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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

Open Access 01-12-2020 | Care | Research

Setting health care services tariffs in Iran: half a century quest for a window of opportunity

Authors: Leila Doshmangir, Arash Rashidian, Farhad Kouhi, Vladimir Sergeevich Gordeev

Published in: International Journal for Equity in Health | Issue 1/2020

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Abstract

Background

The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades.

Methods

We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using ‘policy triangle’ and ‘garbage can’ models.

Results

Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship.

Conclusion

Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.
Literature
1.
McLean TR. Using the market to regulate health care price: why heart hospitals will have a competitive advantage in the world of post-diagnostic related group pricing. Am Heart Hosp J. 2004;2(3):165–9.PubMed
2.
Sweeney RE, Franklin SP. Pricing health care services: applications to the health maintenance organization. Health Mark Q. 1986;4(1):47–64.PubMed
3.
Waters HR, Hussey P. Pricing health services for purchasers—a review of methods and experiences. Health Policy. 2004;70(2):175–84.PubMed
4.
Barber SL, Lorenzoni L, Ong P. Price setting and price regulation in health care: lessons for advancing Universal Health Coverage. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2019. Licence: CC BY-NC-SA 3.0 IGO.
5.
Sun X, et al. Measurement and analysis of equity in health: a case study conducted in Zhejiang Province, China. Int J Equity Health. 2018;17(1):36.PubMedPubMedCentral
6.
Kumar, A., et al., Pricing and competition in specialist medical services. 2014.
7.
Getzen TE. Medical care price indexes: theory, construction & empirical analysis of the US series 1927-1990. Adv Health Econ Health Serv Res. 1992;13:83–128.PubMed
8.
9.
Zuckerman S. Reconsidering geographic adjustments to Medicare physician fees; 2004.
10.
Dowd B, et al. Setting physicians' prices in FFS medicare: an economic perspective. Health Care Financ Rev. 2006;28(2):97–111.PubMedPubMedCentral
11.
Russo G, McPake B. Medicine prices in urban Mozambique: a public health and economic study of pharmaceutical markets and price determinants in low-income settings. Health Policy Plan. 2010;25(1):70–84.PubMed
12.
Fattore G, Torbica A. Inpatient reimbursement system in Italy: how do tariffs relate to costs? Health Care Manage Sci. 2006;9(3):251–8.
13.
Mason A, Ward P, Street A. England: the healthcare resource group system. In: Diagnosis-related groups in Europe—moving towards transparency, efficiency and quality in hospitals, vol. 24; 2011.
14.
Hsiao WC, et al. Resource-based relative values. An overview. Jama. 1988;260(16):2347–53.PubMed
15.
16.
Trombert-Paviot B, et al. The development of CCAM: the new French coding system of clinical procedures. HIM J. 2003;31(1):1–11.
17.
Hasanzadeh A, FAS. Setting Medical Tariffs in Iran: A review. Social Security. 2000;8(28).
18.
Davari M, Haycox A, Walley T. Health care financing in Iran; is privatization a good solution? Iran J Public Health. 2012;41(7):14.PubMedPubMedCentral
19.
Bazyar M, et al. Combining health insurance funds in a fragmented context: what kind of challenges should be considered? BMC Health Serv Res. 2020;20(1):1–14.
20.
Doshmangir L, et al. Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran. BMC Health Serv Res. 2016;16:138.PubMedPubMedCentral
21.
Karimi I, Nasiripour A, Maleki M, Mokhtare H. Assessing financing methods and payment system for health service providers in selected countries: designing a model for Iran. Journal of health administration. 2006;8(22):15-24.
22.
Danaei G, Farzadfar F, Kelishadi R, Rashidian A, Rouhani OM, Ahmadnia S, et al. Iran in transition. The Lancet. 2019;393(10184):1984-2005.
23.
24.
Davari M, Haycox A, Walley T. The Iranian health insurance system; past experiences, present challenges and future strategies. Iran J Public Health. 2012;41(9):1.PubMedPubMedCentral
25.
Zare H, et al. Health inequalities and development plans in Iran; an analysis of the past three decades (1984–2010). Int J Equity Health. 2014;13(1):42.PubMedPubMedCentral
26.
Bazyar M, et al. Combining health insurance funds in a fragmented context: what kind of challenges should be considered? BMC Health Serv Res. 2020;20(1):26.PubMedPubMedCentral
27.
Bazyar M, et al. Policy options to reduce fragmentation in the pooling of health insurance funds in Iran. Int J Health Policy Manag. 2016;5(4):253.PubMedPubMedCentral
28.
Jahangir M. Provision and regulations of social security and welfare. Tehran: Dowran Publication; 2006.
29.
