By Faranak Bakhtiari

Coronavirus brought healthcare reforms into sharp focus

May 5, 2020 - 0:16

TEHRAN – The coronavirus outbreak proved that one-dimensional health systems cannot survive from health-threatening crises, which occur every few years in the form of infectious diseases, a mere view of treatment is not enough, so that the need for healthcare reforms should be brought into sharp focus.

Now that the globe is dealing with a pandemic of such dimension, with the help of transformational measures that have taken place in the country's healthcare, we have been able to take control of the disease.

It is essential to know that as much as creating new hospital beds, developing hospitals, renovating dilapidated hospital tissue and upgrading medical centers are important; the establishment of comprehensive health centers, health houses, health workers training, the launch of electronic health records for the people, and numerous screening schemes, medical supply, quantitative and qualitative improvement of medical education, and medical research are of great importance which needs to be considered.

The healthcare reform plan, aiming at decreasing the out-of-pocket expenses for the patients, promoting natural birth, and supporting underprivileged patients suffering from rare or incurable diseases, was launched in the country in May 2014.

A plan that has succeeded in enforcing many of the health-deferred laws and regulations, and continues to do so despite all the credit and manpower deficiencies.

Steps toward public health coverage

Increased access to medicine and treatment was among the achievements of the plan. In the first, treatment was considered an emergency, and the increase in hospital beds, the accommodation of specialist physicians in hospitals, and deprived areas were among the important measures taken.

According to Iraj Harirchi, the deputy health minister, at the beginning of last year (March 2019), there were a total of 140,859 beds in the country, with a hospital bed index of 1.7 per 1,000, with 69 percent of which, equaling 97,205 beds, are located in medical universities.

At the same time, the creation of 32,000 hospital beds, renovation of more than 45,000 hospital beds, commissioning of 42 air emergency bases, development of 180 emergency departments in the country and construction and equipping of 3,000 new ICU special care beds are other measures taken in the field of treatment.

11 million people covered by free insurance

With increasing access to healthcare, it was necessary to plan for cost-effectiveness so that people could benefit from healthcare, as one of the major goals of the plan was to protect patients financially from the debilitating costs of health. 

So, 11 million Iranians who did not have any health insurance coverage were covered by public insurance.

People’s share of medical expenses reduced

Prior to the project, public spending on healthcare services was more than 50 percent. Meanwhile, with the implementation of the plan, the share of payment from the pockets of patients in the field of health has decreased to 32.4 percent. 

Also, it was also forbidden to refer patients outside the hospital for medication and medical supplies, and hospitals were required to provide the patients with the items they needed.

250 special clinics launched 

At the same time, it should be noted that before the plan was implemented, public hospitals affiliated with the Ministry of Health were not providing outpatient services appropriately, and patients usually did not go to these hospitals to receive specialized services, but outpatient services in the form of 250 special clinics could achieve the three main goals of financially protecting people against healthcare costs, increasing access to healthcare, and improving the quality of healthcare.

Physicians stayed in deprived areas

On the other hand, specialist physicians and doctors were dispatched to deprived areas temporarily as a force for specialized services, and in most cases, they left these areas due to lack of necessary incentives to stay. 

The plan started supporting physicians in those areas, which increased the number of doctors in deprived areas, so that more than 4,300 general practitioners, specialists, and subspecialists in deprived areas of the country are offering services, which has increased people's access to medical treatment.

55,000 health workers in the front line 

The healthcare network in rural areas of the country is called Health House and with the efforts of healthcare providers, primary care is provided to the people covered with an approximate population of about 1,000 people. 

On the other hand, on average, each five health houses are supervised and connected to a comprehensive rural service center where doctors, nurses, and, in some areas, laboratory and dental services are provided free of charge to the public.

In cities, the first units are health service providers. Healthcare providers are operating at these bases, providing services similar to those provided by health workers in the villages, with the difference that the population covered by healthcare providers is about 2,500. 

It should be noted that each three to four health bases are a subset of a comprehensive urban health service center.

There is one doctor for every 12,000 people in the city's comprehensive health centers. Oral care, mental health, nutrition, environmental health, occupational health and midwifery services, and breastfeeding education are also provided in these centers, although these services have been added to the capacity of these centers after the implementation of the plan.

Therefore, one of the important health measures was the construction, equipment, and development of health houses and comprehensive health centers, so that currently 17,800 health houses are active in the villages in the whole country, with 31,500 health workers. There are also 4,700 comprehensive healthcare centers in operation. 

There are about 5,700 active health centers in the cities, which employ 24,000 healthcare workers. According to the Ministry of Health, a total of 55,000 people in the country are providing prevention, healthcare, and treatment services, who also have made a good record in the coronavirus crisis.

After doctors and nurses in hospitals, healthcare providers, urban and rural doctors, who are responsible for screening the entire population in remote areas for COVID-19 detection, are in charge of providing services to the people. 

Health houses in COVID-19 crisis

About 1,100 comprehensive healthcare centers across the country are now offering medical services to patients and providing the necessary care since the onset of the epidemic. If the person has more problems, they will refer them to the hospitals. So far, more than 72 million Iranians have been screened by healthcare providers in remote areas.

One of the important health capacities that came to the aid of the country in the coronavirus crisis was the electronic health record, and according to the Minister of Health Saeed Namaki, at least 75 million Iranians with a national code can file electronic health records. 

Undoubtedly, the construction of more than one hundred hospitals in the form of 32,000 hospital beds and thousands of special beds and new ICUs and equipping them played a significant role in providing services to critically ill corona patients and reduce the number of deaths in the country.

These capacities, along with the sacrifices of the healthcare staff, have enabled the country's "health" structure to cope with COVID-19 and manage its process in the country. Coronavirus showed that not only should "health" not be viewed through the lens of "politics", but that far from any kind of political work, the margins of this field should be promoted and its capacities should be upgraded in accordance with modern international standards, because novel diseases may revolt against humans at any moment.