Untangling the Complex Knot of Health Services Tariffs in Iran

Abstract The health services tariff system is a cornerstone of every nation's healthcare system, with direct implications for resource allocation, service quality, and public access to healthcare. With the enactment of the Universal Health Insurance Act in November 1994, efforts were made to establish a scientific, structural, and legal foundation for setting tariffs for diagnostic and therapeutic services. This initiative aimed to enhance efficiency and equity while increasing stakeholder satisfaction within the healthcare system. Since then, government oversight and interaction between service providers and consumers have determined health services tariffs (diagnostic and therapeutic services). However, the tariff-setting mechanisms and the resulting tariffs have consistently faced criticism from healthcare stakeholders. Evidence suggests that, despite 30 years of implementation, the Act has fallen short of achieving its legislative objectives. Both the supply and demand sides of healthcare services remain dissatisfied with the approved tariffs under this framework. Service providers, particularly in recent years, argue that the tariffs are unrealistic and fail to cover service costs. Concurrently, patients and insurers express dissatisfaction with the financial burdens imposed on them.