CHAPTER TWENTY FIVE:

Health and Medical Care

 

ARTICLE 192-

   A- The following measures shall be taken in order to enhance the efficiency of the medical care, to develop health and medical care services in the country, to facilitate accessibility of the public to these services, and also to determine the scope and extent of the government and non-public sectors’ responsibility in these areas:

     1- All the hygienic services in urban and rural areas will be rendered by government free of charge.

     2- The outpatient medical care services for the rural population will be provided by government in the existing units. Development of the rural medical care centers in the regions where there is no incentive for the private and cooperative sectors to invest will also be made by government.

     3- The urban outpatient medical care services in the existing health and medical care centers is the responsibility of the government, but further development of these services shall be made possible through participation of the private and cooperative sectors.  Development of the public sector activities will be confined to the regions where the private sector finds no incentive to make investment.

     4- Government will continue its undertakings in providing inpatient medical care in the undeveloped or less-developed regions and towns (of less than one hundred thousand population) and will provide educational beds proportionate with the number of students of the medical science universities.  Development of the inpatient treatment centers in large cities (of over one hundred thousand population) shall be the responsibility of the non-public sectors.  Moreover, in the large cities facilities will be provided to divest the existing inpatient treatment facilities and to set up new inpatient treatment center by the non-governmental sectors, with priority given to the medical cooperative groups.

     5- The Welfare Organization is charged with taking action in preparation, design and execution of a plan for reorganizing and rehabilitating chronic mental patients and the aging people during the first year of the Plan.

   The executive by-law of the above Item shall be prepared through cooperation of the Ministry of Health-Medicare and Medical Education, and the Plan and Budget Organization.  The by-law shall be approved by the Cabinet.

   B- In order to enhance efficiency and participation of the employees and the public in provision of the health, medical care, pharmaceutical and rehabilitation services, Ministry of Health-Medicare and Medical Education is authorized to take the following actions, taking into consideration the provisions of Item (A) of this Article:

     1- To compensate the specified services rendered by its own employees according to the approved tariffs (service charge system instead of daily payment).  The non-public sector may provide the same services likewise.

     2- Payment of a portion of the proceeds of the services rendered by the employees in the units under auspices of the government to them in the form of merit rewards aiming at enhancing the work efficiency of the employees.

     To implement the provisions of Item (B) of this Article, the required funds will be provided in the annual budget bills. The proceeds of the same services in each province shall be appropriated within the framework of the annual budget in order to develop the quality and quantity of the health and medical care services in the same province.

   The executive by-law of this Item including identification of the status of the active employees, the criteria for defining the  services to be rendered, the manner of assigning the services, the manner of pricing the services, the mode of payment,  and the manner of spending the proceeds, etc. will be prepared within a maximum period of six months from the date of enactment of this Law jointly by the Ministry of Health, Medicare and Medical Education and the Plan and Budget Organization for the Cabinet for approval.

ARTICLE 193- In order to secure and properly distribute the inpatient treatment services in proportion to the needs of different regions of the country, and in due consideration of two important factors of accessibility of the services to individual people and to prevent over-investment, classification and grading the inpatient treatment services while taking into account the compensation for the cost of patient transportation, and preserving the ratio of the dispatched patients from the lower levels by government, shall be performed according to the different specializations and their locations as broken down by county.  The establishment, development, and equipping  the country’s inpatient treatment facilities, and also, allocating the manpower to provide the treatment services shall be done according to the organization and grading of the country’s treatment services.  The criteria and the grading program for the country’s inpatient treatment services shall be prepared jointly within six months from the enactment of this law, by the Ministry of Health-Medicare and Medical Education and the Plan and Budget Organization, for approval by the Cabinet.

   A- To achieve the goals of service grading, the Ministry of Health, Medicare and Medical Education is required to take necessary actions during the Third Plan period to eliminate inadequacies of the services and to reduce the possibilities of over-treatment in excess of need, including the excess manpower, equipment, replacing the outworn and dilapidated and substandard units, in order to make necessary adjustment in the existing inpatient treatment capacities and ordering the urgent medical services.

    Note: In order to range the care-taking services of the accident victims and to improve the emergency care system, government is required to set up urgent care system (trauma centers) for these patients and convert sections in the medical care centers to these units (trauma centers), and establish new centers wherever needed in such a way that all the accident victims could receive the urgent care free of charge.

    B-  In order to adapt and harmonize the proper and needed capacities with the existing capacities, the whole set of the country’s inpatient treatment facilities including those of the Ministry of Health, Medicare and Medical Education, the Social Security Organization, banks and the state-owned enterprises, Armed Forces, the charity and private organizations, and the like will be viewed as one integrated system and seen together as a whole regardless of their proprietorship and management.

   C- In order to enhance the quantity and quality level of the rehabilitation services and facilitate people’s accessibility to these services aiming at equalizing the opportunities and enabling the disabled to actively participate in the society, proper preparation  of the public facilities (private or public) will take place during the Third Plan.  Moreover, during the Plan period, a certain number of sanitariums will be allocated to the war-injured female patients; the use of ambulance service for the war-injured with the intensity of above seventy percent (70%), spinal cord cut, neurological,  psychological and chemical war victims shall be provided free of charge.

   The executive by-law of this Item to be prepared through cooperation of the Ministry of Housing and Urban Planning, the State Administrative and Employment Affairs Organization and the Plan and Budget Organizations, and shall be approved by the Cabinet.

