Abstract
BackgroundThe 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.MethodsWe 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.ResultsOur 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.ConclusionUse 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.
Highlights
To prevent healthcare market failures due to possible externalities, failures of competition and market controller information asymmetry, governments may decide to intervene directly or indirectly by setting medical tariffs for goods and services and introducing price ceilings and floors [1, 2]
In 1982, Iran adopted these tariffs by introducing a similar disease coding system, adjusting the relative value units, and applying the Rial coefficient, which would be revised annually based on the cost of living index to provide the actual and rational costs of medical services
In 1995, the Universal Medical Services Insurance (UMSI) Act declared that medical tariffs should be based on actual costs and be revised annually
Summary
To prevent healthcare market failures due to possible externalities, failures of competition and market controller information asymmetry, governments may decide to intervene directly or indirectly by setting medical tariffs ( termed as prices, fees, or rates) for goods and services and introducing price ceilings and floors [1, 2]. Medical tariffs usually include a set of prices reimbursed for provided health care goods and services and payment rules for purchasers and providers valid for a specified period. Medical tariffs can be applied to any type of health care service but will correspond to existing service coverage and resource distribution in public and private healthcare sectors. They are central to establishing sound payment systems for public health and healthcare services. In many countries such as Australia, England, France, Germany, and Japan, tariff setting is integrated into provider payment systems. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades
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