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

3. 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

4. Improving Health Indicators* in Iran Indicators19901995200020022003 Life Expectancy at Birth 62.96769.8 72.8 Infant mortality rate 453828.624.524 Maternal mortality rate 914037.428.2 *The World Health Report, 2002, 2004 * Maternal Mortality Surveillance System,2003 Indicators19901995200020022003 Life Expectancy at Birth 62.96769.8 72.8 Infant mortality rate 453828.624.524 Maternal mortality rate 914037.428.2

5. Improving Health Indicators* in Iran Indicators19901995200020022003 Life Expectancy at Birth 62.96769.8 72.8 Infant mortality rate 453828.624.524 Maternal mortality rate 914037.428.2 *The World Health Report, 2002, 2004 * Maternal Mortality Surveillance System,2003 Indicators19901995200020022003 Life Expectancy at Birth 62.96769.8 72.8 Infant mortality rate 453828.624.524 Maternal mortality rate 914037.428.2

6. 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%

8. 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