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      Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

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          Abstract

          In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021).

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          Author and article information

          Journal
          Int J Health Policy Manag
          International journal of health policy and management
          2322-5939
          2322-5939
          Aug 31 2015
          : 4
          : 10
          Affiliations
          [1 ] Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
          [2 ] Department of Community Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran.
          [3 ] Health Sector Policy CoordinationGroup, in Charge of Minister for Policy Making Affairs Bureau, Ministry of Health and Medical Education, Tehran, Iran.
          [4 ] NCD Research Center, Endocrine and Metabolism Research Institute, Tehran University of Medical Sciences and Health Services, Tehran, Iran.
          Article
          10.15171/ijhpm.2015.160
          4594102
          26673172
          © 2015 by Kerman University of Medical Sciences.

          Health Policy, Health System, Healthcare Reform, Iran

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