Title: Navigating Healthcare Coverage: A Policy Debate on Supplementary Insurance
Introduction
A significant debate is unfolding within Iran’s social security framework, centering on the role and necessity of supplementary medical insurance. While officials point to the capabilities of state-affiliated medical centers, retirees and policy experts highlight a gap between policy aims and the practical realities of healthcare access, calling for a fundamental review of the system’s commitments.
Official Stance: Claimed Self-Sufficiency
In recent remarks, Shahram Ghaffari, Deputy of Treatment at the Social Security Organization, criticized the organization’s and its beneficiaries’ reliance on supplementary insurance. Using an analogy, he stated, “Someone who owns a bakery should not need to buy bread from elsewhere.” This comment was intended to underscore the asserted sufficiency of the services provided through the organization’s own medical centers and its indirect treatment contracts.
The Retirees’ Perspective: A Clash with Reality
This official position, however, is met with skepticism from the very people it serves. Representatives for retirees pose a critical question: if the quality of services in the designated centers were truly adequate to cover the needs of millions of pensioners and insured individuals, what necessity would there be to enroll and pay extra for supplementary insurance? They report that even with supplementary policies, pensioners bear a significant portion of their medical costs personally.
Expert Analysis: The Gap Between Law and Practice
Mehrdad Darani, a social security expert and member of the Insurance and Social Security Committee of the Workers’ House, provided a detailed analysis. He noted that while Mr. Ghaffari’s statement reflects an ideal scenario, it does not align with the on-the-ground challenges.
Darani explained that the Social Security Organization is legally obligated to provide free medical services to all its 42 million insured individuals. Yet, in practice, the allocated budget falls drastically short, covering only a small percentage of the target population. “If the existing problems were resolved,” Darani argued, “the insured would have no need to pay extra for supplementary insurance.”
The Drivers for Supplementary Insurance
The expert outlined the practical reasons driving retirees towards supplementary plans. Long waiting times for even minor services or surgeries, coupled with a shortage of facilities in state-affiliated centers, force individuals to seek care in non-affiliated medical centers, incurring higher out-of-pocket expenses. This move, he clarified, is born of necessity and urgent medical need, not preference.
Systemic Challenges and Proposed Solutions
Darani pointed to broader systemic issues. He suggested that the organization’s current financial resources should be channeled into a new, professionally managed fund to improve healthcare services, a move he believes would address public dissatisfaction more effectively than the current approach.
Looking ahead, he emphasized that based on scientific calculations, by the year 1442 in the Persian calendar, at least one-quarter of the collected insurance premiums would need to be allocated to healthcare—a target far beyond current budget capabilities. He underscored that, fundamentally, healthcare costs should be covered by the government, with the Social Security Organization receiving its necessary budget directly.
Infrastructure and Quality Hurdles
Compounding the financial challenges are infrastructural constraints. Darani noted that adding new state-owned medical centers is not currently feasible. Furthermore, the quality of service in existing centers, affected by overcrowding and a shortage of medical staff, cannot compete with the standards of centers covered by supplementary insurance.
Conclusion: A Call for Realistic Appraisals
In conclusion, the expert stressed that claims of the state-affiliated medical network’s sufficiency are currently unrealistic and idealistic. The existing pressures of high patient loads and equipment shortages indicate that a significant improvement in healthcare services is impossible without foundational changes and precise, forward-looking planning. The ongoing discourse highlights a critical juncture for social welfare policy, balancing legal obligations with the tangible needs of the populace.