Table 2:

Health system functions strategies in I.R. of Iran 5^th 5-Years Development Plan Act

Stewardship
Independency of Universities of Medical Sciences and Health services: - Educational expenditures of required human resources and supported research expenditures financed based on unit costs and operational budgeting. (20-A-1) - work only with financial and executive rules and regulations and structures approved by their board of trusties after final agreement of Minister of Health. (20-B) Preparing strategic plan for “improving the level of HDI” (24) Establishing High Council of Health and Food Security at national level and a similar structure at provincial level. (32-A) Large developmental projects should have health Impact Assessment Appendix(32-B) Centralizing policy making, planning and supervision on health sector in MOHME. (36-B) MOHME is policy maker and highest supervisor of health in country (38-H) Announcing the list of health threatening products/interventions and drugs with a potential of abuse at the beginning of each year to increase taxation for them (37-A). Prohibition of advertisements of health threatening products and services by all public medias. Penalty is 10 to 1000 Million Rials. (37-J) Supervision on health care delivery institutes, based on MOHME accreditation standards, outsourced to nongovernmental institutes.(38-V)
Service Provision
Providing educational programs for physical and mental health promotion of students.(19-A-10) Counseling services for student and families to improve student’s mental health. (19-A-11). Modifying and implementing “universal and comprehensive health care system” based on PHC system, family physician initiative and its referral path, service stratification, strategic purchasing of services, decentralizing of delivery and paying for performance. Less developed areas are priority (32-J). Defining country medical treatment system considering : integration of basic medical insurance, family physician, referral path, clinical guidelines, medical emergencies, creating boards of trusties in academic hospitals, geographical fulltime faculties and required tariffs and special clinics, complementary insurances.(32-D) Nongovernmental health care providers who are not interested in cooperating with “universal and comprehensive health care system”, are not allowed to contract to basic and complementary medical insurance and using public fund and subsidies. (32-D-1) Employed medical doctors of governmental and public sectors are not allowed to work in private or nongovernmental medical organizations and hospitals (32-D-2). Personnel of MOHME and Ministry of welfare and related organizations, executive boards of medical universities, heads of hospitals and health networks are not allowed to work in medical, diagnostic and educational organizations of nongovernmental sector (32-D-2). Evolving the medical, laboratory and dental centers and providing and distributing the medical devices must be based on country needs and health service stratification framework.(32-D-3) Development of natural and traditional medicine remedies and services(34-H).
Financing
Pay for performance (32-J). National Tariff of medical services set appropriately to real price.(32-D-2) 10% of resources pooled through Targeting Subsidies Act will be paid to MOHME annually.(34-B) Special bonuses for doctors working in less developed regions.(36-A) Allocation of 10% of car insurance premiums for compensating expenditure of providing free health care services for car accident injuries. (37-B). Quantitative and qualitative improvement of health insurances by reorganizing the structure of insurance funds, resource management, rationalizing tariffs, using internal resources of funds and governmental financial supports. (38) Basic health insurance is universal and mandatory(38-A). Creating Health Insurance Organization (HIO)by integrating all medical funds to Medical Services Insurance Organization, except Fund of Social Security Organization(SSO) and, Military Force Medical Services and the Ministry of Intelligence by permission of the Supreme Leader. (38-B) Establish a High Council of Health Insurance.(38-B-3) Paying more for the basic health care benefit package by complementary medical insurances is banned.(38-B-5) Uniform basic health insurance services for population is defined and gradually implemented (38-J). Basic health insurance premium is a proportion of the income of household’s head as follows: (38-D-1) - Rural, indigenous and poor: 5% of minimum salary of Employment Act for years 1,2 and 3 of the plan; 6%. Afterwards. Government pays for them. - Civil and military servants families: 5% of salary and benefits for years 1,2, and 3 then 6% for other years. Government pays some parts. - SSO insures : based on Social Security Act, 30% of amount of monthly salary of employee will be paid for social security benefit package; 20% by employer, 7% by employee, 3% by government (9/27 of it is for medical service insurance) - premium for others will be set by the High council of Health Insurance according to income groups. Setting relative value and tariff of medical services yearly by health insurance high council for Governmental and nongovernmental and private sectors for strengthening suitable behavior(38-H) Strategic purchasing of health services from all sectors by HIO considering referral path, stratification of services, Payment system modification and basic benefit package. (38-Z).
Resource Generation (Human, Physical, Information, drugs and other health products)
Governmental Support to build Health Knowledge Cities(34-A) Estimation of educational needs and entrees numbers of governmental and nongovernmental medical universities appropriated to the strategies of family physician, referral path and stratification of services and country science comprehensive map. (34-J) Establish Iranian electronic health record system and health centers databases for delivering electronic health services (35-A). Organizing integrated health insurance services based on information technology and related to Iranian Electronic Health Record System (35-B).