Achievements and Challenges of Social Achievements and Challenges of Social Security Health Insurance: Security Health Insurance:
The Experience of the Islamic Republic of IranThe Experience of the Islamic Republic of Iran
Achievements and Challenges of Social Achievements and Challenges of Social Security Health Insurance: Security Health Insurance:
The Experience of the Islamic Republic of IranThe Experience of the Islamic Republic of Iran
Current Challenges in Delivering Social Security Health Insurance
Meeting of Directors of Social
Security Organizations in Asia and the Pacific
Seoul, Korea
9 - 11 November 2005
Social SecurityOrganization
HealthHealth
• Definition: Health is a state of
complete physical, mental and social well-being and not merely the absence of disease or infirmity.
WHO
Dimensions of Health PlanningDimensions of Health Planning
• All Ages
• Both Sexes
• Comprehensive
• Integrated
Biological FactorsSocial FactorsPsychological FactorsSpiritual Factors
Preventive CareTherapeutic CareRehabilitative Care
IRAN in PerspectiveIRAN in Perspective
• Area: ………………………………… 1/648/000 sq. km• Population: ………………………… 68 millions• Labor Force: ………………………. 15.4 millions• Labor Structure: …………………... 23% Agriculture, 32% Industry, 45% Service Sector• 42.28% of Population Under Age 15
IRAN in PerspectiveIRAN in Perspective
• 23 Million Students in School• 2.1 Million Students in University• Iran Has the 4th Largest Oil Reserves of the World• Iran Has the 2nd Largest Gas Reserves of the World• Iran Has the 2nd Largest Copper Reserves of the
World• GDP: 108.2 billion US$ (2002)• GDP Growth for 2003: 6.4%• GDP Per Capita:
7,217 US$ PPP (2002)
National Health Indicators:National Health Indicators:Health Investment: GDP/ Health6%
Life Expectancy at Birth (M/F)70.3 Yr (68.6 / 72)
Infant Mortality Rate (Per, 1000 live births) 26
Under-five Mortality Rate (Per, 1000 live Births)42
Maternal Mortality Rate (Per, 100,000 live Births)37.4
Annual population growth rate (%), 1993 to 2003 1.3
Number of Physicians70,000
Number of Hospitals & Day Clinics (public & private)
850 with 104,000 beds
Number of Public Health &Treatment Clinics4900
Number of Rural Health Houses16,800
Access to Primary Health Care (PHC) 100 %-Urban / 95%-Rural
Health Care Insurance Coverage94%
• To benefit from social security with respect to retirement, unemployment, old age, disability, absence of a guardian, and benefits relating to being stranded, accidents, health services, and medical care and treatment, provided through Insurance or other means, is accepted as a universal right. The government must provide the foregoing services and financial support for every individual citizen by drawing, in accordance with the law, on the national revenues and funds obtained through public contributions.
Social Protection ProgramsSocial Protection Programs• The right to social security is embedded in
the Constitution:
Art
icle
29
Social Protection ProgramsSocial Protection Programs
• The social protection programs in Iran are legislated by the Ministry of Welfare and Social Security and are carried out by several organizations, the largest of which is the Social Security Organization (SSO).
• Unemployment and injury benefits existed in 2500 years ago in the construction of “Persepolis Palaces”.
