Table 1:

Iranian health system functions challenges

Stewardship
Disintegration of health governance bodies
Conflict of interest in some of policy makers and managers
Weakness in hiring skilled human resources for policy making, planning and effective monitoring
Lake of agreed instruction for health policy making and planning process and procedures.
Weakness of financial resources for policy making and planning
Weakness of attention of policy makers to periodical monitoring of policy and plan implementation
Weakness of stakeholder contribution in policy making and planning
Weakness of project management skills in national and provincial experts
Undirected applied researches for responding to health priorities
Service Provision
Development of various and uncoordinated health care delivery systems by different organizations that their mission are not promoting health and are funded in different ways (such as Municipalities, Banks, Judiciary system, Ministry of Oil, Broadcasting, ...).
Different health services packages of various funders that sometimes are not defined based on priorities.
Different ways of financing which has a direct effect on service delivery methods.
Effects of different cultural backgrounds on the utilization of health services
The public demand and some of planners’ and policy makers’ interests on developing specialized and complex services instead of expanding and strengthening the primary prevention services approach.
Lack of effective control on health service delivery in different sectors.
Financing
Lack of enough total and public financial resources(regressive trend in public resources)
Unfair health financing : Fair Financial Contribution Index =0.832 (2007)
Unfair payments for health services by population: Out Of Pocket = %51.7, Catastrophic Health Expenditure = %2.5.(2007)
Lack of a profound vision in medical insurances
Untargeted health sector resources towards low income deciles(Geographical targeting, targeting supply side, weakness of informal sector groups finding)
Unsustainability of resources and in coordination between resources and required service packages and quality of care and costs
Incoherency in revenue collection and risk pooling (different methods of premiums, several public, semi public and private insurance funds)
Lack of cohesion in stewardship of financing system
Inequitable and cost producing Payment system, mostly fee-for- service. (equal payment to services with different quality, different prices for a similar service, not to obey the public and private tariffs)
Excessive capacity building inappropriate to the health needs (educating extra human resources, irregular import of medical equipments)
Resource Generation (Human, Physical, Information, drugs and other health products)
Lack of national policies, strategies and plans of Human Resources of Health(HRH) appropriated to the Iran vision 2025
Lack of need assessment information and incorporating existing evidences in HRH planning.
Surplus of manpower in various fields and unemployment and immigration of some of graduates.
Lack of internal and external coordination with human resources production and management bodies.
Lack of a monitoring system for periodical situational analysis of HRH.
Inadequate knowledge and skills of human capital resources management.
Inappropriateness between quality and quantity of medical education and employment market needs.
Lack of effective presence of faculties in medical universities and public hospitals.
Low job satisfaction and weakness of incentive system in improving performances.
Low salary and unbalanced income of similar level groups and inequitable payment to different levels.
Reduction of real value of salaries due to price inflation.
weakness of technical knowledge and technology for producing diagnostic medical devices and equipments.
weakness of defined and updated standards of medical equipments.
Export development and emerging medical technologies in countries.
Effects of media in defining medical equipment market
Lack of adequate physical facilities.
Weakness of capacity of physical facilities management.
Unprofessional and sometimes nonstandard building construction.
Uncoordinated building construction by health donors.
weakness of legislation about E-health in the country
Lack of a coherent national strategy on development of E-health
Conflict and contention between various governmental agencies regarding stewardship of E-health plans and programs
weakness of technical, information, security and technological infrastructure in the field of electronic health
Lack of accurate and oriented investment for support of E-Health policies and programs
Being a governmental (under government) field, that hampers investment of the private sector.
Remoteness of some of information generating areas (eg rural health houses) and lack of required infrastructure in these sections
Lack of human resources, skills and abilities that is necessary for E-health development.
Weakness of drug policies due to lack of national health policies.
Drug Act is not updated to the current situation.
Hospital drugs budget are included in hospital total budget and there is no integrated system for monitoring the performances.
Prescribing the out of national list drugs by some of famous medical specialists increases the health expenditures and out of pocket rate.
Irrational prescribing of antibiotics, corticosteroids and injections by some of doctors.
Weakness of effective contribution of pharmacists in treatment cycle of the patients in hospital and ambulatory settings.
Privatizing drug industries has not led to real independent private drug companies. Some of drug holdings are drug purchasers.
Weakness of drug pricing mechanism.
Some drugs in the market are illicit.
Weakness of drug laboratories in quality control.