Health Systems of Iran and Portugal: A Comparative Study

Background: A health system consists of people, institutions, and resources that provide health services to meet the health needs of the target population. Health systems in developed and developing countries have different characteristics from which some lessons can be learned. The aim of this study is to compare the two health systems of Portugal and Iran. Methods: The study was conducted in 2021 using a comparative study approach. The WHO's six building blocks framework was used for the comparison (i.e., governance and leadership, health financing, health workforce, health information system, medication, and service delivery). A six-step protocol was used to review the literature. International databases such as Medline / Pub Med and Scopus were searched. Policy briefs, reports, and dissertations were also reviewed. Results: In both countries, the Ministry of Health is centrally responsible for health system governance. Healthcare financing is 80% government-funded in Portugal and 55% in Iran. In both countries, Health systems are mixed (NHS, NHI, and out-of-pocket model) and the unbalanced regional distribution is a major problem for human resources. In Iran, generic drugs are used, while Portugal combines generic and branded systems. In both countries, there are some challenges in integrating health information systems for health centers and hospitals. Conclusion: In both countries, some autonomy should be delegated to the regions. In Iran, public sector investment in the health system in Iran should be increased to reduce the currently very high out-of-pocket payments in the health system. In both countries, the distribution of resources, especially human resources, should be modified by designing some incentives. Increasing the share of generic drugs in Portugal will have a positive impact on cost control in the drug sector. It seems necessary to develop programs to strengthen the health information system in both countries.