اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

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کد مقاله 1627

عنوان Paying for the Right Test: Laboratories, Health Insurers and the State, and a Strategic Purchasing Model for Iran

نویسندگان Mehdi Mahdavian Sadr - Fatemeh Sadeghi

چکیده Background: Laboratory tests shape most clinical pathways, and in most health systems an insurer pays for them. How laboratories, insurers and the state interact decides which tests are performed, at what price and with what quality. Iran, with over 8,200 laboratories, several basic insurance funds and centrally approved tariffs, lacks an explicit model for this relationship. Method: A comparative narrative review of laws, payer and regulator documents, audit reports and peer-reviewed studies, mainly from 2016-2026. The United States, Germany, France and Australia were analysed against four interfaces between laboratories and payers (entry, price, volume and information) and the role of the state; Iran was examined with the same frame. Finding: The cases show four roles for the state: market referee in the United States, delegating steward in Germany, negotiating partner in France and conditional payer in Australia. Stronger arrangements link quality to the right to bill, control price and volume together through budgets, negotiated growth caps or ordering rules, and set prices through transparent procedures. In Iran the state is at once owner, price-setter and regulator; tariffs are not based on systematic costing, laboratories are not graded, insurers pay rather than purchase, and electronic prescribing is not used to guide ordering. Conclusion: We propose a strategic purchasing model for Iran in which the state acts as steward and the basic insurers purchase jointly, with graded contracting, costed tariffs under a multi-year price-volume protocol, shared ordering rules in electronic prescribing and results that follow the patient, phased in between 2027 and 2035.

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