ARTICLE 194- All the centers of production and distribution of the food items, cosmetic and hygienic products and also all the centers rendering services related to the these areas must, in addition to complying with the hygienic criteria that will be set forth by the Ministry of Health-Medicare and Medical Education and other related agencies, obtain periodical certificate of inspection and compliance from the legal and real persons (public and private) whose qualification in the matter has been confirmed for a certain period of time by the aforesaid agencies.  Ministry of Health, Medicare and Medical Education and other concerned agencies are required to monitor continually the services of the real and legal persons whose qualification has been confirmed.  In case of any violation the qualification license must be revoked and the matter be reported to the competent authorities.

   The by-law of this Article including the method of identification of the production, distribution and service units content of this Article, determining the period of validity of the hygienic certificate for any of the concerned centers, tariff rating, handling the violators either to charge them or to refer them to the court of law, the criteria for determining qualification of the real and legal supervisors, and other related matters will be prepared within a maximum period of six months from the date of enactment of this Law by the Ministry of Health, Medicare and Medical Education in cooperation with the relevant agencies and shall be approved by the Cabinet.

ARTICLE 195-Setting up and building any type of medical treatment unit by the entities content of Article (11) of this law and the non-public entities and institutions except Ministry of Health, Medicare and Medical Education and Ministry of Housing and Urban Planning (as the executor) and except for the cases authorized in Article (192) of the Law, is prohibited.  Setting up and building medical care units by the aforesaid entities in urgent cases shall be permissible upon confirmation by the Ministry of Health, Medicare and Medical Education and ratification of the Cabinet.  Special centers for treatment of the war-injured are excluded from this provision.

ARTICLE 196- The following measures will be taken in order to regulate the pharmaceutical market, to provide  the required foreign exchange and import of the pharmaceutical raw material and medicine, to prevent irregular increase of price of the urgent hygienic drugs for long term use, to support the insurance system and also to prevent the side effects and risks related to the use of drugs:

   A- The list of authorized drugs will be published annually.  Import, production, distribution and administration of the medicine, other than those listed officially, are prohibited.

   B- Import of raw material for production of medicine and import of the subsidized drugs will take place at the official rate of exchange.  In the event of change in the rate of foreign exchange, the differentials will be computed and provided for within the budget law in form of subsidy in local currency (Rial) .   

   C- The hygienic and necessary drugs for long term use and the drugs needed for refractory and the war-injured patients are entitled to receive subsidy in local currency (Rial) in addition to the facilities indicated in item (B) of this Article.

   D- The Rial subsidy and the differentials indicated in items (B) and (C) of this Article shall be paid proportionate with the coverage of population by the insurance and through strengthening and expansion of the insurance system.

   F- Supply of drug to the end-users out of the pharmacy system  (with the exception of non-prescription pharmacies whose list will be made available by the Ministry of Health, Medicare and Medical Education) is prohibited.

   G- In order to guarantee the quality of the drugs produced domestically, all factories producing medicine are required to control the quality of their products by setting up the quality control units and utilizing the service of the specialists in the field.  To achieve this objective, the said factories are authorized , in coordination with the Ministry of Health, Medicare and Medical Education, to utilize up to fifty percent (50%) of the revenue content of the Law of Amending Item (2) and Note (2) of Article (5) of the Law of the Need for Re-training and Training of the Medical Society enacted on 5/09/1992, within the framework of the annual budget.

   H- One hundred percent (100%) of the per capita share subject of the Law of the Universal Insurance of the Country’s Medical Services enacted on 24/10/1994 for the war-injured patients, and also the doubled insurance of the war-injured patients with the intensity of fifty percent (50%) and over, provisions for import of drugs and medical and rehabilitation equipment for the war-injured patients will be paid through the foreign exchange at the official rate, and they will be exempted from charges, tax, customs fees and the trade tariffs.

   The executive by-law of this Article shall be prepared by he Ministry of Health, Medicare and Medical Education, and shall be approved by the Cabinet.

ARTICLE 197- In order to institutionalize food security (accessibility of all the society to sufficient and healthy food), to improve people’s diet, to reduce sickness emanating from malnutrition, and to promote the society’s health, Ministry of Health, Medicare and Medical Education is required to determine, within a maximum period of one year, the desirable diet and nutritional basket.   The following actions shall be taken in order to materialize the said basket:

   A- The cultural and educational ministries and the Islamic Republic of Iran Broadcasting Organization are required to take measures to enhance awareness, to promote nutritional culture and to provide people with necessary training in order to secure the desirable nutritional basket.

   B- In allocating the financial resources in form of subsidy on food items and upon soliciting the opinion of the Ministry of Health, Medicare and Medical Education, the Economic Council shall prepare the ground for implementation of the policies of desirable nutritional basket.

   C- In order to eliminate malnutrition amongst the low income families, the subsidies granted to the needy and rural inhabitants and residents of the less-developed area will be increased in proportion to the rest of the population.

   D- In order to raise the level of public health, Iran Standard and Industrial Research Institute is required to prepare the whole set of the food safety standards no later than the end of the Third Plan, and advise the Ministry of Health, Medicare and Medical Education and other relevant agencies in order to enable them to impose quality control over the production and supply of the food items.

   E- The proper structure and organization of food and nutritional safety at the national and provincial levels will be designed by the Ministry of Health, Medicare and Medical Education within six months from the date of enactment of this Law, and to be approved by the Cabinet upon confirmation of the State Administrative and Employment Affairs Organization.