Ibrahimipour H, et al. A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran. Health Policy Plan. 2011;26(6):485–95.PubMed
30.
Kazemi-galougahi M, Dadgar E, Kavosi Z. et al. Increase of catastrophic health expenditure while it does not have socio-economic anymore; finding from a district on Tehran after recent extensive health sector reform. BMC Health Serv. 2019;19:569. https://​doi.​org/​10.​1186/​s12913-019-4418-1.
31.
32.
Ministry of Health and Medical Education. Budget and Financing Office. 2019. Tehran, Iran.
33.
Buse K, Mays N, Walt G. Making health policy. UK: McGraw-Hill Education; 2012.
34.
Cohen MD, March JG, Olsen JP. A garbage can model of organizational choice. Adm Sci Q. 1972;17(1):1–25.
35.
Mucciaroni G. The garbage can model & the study of policy making: a critique. Polity. 1992;24(3):459–82.
36.
Mendelow A. Stakeholder mapping. Proceedings of the second international conference on information systems. Cambridge, MA (cited in Johnson et al. 2008).
37.
38.
Doshmangir L, et al. Opening the black box: the experiences and lessons from the public hospitals autonomy policy in Iran. Arch Iran Med. 2015;18(7):416–24.PubMed
39.
Doshmangir, L., et al., Effect of proposed changes of relative values of different specialists medical tariffs on payment weight of specialties and health system costs. 2011.
40.
41.
Doshmangir L, et al. So near, so far: four decades of health policy reforms in Iran, Achievements and Challenges. Arch Iran Med. 2019;22(10):592–605.PubMed
42.
Rasidian A, Doshmangir L. Substitution of ‘California’book, the first clinical and diagnosis tariff reference book in Iran: Expert’s view points. Med Cultivation Res J. 2013;22(3):59–78.
43.
44.
Nazari A, et al. Interaction between stewardship and social health insurances: a comparative and document analysis. Med J Islam Repub Iran. 2018;32:77.PubMedPubMedCentral
45.
Ghoddoosi-Nejad D, et al. Stewardship as a fundamental challenge in strategic purchasing of health services: a case study of Iran. Value Health Reg Issues. 2019;18:54–8.PubMed
46.
Howlett M, McConnell A, Perl A. Streams and stages: R econciling K ingdon and policy process theory. Eur J Polit Res. 2015;54(3):419–34.
47.
Parsa M, et al. Informal payments for health care in Iran: results of a qualitative study. Iran J Public Health. 2015;44(1):79.PubMedPubMedCentral
48.
Zarei E, et al. Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran. Health Scope. 2018; (In Press).
49.
Bayat M, et al. Extent and nature of dual practice engagement among Iran medical specialists. Hum Resour Health. 2018;16(1):61.PubMedPubMedCentral
50.
Bazyar M, et al. Prohibiting physicians' dual practice in Iran: policy options for implementation. Int J Health Plann Manag. 2018.
51.
Bayat M, et al. Factors influencing medical specialists' dual practice in the Islamic Republic of Iran. East Mediterr Health J. 2018;24(9):877–87.PubMed
52.
Palesh M, et al. "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.PubMedPubMedCentral
53.
Doshmangir L, et al. Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran. BMC Public Health. 2020;20(1):1–14.
54.
Khorasani E, et al. Views of health system experts on macro factors of induced demand. Int J Prev Med. 2014;5(10):1286.PubMedPubMedCentral
55.
Doshmangir L, et al. The experience of implementing the board of trustees' policy in teaching hospitals in Iran: an example of health system decentralization. Int J Health Policy Manag. 2015;4(4):207–16.PubMed
56.
Gilson L, et al. The SAZA study: implementing health financing reform in South Africa and Zambia. Health Policy Plan. 2003;18(1):31.PubMed
57.
Jegers M, et al. A typology for provider payment systems in health care. Health Policy. 2002;60(3):255–73.PubMed
58.
Doshmangir L, et al. Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis. Cost Effectiveness and Resource Allocation. 2020;18(1):1–21.
59.
Batty M, Ippolito B. Financial incentives, hospital care, and health outcomes: evidence from fair pricing laws. Am Econ J Econ Pol. 2017;9(2):28–56.
60.
Clemens J, Gottlieb JD. Do physicians' financial incentives affect medical treatment and patient health? Am Econ Rev. 2014;104(4):1320–49.PubMedPubMedCentral
61.
Mikkola H. Hospital pricing reform in the public health care system--an empirical case study from Finland. Int J Health Care Finance Econ. 2003;3(4):267–86.PubMed
62.
Doshmangir L, et al. Health financing consequences of implementing health transformation plan in Iran: achievements and challenges. Int J Health Policy Manag. 2019;8(6):384.PubMedPubMedCentral
Metadata
Title
Setting health care services tariffs in Iran: half a century quest for a window of opportunity
Authors
Leila Doshmangir
Arash Rashidian
Farhad Kouhi
Vladimir Sergeevich Gordeev
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-01224-1

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