OBJECTIVE To understand the Iranian health financing system and provide lessons for policy makers about achieving universal coverage. METHODS Twenty-five interviewees from seven major health insurance companies were selected for a qualitative study in 2007. Using a semi-structured interview, three main tasks of the health financing system (revenue collection, risk pooling and purchasing) were investigated. A framework method was applied for the data analysis. RESULTS The results of the study show the following seven major obstacles to universal coverage: unknown insured rate; regressive financing and non-transparent financial flow; fragmented and non-compulsory system; non-scientifically designed benefit package; non-health-oriented and expensive payment system; uncontrolled demands; and administrative deficiency. A long-term systematic plan is required to address the above problems.

Objectives To determine the rate and nature of complaints and the outcomes of the complaint management at a large heart centre in Tehran. Results A total of 1642 (5.2 per 1000) complaints were received, of which 1457 (4.64 per 1000) were verbal, and 185 (0.56 per 1000) were in written format. 34.7% of the complaints were related to admission procedures, followed by 34.1% communication, 13.8% waiting time, 6.8% delay and 4.1% ignoring the standards of clinical care. Over 90% of complaints were resolved by explanation or verbal apology, 2.1% of them led to a change in the process or procedure, and 4.8% were deemed disapproved claims. Conclusions The majority of patient complaints in Tehran Heart Centre are related to admission procedures or communication; most of them are verbal and resolved in the early stage as an explanation or apology. The hospital complaint management system has the potential to resolve the majority of such complaints in an early stage.

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