Social Protection ProgramsHistorical Backgrounds
Social Protection ProgramsHistorical Backgrounds
Social Protection ProgramsContemporary Era
Social Protection ProgramsContemporary Era
• 1931 Railway Workers Provident Fund• 1952 SS Legal Bill Ratified• 1975 Modern SSO was born
SSO NationalHeadquarters
Social Security OrganizationSocial Security Organization
Defined Benefit
Scheme
This MeansThis Means 43%43% of the wholeof the whole PopulationPopulation
and and 62%62% of the of the Urban PopulationUrban Population
Total number of insured under the SSO scheme:
27/000/000
Coverage includes:1- Formal Blue-collar workers
2- Self-employed3- Voluntary insured persons
PLUStheir dependants
1979……….17%2004………43%
SSO SchemeSSO SchemeSSO SchemeSSO Scheme
Extension of Coverage Slide1of 2 Extension of Coverage Slide1of 2
1979……….9%2004………21%
Other SchemesOther Schemes
Whole Package
of SS Benefits
64%
27,000
22,250
6,800
4,200
2,750
1000
4,000
SSO
RPHI
MSIO
IKRF
AF MSIO
Others
Without Coverage
Extension of Coverage Slide 2 of 2 Extension of Coverage Slide 2 of 2 Health Care Coverage
X1000
94%
30% of the Payroll
Rate of ContributionRate of Contribution
20% Employer
Employee 7%
Government 3%
SSO BenefitsSSO Benefits
Lump sumcompensatio
nOld age pension
Unemployment pension
Payment of allowance to the
women as head of the family
Sickness benefit
Maternitybenefit
Work related total and partial
disability
Funeral grant
Survivor’s pension
Accommodation and travel expenses
of patients
Housing allowance
Marriage grant
Benefit in kind for pensioners
Health care
Family allowance
Expenses of prosthesis &
orthos
An Iranian ProverbAn Iranian Proverb
Sound wisdoms dwell
only in healthy bodies.
SSO Medical Services Slide1of 2SSO Medical Services Slide1of 2
Preventive, Curative, and Rehabilitative CarePreventive, Curative, and Rehabilitative Care
• Out-patient & In-patient Medical Services
• All Types of Surgeries• Emergency Medical Services• Dental Care• Medical Imaging and Laboratory
Services• All Types of Medications • Child and Maternity Care • Rehabilitation Services• Providing and Replacing Orthos &
Prosthetic Appliances
SSO Medical Services Slide2 of 2SSO Medical Services Slide2 of 2
Preventive, Curative, and Rehabilitative CarePreventive, Curative, and Rehabilitative Care
• Daily allowances during temporary incapacity
• Transfer to a hospital in another area or district for treatment and care, if necessary
• Periodical Examination of Workers who Deal with Hazardous Substances
• Medical Examination of Workers upon Recruitment and Annually During Employment
SSO’s Health Care NetworksSSO’s Health Care Networks
SSOHealth
Direct Health Network (DHN) Indirect Health Network (IHN)
Direct Health Network (DHN)Direct Health Network (DHN)
• 76 Modern Hospitals
• 11,000 Beds (8,981 Active)
• 270 Clinics and Polyclinics
• 49 Centers for Occupational Medicine
• 112 Medical Commissions
• 34,000 Staff (6000 Physicians)
Indirect Health Network (IHN)Indirect Health Network (IHN)• SSO Have Contracts With 95% of All Providers
of Health Care in Iran: - Independent Physicians and
. Dentists………………...............28,417 - Hospitals………………………..772 - Private Clinics…………………750 - Public Clinics………………….4,102 - Drugstores……………………..6,461 - Medical Labs…………………..1,752 - Imaging Centers……………....1,286 - Independent Hemodialysis & Lithotripsy Centers……………199 - Independent Physiotherapy….970 - Miscellaneous…………………..70 Total……………………………..44,779
Administration of DHN & IHNAdministration of DHN & IHN
SSO Board
SSO Chairman
Health Deputy
31 Provincial Hlth. Management Offices
32 Medical Documents Offices
SSO’s Health CareSSO’s Health Care
Achievements Challenges
1-Comprehensive and Diverse Services 1-Comprehensive and Diverse ServicesA
chie
vem
ents
DHN2004No. of Hospital Admissions
689,663
No. of Surgeries431,291
Patient Length of Stay
3.2
Bed Occupancy Rate
73.13%
Case Flow80.37
No. of Outpatient visits
41,941,648
IHN2004No. of Hospital Admissions
1,484,987
No. of Outpatient visits
182,762,519
2-Full Geographic Coverage 2-Full Geographic Coverage
• The Direct and Indirect Health Networks of the SSO cover the entire country, including the rural and remote areas in all 31 provinces.
