A Review of Health Provisions from the First to the Sixth Plans, an Overview of the Provisions in the Seventh Plan, and an Analysis of Its Strengths and Weaknesses
Abstract
The experience of six development plans in the Islamic Republic of Iran shows that the absence of a clear strategy in drafting these plans has led to the enactment of legal provisions, of which generally less than 30% have been implemented, or lack proper infrastructure for execution. The repeated failure to implement even 50% of the provisions in the past six plans serves as a warning to policymakers that, in terms of content, the country needs a development plan with a different design that does not follow the same path. However, this shift has not occurred in the Seventh Development Plan either. Furthermore, the neglect of the general policies of development plans—and at times even the adoption of provisions that contradict those general policies—has exacerbated the lack of direction in the health sector.
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A Look at Health Provisions in the First to Sixth Development Plans
First Development Plan: Launched with an “economic liberalization” strategy, the plan focused on expanding healthcare coverage, ensuring public access, improving service quality, and increasing the health sector’s budget share.
Second Development Plan (1995–1999): Focused on public health, expanding universal insurance, promoting population control through awareness, removing incentives for large families, and strengthening primary healthcare, especially in rural and underserved areas.
Third Development Plan (2000–2004): Emphasized structural reforms in health through expanding inpatient care via the private sector, introducing a tiered healthcare system, regulating the pharmaceutical market, stabilizing drug prices, supporting health insurance, and setting service tariffs based on actual costs.
Fourth Development Plan (2005–2009)
- Integrated with the annual budget
- Dedicated health chapter with 11 articles
- Introduced Fair Financial Contribution concept
- Reforms in public hospital management and engagement with global markets
Fifth Development Plan (2011–2015)
- Continued focus on health insurance and social security system
- Launched the Electronic Health Record system
- Implemented the referral system with private sector prioritization
- Banned dual practice for publicly employed physicians in private hospitals
Sixth Development Plan (2016–2020)
- Aimed for universal and mandatory health insurance
- Merged the Health Insurance Organization with the Ministry of Health
- Created the National Pre-hospital Emergency Organization
- Introduced taxes on tobacco products
- Emphasized prevention over treatment and strengthened the family physician and referral system
Seventh Development Plan – Health Summary
- Government-set prices for medical supplies, drugs, and vaccines
- Broader insurance coverage (including traditional medicine, home care, rehab)
- Nationwide smart health system, family physician, and e-referral
- Focus on prevention and self-care funding by basic insurers
- Unified service purchasing and insurance rules
- Switch to bundled (global) payment for services
- Strengthening hospital safety and resilience
- Clinical and treatment guideline enforcement
- +12% annual increase in medical specialty training
- Iran to become a regional health hub
- Out-of-pocket health costs capped at 30%
- Free milk program in primary schools
- Physician single-job policy and tobacco taxation
Health in the Seventh Development Plan
Strengths
- Strong focus on e-health and digital infrastructure
- Reforms in payment models and insurance efficiency
- Full-time physician employment and support for traditional medicine
- Continued commitment to universal basic health insurance
- Overall alignment with General Health Policies
Weaknesses
- Focuses more on symptoms than root causes of health issues
- Some outdated solutions and lack of strategic coherence
- Legalization of inefficient complementary insurance practices
- Imposes heavy financial burdens unlikely to be supported by current budget capacity
- Several provisions may be unrealistic or unenforceable
This study was conducted at Incubation and Innovation Center of the Islamic Culture and Thought Research Institute by Ali Akhavan Behbahani in 2023.
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