Trends and opportunities
According to the Iranian Constitution, the government is required to provide every citizen of the country with access to social security that covers retirement, unemployment, old age, disability, accidents, calamities, health and medical treatment and care services. This is covered by public revenues and income derived from public contributions.
Today the largest healthcare delivery network is owned and run by the Ministry of Health and Medical Education (MOHME) through its network of health establishments and medical schools in the country. MOHME is in charge of provision of healthcare services through its network, medical insurance, medical education, supervision and regulation of the healthcare system in the country, policymaking, production and distribution of pharmaceuticals, and research and development. Additionally, there are other parallel organisations such as Medical Services Insurance Organizations (MSIO) that have been established to act as a relief foundation as well as an insurance firm.
With a population of almost 70 million, Iran is one of the most populous countries in the Middle East. The country faces the common problem of other young demographic nations in the region, which is keeping pace with growth of an already huge demand for various public services. Fifty per cent of Iran’s population are currently under 20 years old. Soon they will be old enough to start new families, which will boost the population growth rate and subsequently the need for public health infrastructures and services.
The total market value of Iran’s health and medical sector was almost US$240 billion in 2002 and is forecasted to rise to US$310 billion by 2007.
According to the last census that Statistical Centre of Iran undertook in 2003, Iran possesses 730 medical establishments (eg. hospitals, clinics) with a total of 110,797 beds, of which 488 (77,300 beds) are directly affiliated and run by the MOHME and 120 (11,301 beds) owned by the private sector and the rest belong to other organisations, such as the Social Security Organization of Iran (SSO).
Given the performance of the private sector hospitals and the demand for their services and the fact that state owned hospitals occupancy rates is 56 per cent, privatisation of some of the state hospitals seems a move in the right direction.
Iran has been very successful in training/educating the necessary human resources for its health system. The system of almost 30 years ago where the country was facing a shortage of all kinds of skilled personnel in the health and medical sector has been completely changed into one in which the necessary professionals now completely suffice the country’s needs.
Although overall improvements have been achieved in all health areas since the 1979 revolution, the present challenging economic conditions of the country, combined with rapid advances in medical technology, individuals’ expectations, and the young demographic of the population will undoubtedly challenge the sustainability of past improving trends. Moreover there is a considerable variation in the human development index and the human poverty index across different provinces in the country.
In 2004, in line with government plans for using IT, MOHME also adopted plans to employ IT for improving the efficiency of health service providers in delivering their services to the public. Implementation of these plans, including establishing a 'National Online Health Record Service', is in the early stages. However, once it gains some momentum, significant demand will emerge for IT solution in health and medical applications.
Overall, the Iranian health services are lagging behind compared to world-class standards and need serious reforms/improvements. These reforms will need huge financial resources. Additionally stakeholders, including SSO, MSIO and MOHME will have to comply with the requirements of such reforms, however, they might mean partially losing their control over this sector.
Iran has a rather developed pharmaceutical production capability, however, the country still relies on imports for raw materials and many specialised drugs.
Iran’s Ministry of Health has a mission to provide access to sufficient quantities of safe, effective and high quality medicines that are affordable for the entire population. Since the 1979 revolution, Iran has adopted a full generic-based National Drug Policy (NDP), with local production of essential drugs and vaccines as one of the main goals.
Currently 55 pharmaceutical companies produce more than 96 per cent (quantitatively) of medicines on the market. Although over 85 per cent of the population use an insurance system to reimburse their drug expenses, the government heavily subsidises pharmaceutical production/importation in order to increase affordability of medicines. Despite significant government subsidies for pharmaceuticals, households spend about 19 per cent of their healthcare expenditures on pharmaceuticals. One major problem in this sector, according to the statistics, is over consumption/prescription of various drugs in Iran, especially antibiotics.
The regulatory environment of the country is rather strict on the import of drugs and pharmaceuticals towards companies that intend to enter into the market for the first time.
In the case of new unregistered companies, upon request of the importer, representatives of the MOHME will visit/inspect the manufacturing facility to evaluate its competency according to GMP. Once a company is registered it’s still subject to frequent inspections making sure it can sustain its competence.
In the case of the import of new medicine, if the drug is already in the Iran Pharmaceutical Index, the import is only subject to the approval of the Ministry’s accredited laboratories. Otherwise the importer of that medicine should first undertake the process of registering the drug into the list. This is subject to many requirements and can take up to one year.
Iran is a mature market when it comes to medical equipment. Most of the major international players in this sector are present in the Iran market:
- Boston Medical
- Johnson & Johnson
- Smith & Nephew
The Department of Medical Equipments in the Ministry of Health is responsible for supervising imports in this segment, but the import and distribution of such equipment is mostly handled by the private sector. There are over 100 Iranian companies representing the international suppliers in this market, handling both promotion and the after-sales service of the products.
Some of the major opportunity areas for Australian companies within the Iran health and medical sector include:
- Sophisticated medical/laboratory equipment
- Active raw ingredients for pharmaceutical production
- Pharmaceuticals for special diseases (eg. cancer, HIV, HBV, etc.)
- Medical consumables
- Biotechnological know-how/pharmaceutical products
- IT solutions for health and medical sector
- Health and medical educational services (please refer to Education and training to Iran)
Iran has undergone the primary stages of development in terms of industrialisation and a rather strong indigenous manufacturing capability exists in the country. Therefore one can expect to find a handful of local producers for basic medical equipment, making it very hard to penetrate into the Iranian market for similar imported ones.