American healthcare reform:Possible lessons for Iran

Carol Molinari, PhDAssociate ProfessorUniversity of BaltimoreBaltimore, MD US

6

Health Care Spending as a Percentage of GDP, 1980–2010

Percent

18

16

14

12

10

8

6

4

2

US (17.6%)

NETH (12.0%)

FR (11.6%)

GER (11.6%)

CAN (11.4%)

SWIZ (11.4%)

NZ (10.1%)

SWE (9.6%)

UK (9.6%)

NOR (9.4%)

AUS (9.1%)*

0 * 2009

1980 1984 1988 1992 1996 2000 2004 2008

THE COMMONWEALTH

Affordable Care Act (ACA) 2010“Obamacare”

• Access – Health insurance with basic

coverage (prevention and treatment)

• Expand to cover low income under public Medicaid insurance

• Subsidies based on income for those ineligible for expanded Medicaid

• Changes in Delivery– Provider payment– Organization into

systems to coordinate care

Improving Health Indicators* in IranIndicators 1990 1995 2000 2002 2003

Life Expectancy at Birth

62.9 67 69.8 69.8 72.8

Infant mortality rate

45 38 28.6 24.5 24

Maternal mortality rate

91 40 37.4 28.2

*The World Health Report, 2002, 2004* Maternal Mortality Surveillance System,2003

Indicators 1990 1995 2000 2002 2003

Life Expectancy at Birth

62.9 67 69.8 69.8 72.8

Infant mortality rate

45 38 28.6 24.5 24

Maternal mortality rate

91 40 37.4 28.2

Improving Health Indicators* in IranIndicators 1990 1995 2000 2002 2003

Life Expectancy at Birth

62.9 67 69.8 69.8 72.8

Infant mortality rate

45 38 28.6 24.5 24

Maternal mortality rate

91 40 37.4 28.2

*The World Health Report, 2002, 2004* Maternal Mortality Surveillance System,2003

Indicators 1990 1995 2000 2002 2003

Life Expectancy at Birth

62.9 67 69.8 69.8 72.8

Infant mortality rate

45 38 28.6 24.5 24

Maternal mortality rate

91 40 37.4 28.2

Iran’s health system

• Hyperinflation of health costs – – 400% increase- 2005-

2012– 70% paid out of pocket

• Restrict access• Major financial

burden

Supply- based demand • Growing surplus of

private providers in urban areas

• Fee-for service provider payment

Consumer-based demand• Very high c-section rate

around 40%

National C-section Rates in Iran

Source: Yazdizadeh, Nedjat, Mohammad, Rachidian, Changizi & Majdzadeh (2011)

35.0%40.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Year

2000

2005

Iran Reform• Govt support of private

medical insurance for Iranians who cannot afford care

• Consider – Financial incentives to reform

delivery system– More government oversight

of private sector

United States Reform• Health care plan –

– Govt subsidies dependent on individual’s income

– Comprehensive coverage

• Financial incentives to reform– Provider payment– Organization of care