Assessment of Methods for Determination of Medical Tariffs in Developed Countries and Proposing a Model for Iran

The article aims to present the experiences of the countries having a proper status in the ranking of the World Health Organization or their tariffs models have been frequently used in Iran. Delphi method and opinions of experts have been used for presenting a proper model and solutions. Data collection about Iran and other countries is based on library recourses until the end of 2011. Methods for determination of medical tariffs in these countries are affected by the financing system of the health sector. In countries with an integrative approach، the priority is given to the method of purchasing services، the professional associations are responsible for determination of medical tariffs، and the government has a regulatory role and final announcement of the tariffs. In countries with Beverage model، the focus is on the public sector and the tariffs are determined by receiving opinions of professional associations. In Bismarck model، the focus is on the sickness funds، which mostly purchase services. Regarding the current situation of Iran and based on the research findings، the structure، organization and management of medical tariffs require revising. In determination of medical tariffs، participation of all relevant groups and centrality of relative value units are suggested. Due to the geographical area of Iran and the significant difference in the consumer price index، especially in medical products، the regional approach should be the second priority. The research findings could be used for the structure of policymaking in the Supreme Council of Health Insurance.