Current Challenges in Delivering
This presentation is the property of its rightful owner.
Sponsored Links
1 / 42

Current Challenges in Delivering Social Security Health Insurance PowerPoint PPT Presentation


  • 121 Views
  • Uploaded on
  • Presentation posted in: General

Current Challenges in Delivering Social Security Health Insurance. Social Security Organization. Achievements and Challenges of Social Security Health Insurance: The Experience of the Islamic Republic of Iran. Meeting of Directors of Social Security Organizations in Asia and the Pacific

Download Presentation

Current Challenges in Delivering Social Security Health Insurance

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Current challenges in delivering social security health insurance

Current Challenges in Delivering Social Security Health Insurance

Social Security

Organization

Achievements and Challenges of Social Security Health Insurance: The Experience of the Islamic Republic of Iran

Meeting of Directors of Social

Security Organizations in Asia and the Pacific

Seoul, Korea

9 - 11 November 2005


Health

Health

  • Definition: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

WHO


Dimensions of health planning

Dimensions of Health Planning

  • All Ages

  • Both Sexes

  • Comprehensive

  • Integrated

Biological Factors

Social Factors

Psychological Factors

Spiritual Factors

Preventive Care

Therapeutic Care

Rehabilitative Care


Iran in perspective

IRAN in Perspective

  • Area: ………………………………… 1/648/000 sq. km

  • Population: ………………………… 68 millions

  • Labor Force: ………………………. 15.4 millions

  • Labor Structure: …………………... 23% Agriculture,

    32% Industry,

    45% Service Sector

  • 42.28% of Population Under Age 15


Iran in perspective1

IRAN in Perspective

  • 23 Million Students in School

  • 2.1 Million Students in University

  • Iran Has the 4th Largest Oil Reserves of the World

  • Iran Has the 2nd Largest Gas Reserves of the World

  • Iran Has the 2nd Largest Copper Reserves of the World

  • GDP: 108.2 billion US$ (2002)

  • GDP Growth for 2003: 6.4%

  • GDP Per Capita:

    7,217 US$ PPP (2002)


National health indicators

National Health Indicators:


Social protection programs

Social Protection Programs

  • The right to social security is embedded in the Constitution:

  • To benefit from social security with respect to retirement, unemployment, old age, disability, absence of a guardian, and benefits relating to being stranded, accidents, health services, and medical care and treatment, provided through Insurance or other means, is accepted as a universal right. The government must provide the foregoing services and financial support for every individual citizen by drawing, in accordance with the law, on the national revenues and funds obtained through public contributions.

Article 29


Social protection programs1

Social Protection Programs

  • The social protection programs in Iran are legislated by the Ministry of Welfare and Social Security and are carried out by several organizations, the largest of which is the Social Security Organization (SSO).


Social protection programs historical backgrounds

Social Protection ProgramsHistorical Backgrounds

  • Unemployment and injury benefits existed in 2500 years ago in the construction of “Persepolis Palaces”.


Social protection programs contemporary era

Social Protection ProgramsContemporary Era

  • 1931 Railway Workers Provident Fund

  • 1952 SS Legal Bill Ratified

  • 1975 Modern SSO was born

SSO National

Headquarters


Social security organization

Social Security Organization

Defined

Benefit

Scheme

Coverage includes:

1- Formal Blue-collar workers

2- Self-employed

3- Voluntary insured persons

PLUS

their dependants

This Means43%

of the whole

Population

and 62% of the

Urban Population

Total number of insured

under the SSO scheme:

27/000/000


Extension of coverage slide1of 2

Extension of Coverage Slide1of 2

Whole

Package

of SS

Benefits

1979……….17%

2004………43%

1979……….9%

2004………21%

SSO Scheme

Other Schemes

64%


Extension of coverage slide 2 of 2

Extension of Coverage Slide 2 of 2

Health Care Coverage

X1000

94%


Rate of contribution

Rate of Contribution

30% of the Payroll

20%Employer

Government 3%

Employee 7%


Sso benefits

SSO Benefits

Lump sum

compensation

Family allowance

Work related total and partial disability

Old age

pension

Payment of allowance to the women as head of the family

Expenses of prosthesis &

orthos

Unemployment pension

Survivor’s pension

Benefit in kind for pensioners

Health care

Sickness

benefit

Funeral grant

Maternity

benefit

Marriage grant

Accommodation and travel expenses of patients

Housing allowance


An iranian proverb

An Iranian Proverb

Sound wisdoms dwell

only in healthy bodies.


Sso medical services slide1of 2

Preventive, Curative, and Rehabilitative Care

Out-patient & In-patient Medical Services

All Types of Surgeries

Emergency Medical Services

Dental Care

Medical Imaging and Laboratory Services

All Types of Medications

Child and Maternity Care

Rehabilitation Services

Providing and Replacing Orthos & Prosthetic Appliances

SSO Medical Services Slide1of 2


Sso medical services slide2 of 2

Preventive, Curative, and Rehabilitative Care

Daily allowances during temporary incapacity

Transfer to a hospital in another area or district for treatment and care, if necessary

Periodical Examination of Workers who Deal with Hazardous Substances

Medical Examination of Workers upon Recruitment and Annually During Employment

SSO Medical Services Slide2 of 2


Sso s health care networks

SSO’s Health Care Networks

SSO

Health

Direct Health Network (DHN)

