Document Type : Review articles


1 Professor of Health Service Administration, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran

2 PhD Candidate in Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

3 MSc Economy, School of Economic, Management and Social, Shiraz University, Shiraz, Iran

4 Department of Health in Disasters and Emergencies, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.

5 PhD Candidate of health services management, Student Research Committee, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran


Background and objective: Universal health coverage is considered a prerequisite for human health and security. Therefore, the current study aimed to evaluate and compare the healthcare system functions in Iran with those in successful developing countries in terms of universal health coverage (UHC).
Methods: In this comparative study, three developing countries, namely Turkey, Thailand, and China, were selected based on former studies, and the model presented by the World Health Organization in 2000 was used to compare and analyze the data. The required information from the selected countries was collected through searching the Pub Med and Scopus databases using the following keywords: "Health system review", "Health system transition", "International profiles of healthcare systems", "Financing", "Resource generation", "Service provision", "Universal health coverage", and "Health system reform".
Results: The evaluation of the healthcare system's function in four countries showed that the public sector's share of total health spending was much higher than the private sector in both Thailand and Turkey. The issues of integration of insurance funds and risk accumulation and the existence of a strong buyer organization should be considered. The comparison of the payment system in the studied countries showed that the per capita method was used in all primary cares, and the inpatient diagnostic group (diagnosis-related group), fee for service, and salaries and rewards were more focused in the context of hospitalization. The majority of hospitals in the studied countries were state-owned; however, the important point was the presence of different non-university public hospitals in these countries, compared to Iran.
Conclusion: In general, one way to reach the UHC is to utilize the experiences of successful countries in establishing and maintaining this issue.


