1. In the Name of God Flagship Course on: Health Financing & Provider Payment April 12-15, 2005 Khoramabad - Lorestan

2. Flagship Course on: Health Financing & Provider Payment April 12-15, 2005 Khoramabad – Lorestan Dr Hamidreza Jamshidi

3. Islamic Republic of Iran Area:1648000 km 2 Population  66,000,000 (2002) - Rural  23000000 - Urban  37000000 Province:30 District:280 Village:65000 < Average distance Between two villages : 25 km < Average population Per village:350 > GDP:114.1 billion $(2001)

5. Public Hospitals SSO Hospitals NGO’s HOS MSIO Comp INS AF MSIO Un covered Persons IKF Pharmacies Labs RadiologyDay clinics GP & SP Clinics Private HOS SSO

6. Who actually determines the cost ? Physicians Institutes Providers have a major role :

7. . Provider Payment Mechanism in Iran

8. National Tariffs: A list of Health Service prices which have two parts : - Public Institute Prices - Private Institute Prices

9. Setting the National Tariffs: Are suggested by Health Insurance High Council (HIHC), then approved by Cabinet.

10. Outpatient: (Prevention) health houses 17300 rural health centers 2400 health posts 300 urban health centers 1900 Services are almost free Doctors & Health Staff : Health Houses & Centers: Salary Line-item budget Line-item budget

11. Outpatient : (Cure) Solo physicians about 25000 Polyclinics about 900 Private Physicians: (Visit) (Procedures) Per case F F S Public Hos Clinics / H. Centers GPsSalary Public Hos Clinics / H. Centers SpecialistsSalary + % F F S SSO’s Owned Clinics GPsSalary + Per Hour Per Case. + 0-10% PC as bonus SSO’s Owned Clinics specialistsSalary + % Per case Other GOV Clinics SSO Clinics GPsSalary Co-payment is %45 for GPs visit & %50 for Specialists in private sector - %30 in public sector paid at the time of service use (OOP). It had been %25 before 1999 & it was %30 between 1999 till 2002.

12. Payment to Pharmacies: Pharmacies about 6200 Drugs: Fee For Service - National drug list Paid by People & INS ORGs - Insurance drug list Paid by INS ORGs - Other drugs Paid by People Co-payment is 30% of each service by Patient ( Before 1999 it was %25 )

13. Payment to Para Clinics: Laboratories about 1700 Radiology units about 1100 Lab & Graphies: Fee For Service Co-payment is paid by Patient - %30 of each service in public sector - %50 of each service in private sector ( Before 2000 it was %25 )

14. Inpatient (1) : Public Hospitals Income Public Hospitals (SSO & MOH) - 600 1.Partly by Line-item budget 2.Partly by Selling services to. Insurance ORGs & people as : - Fee For Service (K)+ Per dium - Case Payment (100 Surgery begin in. 1999 with 60 cases ) 3. Remaining by Co-Payment 10%

15. Inpatient : Public Hospitals (2) 1- Payment to Physicians: 2- Payment to Health Personnel: Salary + high % of Fee For Service or Case Payment Salary + Extra Payment only From Hospital Income

16. Inpatient (1) : Private Hospital Income Partly : Selling Services to Insurance ORGs & people as : - Fee For Service + Per dium - Case Payment Partly : As People Pay 10% Co-Payment and a variable amount of under table. Tariffs in private sector are higher than those in public sector, but private hospitals do not conform to the tariffs and people also pay under table money. Data are less available & have low accuracy.

17. Inpatient : Private Hospitals (2) 1- Payment to Physicians: Some of them are “ Shareholders” - FFS - Also their share in institute profit Some of them have “ Privilege Contract” - FFS 2- Payment to Health Personnel: Some: Salary Some: Salary + Bonus Some: Salary + % FFS + Bonus

18. Provider Payment Mechanism Is it so complex in Iran?