Ach
ieve
men
ts Equitable Access
DHN
3- Continuous QualityImprovement
3-Continuous Quality Improvement
Ach
ieve
men
ts TQM
Improves the Quality of
Care
Increases Productivity
Enhances Customer
Satisfaction
Ach
ieve
men
ts
ISO 9001:2000
Centers
Status
Ho
sp
itals
Clin
ics
Provincial Health
Management Offices
Medical Documents
Offices
Occupational Health
Centers
Medical Commissions
Certified26183642
In
Process
20291493
3- Continuous QualityImprovement
3-Continuous Quality Improvement
Ach
ieve
men
ts
IntegratedManagement
System
ISO 9001:2000
ISO 14000 ISO 18000
SA 8000
3- Continuous QualityImprovement
3-Continuous Quality Improvement
Ach
ieve
men
ts4-E-health 4-E-health
• Phase 1: Hospitals & Clinics• Phase 2: Medical Documents Offices• Phase 3: National SSO Health Portal• Phase 4: Smart Electronic Health Card
SSO e-health Plan
e-Care
Ach
ieve
men
ts5-Modern Therapeutic Services 5-Modern Therapeutic Services
• Non-invasive Medical Treatment Plan
• Medical Equipment Calibration Plan
• Mutual Medical Projects with France, US, Germany, South Africa, Kuwait, Tajikistan, Azerbaijan, and Malaysia.
Ch
alle
ng
es1-Steep Increase in Health Care Costs 1-Steep Increase in Health Care Costs
YearGrowth in The SSO Overall Expenses
Growth in Health Care Expenses
2000-200124 per cent 36 per cent
2001-200214 per cent 34 per cent
2002-200319 per cent30 per cent
2003-200424 per cent26 per cent
2004-200540 per cent32 per cent
Ch
alle
ng
es1-Steep Increase in Health Care Costs 1-Steep Increase in Health Care Costs
• The major factors responsible for the increase in health care cost :
• Inflation • Health care technology• Shifting trends of diseases• Sub-standard workplace environment• Yearly increase in medical tariffs and salaries • Beneficiaries’ heightened expectations • Increase in life expectancy and consequent aging of the
covered population• Increase in the number of beneficiaries (Dependency Ratio)• Simultaneous and unlimited access to both the DHN & IHN• Improper and deficient regulation of health market
Ch
alle
ng
es2-Lack of Referral System2-Lack of Referral System
• A referral system is a system where patients are first treated by a general practitioner or a family doctor and if necessary, are referred to specialists.
Referral System
Good Governance
Cost Containment
Ch
alle
ng
es3- Absence of a Requisite Medical
Culture in the Society3-Absence of a Requisite Medical
Culture in the Society
Provider
Consumer
Regulator
Ch
alle
ng
es3- Absence of a Requisite Medical
Culture in the Society3-Absence of a Requisite Medical
Culture in the Society• To overcome the problem, SSO has launched
an extensive public programme to educate the insured and their families on issues such as:
• Physical fitness • Dental care• Nutritional information and eating habits• New born care• Smoking• Blood pressure• Diabetes• Medication misuse• Breast feeding• Sexually transmitted diseases
Ch
alle
ng
es4-Population Ageing 4-Population Ageing
Improved HealthHigher Life
ExpectancyLonger Retirement
A
Health care expensesat age range of 20-30
Health care expensesat age range of 60-70
Health care expensesat age range of 80-90
3As 10As
Demographic Indicators:World and Asia
Demographic Indicators:World and Asia
Source: WWW.UN.Org
Ch
alle
ng
es4-Population Ageing 4-Population Ageing
• One SSO research shows that only 4% of the insured population in Tehran is above 65 , however, this group consumed 36% of the SSO in-patient budget of the Capital city.
• An American study indicates population over 65:
• 13% of the population• 36% of hospital stays• 49% of all hospital care• 50% of all physician work hours• 40% of healthcare dollars
Ch
alle
ng
es4-Population Ageing 4-Population Ageing
• People over 65 account for:
• The Iranian population above 60 will double in ten years and reach to more than 12 millions.
• 40% of surgical procedures
• 50% of emergency operations
• 75% of surgery-related deaths
Ch
alle
ng
es5- Political Pressure to Reduce
Contribution5-Political Pressure to Reduce
Contribution
• Macro-economic constraints have always led governments to turn to social security funds as abundant resources in solving state problems.
Awareness Activities
Thank you
Social Security: Welfare and Social Justice for All
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