Goudarzi Zahra, Nouhi Mojtaba, Heydari Majid, Bijlmakers Leon
Faculty of Medical Information and Management, Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Health Economics, School of Medicine, Shahed University, Tehran, Iran; High Council for Health Insurance, Ministry of Health and Medical Education, Tehran, Iran.
J Cancer Policy. 2025 Jun;44:100571. doi: 10.1016/j.jcpo.2025.100571. Epub 2025 Mar 15.
As part of efforts to achieve Universal Health Coverage for priority conditions in Iran, it is crucial to evaluate the breast cancer service package and identify aspects that may require adjustment. This study analyzes the current state of breast cancer service supply, service delivery platforms, health insurance coverage, and patient co-payment levels.
The Universal Health Coverage Compendium (UHCC) developed by WHO served to list and distinguish various types of breast cancer services. Information from health insurance agencies in Iran was obtained on actual service provision in the country. The Universal Health Coverage Service Planning Delivery and Implementation (UHC-SPDI) tool was used to assess the scope of breast cancer service delivery in Iran and human workforce levels, and to identify possible gaps in service coverage.
All 73 actions listed as breast cancer services in the UHC-SPDI are provided in the Iranian healthcare system, with a strong reliance on out-patient centers and hospitals rather than primary health care facilities as service delivery platforms, reflecting suboptimal integration of service delivery. Eighty-seven percent of the services are recognized and accepted by health insurance agencies, with cost coverage levels ranging from 20 % for magnetic resonance imaging to 100 % for intravenous targeted therapy for metastasis. Genomic tests and four medicines (Pembrolizumab, Pertuzumab, Anastrozole, and Fluorouracil) are not covered by health insurance.
The UHC-SPDI has offered an instrumental framework for a comprehensive assessment of Iran's national breast cancer service package composition by connecting it to the service delivery system and human resources competencies. There is room for improvement of the breast cancer service package in Iran, not only in terms of their health insurance coverage, but also in terms of their actual delivery.
作为伊朗实现优先疾病全民健康覆盖努力的一部分，评估乳腺癌服务包并确定可能需要调整的方面至关重要。本研究分析了乳腺癌服务供应的现状、服务提供平台、医疗保险覆盖范围和患者自付费用水平。
世界卫生组织制定的《全民健康覆盖纲要》（UHCC）用于列出和区分各类乳腺癌服务。获取了伊朗医疗保险机构关于该国实际服务提供情况的信息。使用全民健康覆盖服务规划、交付和实施（UHC-SPDI）工具评估伊朗乳腺癌服务的提供范围和人力水平，并确定服务覆盖方面可能存在的差距。
伊朗医疗系统提供了UHC-SPDI中列为乳腺癌服务的所有73项行动，严重依赖门诊中心和医院而非初级卫生保健设施作为服务提供平台，这反映出服务提供的整合欠佳。87%的服务得到医疗保险机构的认可和接受，费用覆盖水平从磁共振成像的20%到转移灶静脉靶向治疗的100%不等。基因组检测和四种药物（帕博利珠单抗、帕妥珠单抗、阿那曲唑和氟尿嘧啶）未纳入医疗保险覆盖范围。
UHC-SPDI通过将其与服务提供系统和人力资源能力相联系，为全面评估伊朗国家乳腺癌服务包构成提供了一个有用的框架。伊朗乳腺癌服务包不仅在医疗保险覆盖方面，而且在实际提供方面都有改进的空间。
