A report by the Ministry of Cooperatives, Labor and Social Welfare regards high levels of out-of-pocket health financing a major problem in Iran’s healthcare system.
Iran performs worst when it comes to the healthcare access and quality index compared with other health indexes. Iranians paid 35% of total health expenditure directly as out-of-pocket expenses compared to the global average of 18% in the fiscal 2018-19, according to data by the World Bank.
The country ranked 116th among 187 countries in terms of out-of-pocket expenses index in that year. Tehran and Kerman registered the highest and lowest levels of out-of-pocket expenditures respectively.
Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.
According to latest data, 30% of Iranian population have to spend 10% of their income when it comes to out-of-pocket household expenditure associated with essential surgery. Iran ranks 93rd out of 132 countries in the risk of catastrophic expenditure for surgical care. Up to 2.5 million people fell below the poverty line due to catastrophic expenditure for surgical care in the fiscal 2019-20.
The number of Iranian physicians, health workers and hospital beds per capita is not only fewer than the average of upper middle-income economies (the income group in which the country has been incorporated); it is also fewer than the global average that also factors in very poor countries.
In the Iranian year ending March 2020, there were 1.6 physicians per 1,000 people; 33 health workers (nurses, operating room staff, technicians, etc.) per 10,000 people and more than one hospital bed per 1,000 people in most Iranian provinces.
Iran has been registering growth in all health status indicators to stand above the global average over the past few years. However, that’s not indicative of a desirable performance, because firstly the country is placed among countries with upper middle income, according to the World Bank. Therefore, its health indicators must be commensurate with the level of these countries and secondly the very poor performance by low income countries has pushed down the global average.
Infant mortality rate and under-five mortality rate in Iran stand respectively at 9 and 14 per 1,000 live births; both above the average of upper middle income countries (7 and 13, respectively.)
The number of reported pregnancy-related deaths stands at 16 per 100,000 live births in Iran, i.e. better than the average upper middle income countries (57 per 100,000 live births).
The rates of low birth weight (babies who are born weighing less 2,500 grams), stunting in under five-year-old children, access to safe drinking water and access to a basic sanitation service are four indexes surveyed among risk factors. Except for access to safe drinking water, other indicators have been viewed as concerning in Iran. The percentage of low birth weight has been constantly on the rise (except for the Iranian year ending March 2019.)
The prevalence of stunting among under five-year-old children is 2.6%, that is higher than the average of upper middle income countries (2.4%). In Kohgilouyeh-Boyerahmad Province and Sistan-Baluchestan Province, this stands at 15.78% and 13.29%, which is even higher than the global average (12.6%).
The decline in Iranians per capita daily caloric intake, particularly in years ending March 2019 and March 2020, and the increase in child malnutrition will have deleterious effects on the intellectual development of children in the future.
Immunization (vaccination) coverage in children less than one year of age in Iran is way above the global average (99% in the year ending March 2021).
