The impact of sanction and healthcare system reform on the healthcare performance and pharmaceutical market in Iran; 2001-2016

Abstract

Background: Iranian government has introduced multiple healthcare system reforms during the last 30 years aiming at improving accessibility and affordability of care. Pharmaceutical products are one of the major sources of financial burden on the healthcare system. The healthcare system and pharmaceutical sector have been balanced out by the partially counteracting effects of the HSEP (Health sector evolution plan) and the imposed sanctions. Methods: This research investigates the healthcare system performance as well as the pharmaceutical market trend mostly based on the financial criteria from 2001. The correlation between the two change patterns was studied to understand the underlying driving market forces. Results: During 2001 to 2013, total health expenditure has grown 25.6% in average. THE (Total health expenditure) share of the GDP remains between 6-7%, while the out of pocket payment has dropped to 37% in 2015 from 57% in 2001, and most health services been directed to the inpatient facilities. Iranian pharmaceutical market has grown rapidly in recent years and grew 28.38% per year and drug consumption per capita reached 34.43$ from 2.28$. However, the import drove most of the market expansion. Noteworthy, the share of pharmaceuticals from THE has also increased. Conclusions: It is concluded that the sanctions and HSEP have enforced partially counteracting forces on the pharmaceutical market to maintain its consistent growing trend.

The Violence of Non-Violence: A Systematic Mixed-Studies Review on the Health Effects of Sanctions

“… 59 , 66 , 68 , 70 , 82 We also found that during sanctions periods, industrial production fell, 40 , 54 national industries were weakened or bankrupted, 13 , 40 , 46 , 48 , 60 , 75 , 82 per capital gross national product and gross domestic product declined substantially, 13 , 42 , 44 , 46 , 47 , 52 , 75 , 83 and recessions developed. 75 These economic disruptions severely weakened health and social systems, 13 , 47 , 54 , 60 impacted social security spending, 13 , 60 reduced resources for health care services, 13 , 47 , 54 , 60 , 66 , 75 , 82 prevented governments from responding to public health emergencies, 47 led to shortages of medicines and other medical supplies, 47 , 50 , 54 , 70 , 73 , 83 and resulted in extensive rationing of food and medicines. …”

“…13,47,59,68,70,80,82 A disturbing finding was articles reporting that under U.S. sanctions, even non-U.S. companies refused to sell supplies to sanctioned countries to avoid U.S. penalties. 59,66,68,70,82 We also found that during sanctions periods, industrial production fell, 40,54 national industries were weakened or bankrupted, 13,40,46,48,60,75,82 per capital gross national product and gross domestic product declined substantially, 13,42,44,46,47,52,75,83 and recessions developed. 75 These economic disruptions severely weakened health and social systems, 13,47,54,60 impacted social security spending, 13,60 reduced resources for health care services, 13,47,54,60,66,75,82 prevented governments from responding to public health emergencies, 47 led to shortages of medicines and other medical supplies, 47,…”

“…About a third of the articles (38%; 9/24) reported that many patients were denied care or were unable to adhere to medications due to cost-related barriers 13,56,64,65,68,70,75,78,81 Reasons reported for decreased health care spending included sanctions-related deficits and blockades to financial flows, 54,59,60,70,71,75,82 rapid increases in inflation, 13,54,59,70,75 bankruptcy of medical industries, 13,67,75 decreases in the availability of the public sector to generate funding for health services, 13,54,59,60,70,73,75,82,83 and privatization of health care services. 56,73 The decrease in funding led to lower quality of care and health system capacity, 13,59,60,68,71,75,76,82 deterioration of medical facilities and equipment, 13,43,46,59,70,73 a weakened health policy sector, 13,59,75,76 and shortages in medicines and health services.…”

“…13,15,56,64,65,67,68,75,78,82 Some articles also noted that in sanctioned countries, patients were often required to pay in advance for surgeries and bring to the hospital necessary medical items for treatment. 56,75 About a third of the articles (38%; 9/24) reported that many patients were denied care or were unable to adhere to medications due to cost-related barriers 13,56,64,65,68,70,75,78,81 Reasons reported for decreased health care spending included sanctions-related deficits and blockades to financial flows, 54,59,60,70,71,75,82 rapid increases in inflation, 13,54,59,70,75 bankruptcy of medical industries, 13,67,75 decreases in the availability of the public sector to generate funding for health services, 13,54,59,60,70,73,75,82,83 and privatization of health care services. 56,…”

“…Nearly two thirds of the articles (65%; 24/37) that described the health effects of sanctions through their economic effects reported on the collapse of the local currency. Articles reported that sanctioned countries experienced currency crises such as hyperinflation 12 – 15 , 40 , 44 , 47 , 50 , 52 , 59 , 66 , 71 , 72 , 75 , 83 ; a national decline in purchasing power, especially for essentials such as medicine, gasoline, food, and construction material 13 , 42 , 44 , 59 , 78 ; restrictions on the central banks 13 , 59 , 77 , 80 , 82 ; blocked access to foreign currencies used for trade 14 , 50 , 59 , 66 , 82 ; and increased national deficits. 82 About a third (29%; 7/24) identified the role of sanctions in rising prices of essential materials, noting that during the sanctions period, there was a rise in the average price of nutritious and traditional foods, medicines and medical supplies, and gasoline.…”