American healthcare reform: Possible lessons for Iran Carol Molinari, PhD Associate Professor University of Baltimore Baltimore, MD US

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 Iran Indicators Life Expectancy at Birth Infant mortality rate Maternal mortality rate *The World Health Report, 2002, 2004 * Maternal Mortality Surveillance System,2003 Indicators Life Expectancy at Birth Infant mortality rate Maternal mortality rate

Improving Health Indicators* in Iran Indicators Life Expectancy at Birth Infant mortality rate Maternal mortality rate *The World Health Report, 2002, 2004 * Maternal Mortality Surveillance System,2003 Indicators Life Expectancy at Birth Infant mortality rate Maternal mortality rate

Iran’s health system Hyperinflation of health costs – – 400% increase – 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%

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