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

Publisher: BioMed Central Country of Publication: England NLM ID: 101147692 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-9276 (Electronic) Linking ISSN: 14759276 NLM ISO Abbreviation: Int J Equity Health Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2002-

Fees, Medical*/trends ; Private Sector* ; Public Sector* ; Reimbursement Mechanisms*; Delivery of Health Care/*economics ; Health Policy/*economics ; Health Services/*economics; Commerce ; Conflict of Interest ; Developing Countries ; Government ; Government Agencies ; Humans ; Iran ; Physician-Patient Relations ; Social Control, Formal ; Trust

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.

Health Policy. 2002 Jun;60(3):255-73. (PMID: 11965334)
BMC Health Serv Res. 2020 Jan 8;20(1):26. (PMID: 31915003)
Iran J Public Health. 2011;40(1):94-9. (PMID: 23113061)
Iran J Public Health. 2015 Jan;44(1):79-88. (PMID: 26060779)
Lancet. 2019 May 11;393(10184):1984-2005. (PMID: 31043324)
Health Care Financ Rev. 2006 Winter;28(2):97-111. (PMID: 17427848)
Int J Health Plann Manage. 2020 Mar;35(2):639-648. (PMID: 31734955)
Int J Health Policy Manag. 2014 Oct 31;4(4):207-16. (PMID: 25844379)
Arch Iran Med. 2020 May 01;23(5):338-352. (PMID: 32383619)
Int J Health Policy Manag. 2016 Feb 11;5(4):253-8. (PMID: 27239868)
Med J Islam Repub Iran. 2018 Aug 26;32:77. (PMID: 30643752)
Health Policy Plan. 2010 Jan;25(1):70-84. (PMID: 19843636)
Int J Equity Health. 2014 May 27;13:42. (PMID: 24885492)
BMC Public Health. 2020 Apr 20;20(1):539. (PMID: 32312238)
Health Res Policy Syst. 2010 Apr 06;8:9. (PMID: 20370906)
Med Care. 1992 Nov;30(11 Suppl):NS1-12. (PMID: 1434963)
Cost Eff Resour Alloc. 2020 May 15;18:17. (PMID: 32467673)
Am Heart Hosp J. 2004 Summer;2(3):165-9. (PMID: 15805767)
JAMA. 1988 Oct 28;260(16):2347-53. (PMID: 3050169)
Int J Equity Health. 2018 Mar 22;17(1):36. (PMID: 29566758)
Iran J Public Health. 2012;41(9):1-9. (PMID: 23193499)
Adv Health Econ Health Serv Res. 1992;13:83-128. (PMID: 10129447)
BMC Health Serv Res. 2019 Oct 16;19(1):702. (PMID: 31619224)
Health Policy Plan. 2011 Nov;26(6):485-95. (PMID: 21303879)
Int J Health Policy Manag. 2019 Apr 13;8(6):384-386. (PMID: 31256572)
Health Policy. 2004 Nov;70(2):175-84. (PMID: 15364147)
Value Health Reg Issues. 2019 May;18:54-58. (PMID: 30445336)
Health Mark Q. 1986 Fall;4(1):47-64. (PMID: 10279287)
Am Econ Rev. 2014 Apr;104(4):1320-1349. (PMID: 25170174)
Health Care Manag Sci. 2006 Aug;9(3):251-8. (PMID: 17016931)
Hum Resour Health. 2018 Nov 20;16(1):61. (PMID: 30453977)
BMJ. 2013 Jun 07;346:f3197. (PMID: 23747967)
Iran J Public Health. 2012;41(7):14-23. (PMID: 23113205)
Int J Prev Med. 2014 Oct;5(10):1286-98. (PMID: 25400888)
East Mediterr Health J. 2018 Dec 09;24(9):877-887. (PMID: 30570120)
J Educ Health Promot. 2018 Oct 29;7:135. (PMID: 30505863)
Int J Health Care Finance Econ. 2003 Dec;3(4):267-86. (PMID: 14650080)
Arch Iran Med. 2019 Oct 01;22(10):592-605. (PMID: 31679362)
Arch Iran Med. 2015 Jul;18(7):416-24. (PMID: 26161705)
Health Inf Manag. 2003;31(1):1-11. (PMID: 19468141)
BMC Health Serv Res. 2016 Apr 21;16:138. (PMID: 27102262)
Int J Health Plann Manage. 2018 Apr 23;:. (PMID: 29683205)
Health Policy Plan. 2003 Mar;18(1):31-46. (PMID: 12582106)

001 International WHO_ World Health Organization

Keywords: Health policy and system research; Iran; Medical payment; Medical pricing; Medical tariff; Policy triangle framework; Policy-making

Date Created: 20200708 Date Completed: 20210125 Latest Revision: 20240730

20240730

PMC7336437

10.1186/s12939-020-01224-1

32631344