HISTORICAL TRENDS OF A NATIONAL ORAL HEALTH PROGRAM IN IRAN

Abstract

In the Islamic Republic of Iran the Ministry of Health and Medical Education is responsible for the levels of health service provision and to improve equitable access within a national economic, social and cultural development program. Within this program health service resources and facilities should be distributed in a way that no one seeking oral care within this public program should pay more than 30% of the costs (fee) and low-income people’s share of the costs (fee) should be reduced to 1%. Oral health services are part of the national primary health care (PHC) network and are part of the national public health services, which are accessible in health centres all over Iran. In this program 0-12-year- old children and pregnant women have been priority groups since 1995. They can enjoy the oral health care, including oral health education, fissure sealants, fluoride therapy, fillings, scaling, extraction of infected teeth, for the same costs (fees) as those paid by others in the public sector. National surveys carried out in 1998, 2009, and 2013 have indicated the failure of this plan and a need to review and make substantial changes to it. Dental costs make up a large proportion of total health payments in Iran. Unofficial estimates have reported that patients must pay about 90% of costs out of their own pockets. In order to modify this existing oral health care system, the government developed a new plan for dentistry and implemented rural insurance in 2015. This program provides new opportunities to improve oral health and helps maintain health equity in terms of access to services and financial protection, based on universal insurance coverage. The necessary costs of the priority groups are paid per capita from health insurance credits (7% of all credits). For others, they are paid in the form of a fee for service. Studies carried out one year after implementation of the program showed an increase of 38%, 91% and 175% for tooth restoration, fissure sealants, and fluoride therapy, respectively. There has also been an 11% reduction in tooth extraction. In addition to enhancement of service coverage, the earnings of public sector dentists increased, as compared with those who deliver services in the private sector. For the public sector dentists, their salary increased from 1000 Euro to nearly 4000 Euro per month.