Table 1 The challenges of health financing system in Iran

Catastrophic costs

[16–19]

Low level of sustainability

[15, 20–22]

Deficit and expensive payment system, relied on fee-for-service

[15, 23–25]

Inadequate share of the public sector in total health expenditures

[16]

Fragmentation of revenue sources and pooling

[15, 23, 24, 26]

Low level of efficiency

[24]

Existence of informal payments

[27, 28]

Increased treatment costs

[16]

Ineffective strategic purchasing mechanisms

[15, 29, 30]

Insufficient redistribution of cross-subsidy between the insurance schemes

[15]

Differences between tariffs of public and private services

[16]

Poor transparency of financial flow

[23, 24]