Importance of timely provision of resources in case of elimination of government currency of medicine

Mohammad Mehdi Nasehi, CEO of the Health Insurance Organization, in a press conference, added: “Health Insurance, as the largest health insurance in the country with 5 funds, provides services to the insured and is an important position in terms of It is responsible for providing resources and public insurance coverage. The duties of health insurance are to provide financial resources for the insured in the face of illness and even prevention in the field of referral system and family medicine. The activities of health insurance during the corona, along with other insurance companies, have provided an important part of the financial burden.
He continued: “We had some cases such as corona identification tests free of charge during this period, and the cost of health insurance in the corona area was over 5,000 billion tomans, which was paid 90% in the inpatient ward and up to 70% in the outpatient ward.”
Nasehi said: “There are mechanisms and strengthening health insurance packages in the future, and we are proud that universal health insurance coverage is the most extensive coverage, and in all villages of the country, we have covered the insured with health insurance.”

* Implementation of referral system

The CEO of the Health Insurance Organization stated: Health Insurance has a contract with about 337,000 diagnostic and treatment centers. An important step that started last year is the insurance referral system in the universal health insurance coverage fund. This will make it easier for people to access services in the private sector. In 1399, this measure was implemented in 4 provinces on a trial basis and by the end of September, 31 provinces were covered by this program.

* Increase the share of insurance for the private sector

He said: “Currently, we pay 70% of the expenses in the private sector with government tariffs.” For this reason, we had a plan and received the approval of the government board to increase the payment of insurance in this field. We need to increase the strength of outpatient insurance packages to make it easier for people to access.

* Proper implementation of the electronic version

Nasehi said: “In the last 18 months, appropriate activities have been carried out in the field of electronic prescription and in some provinces more than 90% of the establishment of electronic version has taken place and in some cities such as Tehran and Karaj this amount is less.” At present, rural level one services are also connected to the electronic version coverage. This program needs the cooperation of doctors and people.

He added: “We do not know of a country that has implemented the electronic version in less than 8 years.” The deadline we took to implement this program is the beginning of January 1400. As a result, we informed the centers that from January 1, no non-electronic payments will be made by insurance companies. All stages of the electronic version are implemented up to 60%, which is a good amount.

* Coverage of special patient services
The CEO of the Health Insurance Organization stated: The Health Insurance Organization also pays attention to specific diseases, and last year we put rehabilitation services related to autism on the agenda and it was covered. In the case of diseases such as cancer, measures are taken and health insurance is ready to cover 100% of the costs.

* The importance of reducing out-of-pocket payments

Nasehi said: “One of the duties of insurance is to provide a suitable package to reduce payments from people’s pockets and to form the right way to provide services in the community.” The steps of health insurance in this direction by supporting the referral system and family medicine are on the agenda so that with its full implementation, out-of-pocket payments will be significantly reduced.

* The importance of timely provision of resources in case of elimination of government currency of medicine

The CEO of the Health Insurance Organization said about the elimination of the government currency of medicine: We are in favor of the elimination of the government currency and the organization of smuggling. Our concern is to provide timely resources. Because if the resources are not provided in time, the price of medicine will skyrocket. With the electronicization of services, health insurance is ready to implement this issue if the price of currency is released, provided that resources are provided. Therefore, the timely arrival of resources is very important.

He added: Nearly 50,000 billion tomans should be given at least for medicine, which we must pay attention to in order to be paid to insurers on time.

* Payment of 90% of hospitalization and 70% of outpatient expenses by insurers

Nasehi said insurance companies are allowed to pay 90 percent of hospitalization and 70 percent of outpatient costs at the government rate. The difference must be paid by the people, which is increasing day by day. The same scheme that is being implemented in health insurance is to reduce costs, especially for chronic diseases.

He continued: “We are trying to increase payments in the private sector to reduce payments from people’s pockets.”

* Trial coverage of rehabilitation services

The CEO of the Health Insurance Organization stated: This is the first period that the Health Insurance Organization has entered the subject of rehabilitation. Based on the findings, we confirmed this issue and approved the High Council of Health Insurance to conduct rehabilitation in 5 universities on a trial basis. No resources have been paid for this yet, and in 1401 we will implement the issue of rehabilitation in chronic diseases.

* Corona test insurance coverage

Nasehi said: “After the task of the Supreme Leader to the insurance organizations, the deductible for corona tests will also be paid by the insurers.” If the doctor who is present in the centers refers to the corona test, one hundred percent of the cost will be paid by the insurers. If one goes to private laboratories for corona testing, one hundred percent of the fee is paid according to the government tariff.

He added: The cost of 440,000 corona tests in the outpatient department has been paid at a cost of 78 billion tomans by the end of July.

* The latest status of health insurance payments

The CEO of the Health Insurance Organization stated: In previous years, the distance between paying health insurance to the centers of the contracting parties was about 6 months. At present, the claims of the private sector have been paid by August. At present, we pay 470 billion tomans per month only for the electronic version.

He continued: in the department of public hospitals, the claims have been paid until July and even in some universities for one more month. In the most critical economic conditions, we tried to keep payments up to date. Even miscellaneous damages have been paid until October 28, 1400.

Nasehi said: at the level of a village, the claims are paid monthly and by the end of September, 80% has been paid on account.