Indirect Health Network (IHN)


Direct health network dhn

Direct Health Network (DHN)

  • 76 Modern Hospitals

  • 11,000 Beds (8,981 Active)

  • 270 Clinics and Polyclinics

  • 49 Centers for Occupational Medicine

  • 112 Medical Commissions

  • 34,000 Staff (6000 Physicians)


Indirect health network ihn

Indirect Health Network (IHN)

  • SSO Have Contracts With 95% of All Providers of Health Care in Iran:

    -Independent Physicians and . Dentists………………...............28,417

    - Hospitals………………………..772

    - Private Clinics…………………750

    - Public Clinics………………….4,102

    - Drugstores……………………..6,461

    - Medical Labs…………………..1,752

    - Imaging Centers……………....1,286

    - Independent Hemodialysis &

    Lithotripsy Centers……………199

    - Independent Physiotherapy….970

    - Miscellaneous…………………..70

    Total……………………………..44,779


Administration of dhn ihn

Administration of DHN & IHN


Sso s health care

SSO’s Health Care

Challenges

Achievements


1 comprehensive and diverse services

1-Comprehensive and Diverse Services

Achievements


2 full geographic coverage

2-Full Geographic Coverage

  • The Direct and Indirect Health Networks of the SSO cover the entire country, including the rural and remote areas in all 31 provinces.

Equitable Access

Achievements


Current challenges in delivering social security health insurance

DHN


3 continuous quality improvement

3-Continuous Quality Improvement

TQM

Achievements

Improves the

Quality of

Care

Enhances

Customer

Satisfaction

Increases

Productivity


3 continuous quality improvement1

3-Continuous Quality Improvement

ISO 9001:2000

Achievements


3 continuous quality improvement2

3-Continuous Quality Improvement

Integrated

Management

System

ISO 9001:

2000

SA 8000

Achievements

ISO 14000

ISO 18000


4 e health

4-E-health

SSO

e-health Plan

  • Phase 1: Hospitals & Clinics

  • Phase 2: Medical Documents Offices

  • Phase 3: National SSO Health Portal

  • Phase 4: Smart Electronic Health Card

Achievements

e-Care


5 modern therapeutic services

5-Modern Therapeutic Services

  • Non-invasive Medical Treatment Plan

  • Medical Equipment Calibration Plan

  • Mutual Medical Projects with France, US, Germany, South Africa, Kuwait, Tajikistan, Azerbaijan, and Malaysia.

Achievements


1 steep increase in health care costs

1-Steep Increase in Health Care Costs

Challenges


1 steep increase in health care costs1

1-Steep Increase in Health Care Costs

  • The major factors responsible for the increase in health care cost :

  • Inflation

  • Health care technology

  • Shifting trends of diseases

  • Sub-standard workplace environment

  • Yearly increase in medical tariffs and salaries

  • Beneficiaries’ heightened expectations

  • Increase in life expectancy and consequent aging of the covered population

  • Increase in the number of beneficiaries (Dependency Ratio)

  • Simultaneous and unlimited access to both the DHN & IHN

  • Improper and deficient regulation of health market

Challenges


2 lack of referral system

2-Lack of Referral System

  • A referral system is a system where patients are first treated by a general practitioner or a family doctor and if necessary, are referred to specialists.

Referral System

Challenges

Good

Governance

Cost

Containment


3 absence of a requisite medical culture in the society

3-Absence of a Requisite Medical Culture in the Society

Provider

Challenges

Regulator

Consumer


3 absence of a requisite medical culture in the society1

3-Absence of a Requisite Medical Culture in the Society

  • To overcome the problem, SSO has launched an extensive public programme to educate the insured and their families on issues such as:

  • Physical fitness

  • Dental care

  • Nutritional information and eating habits

  • New born care

  • Smoking

  • Blood pressure

  • Diabetes

  • Medication misuse

  • Breast feeding

  • Sexually transmitted diseases

Challenges


4 population ageing

4-Population Ageing

Improved Health

Higher Life

Expectancy

Longer Retirement

Health care expenses

at age range of 20-30

Health care expenses

at age range of 60-70

Health care expenses

at age range of 80-90

Challenges

A

3As

10As


Demographic indicators world and asia

Demographic Indicators:World and Asia

Source: WWW.UN.Org


4 population ageing1

4-Population Ageing

  • One SSO research shows that only 4% of the insured population in Tehran is above 65 , however, this group consumed 36% of the SSO in-patient budget of the Capital city.

  • An American study indicates population over 65:

Challenges

  • 13% of the population

  • 36% of hospital stays

  • 49% of all hospital care

  • 50% of all physician work hours

  • 40% of healthcare dollars


4 population ageing2

4-Population Ageing

  • People over 65 account for:

  • The Iranian population above 60 will double in ten years and reach to more than 12 millions.

  • 40% of surgical procedures

  • 50% of emergency operations

  • 75% of surgery-related deaths

Challenges


5 political pressure to reduce contribution

5-Political Pressure to Reduce Contribution

  • Macro-economic constraints have always led governments to turn to social security funds as abundant resources in solving state problems.

Challenges

Awareness

Activities


Current challenges in delivering social security health insurance

Social Security: Welfare and Social Justice for All

Thankyou


  • Login