Industry Spotlight: Healthcare (2021)
/By Lauren Elmore, Research Associate
Iran’s healthcare system, along with the general health of the nation, has developed considerably during the last few decades. Overall, life expectancy in Iran has increased at an annual rate of 0.85% (average life expectancy in 2000 was 69.91 years; average life expectancy in 2021 is 76.94 years). Though economic strife, a result of sanctions and the COVID-19 pandemic, has hampered progress, medical technologies, including vaccines and medicines, along with a novel home health care system, have made the healthcare industry within Iran a growing bright spot of both innovation and economic success.
Progress and Development
Iran’s healthcare system has developed into an affordable, versatile, and innovative industry, rendering it attractive to citizens of many countries.
Outpatient and Home Healthcare Services: Within the last five years, Iran has developed an extensive home healthcare system: providing medical services to patients within the comfort of their own houses. Not only was this considered to be cost effective, both for the patient and for the caregiver, but it was also a necessity for healthcare during the height of the pandemic as hospitals and other medical facilities became overrun. Home healthcare is typically provided after a patient is discharged from a hospital, and serves as both a rehabilitative process and a preventative measure for the development of future diseases.
Medical tourism: Medical tourism is significant within Iran. This is the result of many factors, primarily Iran’s low healthcare costs, short waitlists for care, and credible doctors and medical facilities. Iran is one of the 46 destinations on the Medical Tourism Index. From 2018 to 2019, Iran admitted over 70,000 foreign patients to their healthcare system, and in early 2019, it received over 600,000 medical tourists. Iran’s medical tourism sector is a well established economic industry, and some packages provide translators, medical consultation, living and travel accommodations, and postoperative care. Though depressed as a result of the pandemic, the medical tourism industry is continually advancing in Iran.
Disease Prevention and Control: Many diseases that previously were a significant problem within Iran are now controlled and moderated heavily. For example, malaria was endemic to Iran, affecting approximately 1,500 Iranians annually in the early 2000s, and sixty years prior, had infected more than five million and was the leading cause of death. As of 2021, however, as a result of Iran’s Ministry of Health’s malaria control program, Iran is now in its third consecutive year of having zero indiginous malaria cases, and the World Health Organization will soon provide Iran with a certificate of eradication of malaria. While this is the most prominent example, other progress has been made in mitigating diseases and improving the overall health of Iranians. HIV/AIDS is an increasing epidemic within Iran, and consequently, the Iranian government has implemented several mitigation and control initiatives, such as the UNAIDS 90-90-90 initiative for the diagnosis and treatment of HIV, to reduce the spread; and despite a rocky start, Iran has developed multiple vaccines and treatments against COVID-19.
Coverage and Insurance: Former President Rouhani made healthcare a priority during his leadership and strived to make it affordable to Iranians, eventually developing the Tarh-e Salamaat. Though the Tarh-e Salamaat is Iran’s national healthcare coverage, many other organizations provide coverage. Because of this, approximately 90% of Iran’s population have health insurance. These insurances cover both hospital stays and post operative care, such as necessary medicines and other required medical equipment. Now, Iran’s health insurance system has extended to self-employed Iranians, comprising 96% of Iran’s population. Iran seeks to reach 100% coverage and provide total Universal Health Coverage by 2025.
Limitations and Weaknesses
Despite its progress, Iran’s healthcare system still faces downfalls, each of which could hinder the future of the continual development and improvement of Iran’s healthcare industry.
Economic Difficulties: Iran’s economy has experienced a multitude of hardships over the past few years, namely continual sanctions and a global pandemic. These issues, overall, have hurt many Iranians’ access to medicine and healthcare services. First and foremost, the continual damage to Iran’s economy has resulted in Iran having to decrease overall funding for healthcare. Iran devotes approximately 8% of its GDP to healthcare. This causes it to already have one of the lowest healthcare expenditures as compared to other high spending countries. With the aforementioned economic difficulties, Iran’s GDP has decayed, leaving even less money for Iran to allocate towards healthcare. Additionally, though sanctions do not directly target medicines, the threat of sanctions themselves have caused a decrease in medicine importations, specifically with diabetic and cancer treatments. Furthermore, prices for medicine increased by about 50% in Iran because of sanctions, forcing Iran to now develop over 90% of its medicines. However, pharmaceutical companies that produce these medicines have difficulty obtaining active ingredients within drugs, causing medicinal shortages or high prices for diseases like asthma and multiple sclerosis.
Brain Drain: In light of economic difficulties, poor wages and facilities have resulted in doctors and other healthcare professionals leaving Iran to find work elsewhere. Approximately 1,000 Iranian nurses leave annually, and within the initial months of the COVID-19 pandemic, almost 3,000 medical professionals left the healthcare system. Though this ‘brain drain’ is not unique to just healthcare professionals in Iran, it has had a measured impact on the industry in light of the recent COVID-19 pandemic. Emigration from Iran has grown three times within the past four decades, and this newfound shortage has posed issues to the currency stability and the future development of Iran’s healthcare industry.
Mental Health Care: Mental health issues are prevalent within Iran. Though mental health care is present within Iran, having been integrated into Iran’s primary healthcare system in 1989, it is not nearly as extensive nor as comprehensive as other medical services within Iran, amounting to approximately only 3% of Iran’s total health expenditures. Out of all Iranians who have a mental health issue, only about 15-25% receive treatment. Unfortunately, the consequences of this are becoming more prominent, especially amidst national stressors. Sanctions and their subsequent economic impacts on Iranian’s livelihoods have resulted in a large increase in anxiety and stress levels amongst Iranians, which has led to an increase in mental issue related injuries. Not only that, but addiction is also a growing health problem in Iran. Without proper psychiatric treatment, this is not only likely to increase, but also translate into physical health issues, placing more strain on an already strained system.
Though an extreme case, COVID-19 highlighted the consequences of the existing shortcomings of healthcare in Iran. In 2019, prior to the start of the pandemic, healthcare workers complained of poor working conditions, lack of access to medical equipment, high numbers of patients, and low staffing. There was also a reported nursing shortage in 2020, and the continual brain drain within Iran has only compounded this. While these issues and the ones aforementioned may be manageable under normal circumstances, they proved to be deadly under harsh conditions. Throughout the course of the pandemic, and especially during the initial months, Iranian hospitals were often overrun with patients, forcing Iran to turn parking lots and wedding halls into temporary hospitals; shortages of medical equipment became undeniable; the departure of nurses and doctors placed additional strain on the struggling industry; and opium and alcohol addictions, two of the most prevalent addictions within Iran, both increased in number and severity, resulting in the hospitalization of thousands.
Future
Healthcare was a priority during the Rouhani administration, primarily before sanctions were reimposed. However, with the given election, an uncertain future is posed to the healthcare industry within Iran. President Ebrahim Raisi has asserted that he will increase the production of COVID-19 vaccines to propel Iran out of the pandemic. However, he has made no claims of his intentions with the healthcare system.
If no changes are made to the current healthcare system, Iran will face rising rates of modern diseases with a strain system. Cancer cases are estimated to increase by nearly 50,000 cases by 2025; AIDS and HIV cases, despite mitigation attempts, are also on the rise; tuberculosis is steadily increasing in numbers; and health complications as a result of pollution are significantly increasing.
However, even despite the continual strain on its system, the Iranian health industry has proven to be resilient and flexible.
