Universal Health Coverage in Iran: International Experience, National Reform, and a Governance-and-Trust Perspective

Objective: Universal health coverage (UHC)—ensuring everyone can obtain needed health services without financial hardship—is a core Sustainable Development Goal (target ۳.۸), yet global progress has stalled. This narrative review synthesizes the international experience of health financing and UHC and examines Iran’s health insurance system and reforms, updating both the international and national pictures. Results: as of ۲۰۲۱, about ۴.۵ billion people were not fully covered by essential services and roughly ۲ billion faced financial hardship from out-of-pocket payments. Countries that advanced coverage, such as Thailand and Turkey, unified risk pools, adopted strategic purchasing, and strengthened primary care. Iran built an admired primary health care network, established the Iran Health Insurance Organization (۲۰۱۲), and extended coverage to millions through the ۲۰۱۴ Health Transformation Plan—even covering refugees—but still faces fragmented pooling, a large informal sector, high out-of-pocket and informal payments, and financing-sustainability strains. Conclusion: financing mechanics are necessary but not sufficient; whether they yield coverage, protection, and equity depends on governance quality and institutional trust. We propose a governance-and-trust framework and policy directions, concluding that Iran’s remaining distance to UHC is largely a governance distance.

کلیدواژه ها:

universal health coverage ، health insurance ، health financing ، Iran ، out-of-pocket payments ، health-system governance ، institutional trust ، equity