  1. Asante AD, Irava W, Limwattananon S, Hayen A, Martins J, Guinness L, et al. Financing for universal health coverage in small island states: evidence from the Fiji Islands. BMJ Global Health. 2017;2(2):e000200. doi: 10.1136/bmjgh-2016-000200. [PubMed: 28589017].
  2. Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, et al. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ. 2017;95(7):537-9. doi: 10.2471/BLT.16.187476. [PubMed: 28670019].
  3. Osborn D, Cutter A, Ullah F. Universal Sustainable Development Goals: understanding the transformational challenge for developed countries. Stakeholder: Report of a study by Stakeholder Forum; 2015.
  4. Islam MR, Rahman MS, Islam Z, Sultana P, Rahman MM. Inequalities in financial risk protection in Bangladesh: an assessment of universal health coverage. Int J Equity Health. 2017;16(1):59. doi: 10.1186/s12939-017-0556-4. [PubMed: 28376808].
  5. Rahman MM, Karan A, Rahman MS, Parsons A, Abe SK, Bilano V, et al. Progress toward universal health coverage: a comparative analysis in 5 South Asian countries. JAMA Intern Med. 2017;177(9):1297-305. doi: 10.1001/jamainternmed.2017.3133. [PubMed: 28759681].
  6. Kutzin J. Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ. 2013;91(8):602-11. doi: 10.2471/BLT.12.113985. [PubMed: 23940408].
  7. Beattie A, Yates R, Noble DJ. Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children. BMJ Global Health. 2016;1(Suppl 2):i12-8. doi: 10.1136/bmjgh-2016-000190. [PubMed: 28588989].
  8. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. Lancet. 2012;380(9845):933-43. doi: 10.1016/S0140-6736(12)61147-7. [PubMed: 22959390].
  9. World Health Organization. Tracking universal health coverage: first global monitoring report: Geneva: World Health Organization; 2015.
  10. McIntyre D, Ranson MK, Aulakh BK, Honda A. Promoting universal financial protection: evidence from seven low-and middle-income countries on factors facilitating or hindering progress. Health Res Policy Syst. 2013;11(1):36. doi: 10.1186/1478-4505-11-36. [PubMed: 24228762].
  11. World Health Organization. The world health report 2000: health systems: improving performance. Geneva: World Health Organization; 2000.
  12. Tatar M, Mollahaliloğlu S, Şahin B, Aydın S, Maresso A, Hernández-Quevedo C. Turkey: Health system review. Geneva: World Health Organization; 2011.
  13. World Health Organization. The Kingdom of Thailand health system review. Manila: WHO Regional Office for the Western Pacific. Geneva: World Health Organization; 2015.
  14. Meng Q, Xu L. Monitoring and evaluating progress towards universal health coverage in China. PLoS Med. 2014;11(9):e1001694. doi: 10.1371/journal.pmed.1001694. [PubMed: 25243903].
  15. Manenti A. Health situation in Iran. Med J Islam Republic Iran. 2011;25(1):1-7.
  16. World Health Organization. Western pacific country health information profiles. Geneva: World Health Organization; 2010.
  17. Kutzin J, Witter S, Jowett M, Bayarsaikhan D. Developing a national health financing strategy: a reference guide. Geneva: World Health Organization; 2017.
  18. Paek SC, Meemon N, Wan TT. Thailand’s universal coverage scheme and its impact on health-seeking behavior. Springerplus. 2016;5(1):1952. doi: 10.1186/s40064-016-3665-4. [PubMed: 27933235].
  19. Somkotra T, Lagrada LP. Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand. Soc Sci Med. 2008;67(12):2027-35. doi: 10.1016/j.socscimed.2008.09.047. [PubMed: 18952336].
  20. Manus JM. Thailand's Universal Coverage Scheme: achievements and challenges: an independent assessment of the first 10 years (2001–2010). Synthesis report. Thailand: Health Insurance System Research Office; 2012.
  21. Doshmangir L, Rashidian A, Bazyar M. Universal health coverage in Thailand: achievement and experiences learned. Hakim Res J. 2015;18(3):217-32.
  22. Menon R, Mollahaliloglu S, Postolovska I. Toward universal coverage: Turkey’s green card program for the poor. Washington DC: World Bank; 2013.
  23. Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2010;94(1):26-33. doi: 10.1016/j.healthpol.2009.08.006. [PubMed: 19735960].
  24. Maeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich MR. Universal health coverage for inclusive and sustainable development: a synthesis of 11 country case studies. Washington DC: World Bank Publications; 2014.
  25. Mossailos E, Djordjevic A, Osborn R, Sarnak D. International profiles of health care systems: Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States. New York: The Commonwealth Fund; 2017.
  26. Chen M, Zhao Y, Si L. Who pays for health care in China? The case of Heilongjiang province. PloS One. 2014;9(10):e108867. doi: 10.1371/journal.pone.0108867. [PubMed: 25271768].
  27. Janati A, Maleki MR, Gholizadeh M, Narimani M, Vakili S. Assessing the strengths & weaknesses of family physician program. Knowl Health. 2010;4(4):38-43.
  28. Akhavan Behbahani A, Alidoost S, Masoudi Asl I, Rahbari Bonab M. Investigating the performance of Iran’s health insurance organization and providing solutions for improvement: a mixed method study. J Iran Health Insur. 2018;1(3):88-96.
  29. Hanvoravongchai P. Health financing reform in Thailand: toward universal coverage under fiscal constraints. Washington DC: World Bank; 2013.
  30. Ferdosi M, Vatankhah S, Khalesi N, Ebadi Fard Azar F, Ayoobian A. Designing a referral system management model for direct treatment in social security organization. J Mil Med. 2012;14(2):129-35.
  31. Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I, et al. Universal health coverage in Turkey: enhancement of equity. Lancet. 2013;382(9886):65-99. doi: 10.1016/S0140-6736(13)61051-X. [PubMed: 23810020].
  32. Yasar GY. Health transformation programme in Turkey: an assessment. Int J Health Plan Manag. 2011;26(2):110-33. doi: 10.1002/hpm.1065. [PubMed: 21674612].
  33. Damari B, Vosoogh-Moghaddam A, Delavari A. How does the ministry of health and medical education of iran protect the public benefits? Analysis of stewardship function and the way forward. Hakim Res J. 2015;18(2):94-104.
  34. Jabbari H, Tabibi J, Delgoshaii B, Mahmoudi M, Bakhshian F. Comparative study of decentralization mechanisms in health care delivery in different countries and suggesting a model for Iran. Health Manag J. 2007;10(27):33-40.
  35. Reshadat S, Najafi F, Karami-Matin B, Soofi M, Barfar E, Rajabi-Gilan N, et al. Measuring financial protection in hospitalized patients after the health sector evolution plan in Iran. Health Scope. 2017;6(4):e63163. doi: 10.5812/jhealthscope.63163.
  36. Piroozi B, Rashidian A, Moradi G, Takian A, Ghasri H, Ghadimi T. Out-of-pocket and informal payment before and after the health transformation plan in Iran: evidence from hospitals located in Kurdistan, Iran. Int J Health Policy And Manag. 2017;6(10):573-86. doi: 10.15171/ijhpm.2017.16. [PubMed: 28949473].
  37. Doshmangir L. Assessment of Turkey’s achievements in universal health coverage. Hakim Res J. 2015;18(3):233-45.
  38. Pazouki M, Rezaii A, Pazouki M. Effectiveness of methods of financing the health sector in the economy of Iran. The Fifth Conference of the financing system in Iran, Tehran, Iran; 2012.
  39. Maher A, Bahadori M, Ravangard R. The integration of health insurance funds as a reform approach in Iran. Shiraz E Med J. 2017;18(2):e45600. doi: 10.17795/semj45600.
  40. Bazyar M, Rashidian A, Kane S, Mahdavi MRV, Sari AA, Doshmangir L. Policy options to reduce fragmentation in the pooling of health insurance funds in Iran. Int J Health Policy Manag. 2016;5(4):253-8. doi: 10.15171/ijhpm.2016.12. [PubMed: 27239868].
  41. Hajimahmoudi H, Zahedi F. Justice in the healthcare system: payment and reimbursement policies in Iran. Iran J Med Ethics Hist Med. 2013;6(3):1-16.
  42. Babashahy S, Baghbanian A, Manavi S, Sari AA, Manesh AO, Ronasiyan R. Towards reforming health provider payment methods: evidence from Iran. Health Scope. 2017;6(1):e33575. doi: 10.5812/jhealthscope.33575.
  43. Ayubi E, Mansori K, Ahmadi Pishkoohi M, Khazaei S. Children mortality in Iran: Moving ahead with the sustainable development goals. Int J Pediatr. 2016;4(6):1829-31.
  44. Ramandi SD, Niakan L, Aboutorabi M, Noghabi JJ, Khammarnia M, Sadeghi A. Trend of inequality in the distribution of health care resources in Iran. Galen Med J. 2016;5(3):122-30.