

Jun 31].

Available from: https://www.amar.org.ir/english/Statistics-by-

Topic/Household-Expenditure-and-Income. [Last accessed on

Jun 31].

Iranian Health Insurance Organization. The performance report

of Iranian Health Insurance Organization in 2012, Tehran,

Iranian Health Insurance Organization; 2013.

Available from: https://www.cbi.ir/Inflation/Inflation_en.aspx.

[Last accessed on 2020 Jun 31].

Gorji A. Sanctions against Iran: The impact on health services.

Iran J Public Health 2014;43:381‑2.

Karimi M, Haghpanah S. The effects of economic sanctions on

disease specific clinical outcomes of patients with thalassemia

and hemophilia in Iran. Health Policy 2015;119:239‑43.

Mohammadi D. US‑led economic sanctions strangle Iran’s drug

supply. Lancet 2013;381:279.

Setayesh S, Mackey TK. Addressing the impact of economic

sanctions on Iranian drug shortages in the joint comprehensive

plan of action: Promoting access to medicines and health

diplomacy. Global Health 2016;12:31.

Shahabi S. International sanctions: Sanctions in Iran disrupt

cancer care. Nature 2015;520:157.

Shahabi S, Fazlalizadeh H, Stedman J, Chuang L, Shariftabrizi A,

Ram R. The impact of international economic sanctions on

Iranian cancer health care. Health Policy 2015;119:1309‑18.

Shariatirad S, Maarefvand M. Sanctions against Iran and the

impact on drug use and addiction treatment. Int J Drug Policy

;24:636‑7.

Cheraghali AM. Impacts of international sanctions on Iranian

pharmaceutical market. DARU J Pharm Sci 2013;21:64.

Danaei G, Harirchi I, Sajadi HS, Yahyaei F, Majdzadeh R.

The harsh effects of sanctions on Iranian health. Lancet

;394:468‑9.

Emami Razavi SH. Health system reform plan in Iran:

Approaching universal health coverage. Hakim Health Sys Res

;18:329‑35.

Marandi SA. The health landscape of the Islamic Republic of

Iran. Med J Islamic World Acad Sci 2016;109:1‑9.

Available from: http://nihr.tums.ac.ir/UpFiles/Documents/

ecedcf50-7101-4627-91d9-004139d317aa.pdf. [Last accessed on

Jun 31].

Piroozi B, Rashidian A, Moradi G, Takian A, Ghasri H, Ghadimi T.

Out‑of‑pocket and informal payment before and after the health

transformation plan in Iran: Evidence from hospitals located in

Kurdistan, Iran. Int J Health Policy Manag 2017;6:573‑86.

Available from: http://behdasht.gov.ir/uploads/amalkard.pdf.

[Last accessed on 2020 Jun 31].

Ahmadnezhad E, Abdi Z, Majdzadeh M. Assessment of Health

System toward Universal Health Coverage. In: Harirchi I,

Majdzadeh M, Ahmadnezhad E, Abdi Z, Observatory on Health

System. Tehran: National Institute for Health Research; 2017.

p. 149-61.

Hsu J, Majdzadeh R, Harirchi I, Soucat A, editors. Health system

transformation in the Islamic Republic of Iran: An assessment

of key health financing and governance issues. Geneva: World

Health Organization; 2019.

Senkubuge F, Modisenyane M, Bishaw T. Strengthening

health systems by health sector reforms. Global health action

;7:23568.

Islamic Republic of Iran Parliament. The sixth Economic, Social

and Cultural Development Plan. Tehran: Jahade Daneshgahi;

Thomson S, Foubister T, Figueras J, Kutzin J,

Permanand G, Bryndová L. Addressing Financial

Sustainability in Health Systems. Copenhagen: World Health

Organization; 2009.

Aryankhesal A, Meydari A, Naghdi S, Ghiasvand H, Baghri Y.

Pitfalls of revising physicians’ relative value units (RVUs) in

Iran: A qualitative study on medical practitioners’ perspective.

Health Scope 2018 (In Press).

Babashahy S, Baghbanian A, Manavi S, Akbari Sari A,

Olyaee Manesh A, Ghaffari S, et al. Insight into provider

payment mechanisms in health care industry: A case of Iran. Iran

J Public Health 2016;45:693‑5.

Sajadi HS, Ehsani-Chimeh E, Majdzadeh R. Universal health

coverage in Iran: Where we stand and how we can move

forward. Med J Islam Repub Iran 2019;33:46-51.

Heydari MR, Kalateh Sadati A, Bagheri Lankarani K, Imanieh MH,

Baghi H, Lolia MJ. The evaluation of urban community health

centers in relation to family physician and primary health care in

Southern Iran. Iran J Public Health 2017;46:1726‑36.

Imanieh MH, Sadati AK, Moghadami M, Hemmati A.

Introducing the urban community health center (UCHC) as a

nascent local model: Will it be a linchpin in the health sector

reform in Iran? Int J Health Policy Manag 2015;4:331‑2.

Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I,

et al. Universal health coverage in Turkey: Enhancement of

equity. Lancet 2013;382:65‑99.

Reich MR, Harris J, Ikegami N, Maeda A, Cashin C, Araujo EC,

et al. Moving towards universal health coverage: Lessons from

country studies. Lancet 2016;387:811‑6.