“Give people what they need: food, medicine, clean air, pure water, trees and grass, pleasant homes to live in, some hours of work, more hours of leisure. Don't ask who deserves it. Every human being deserves it” (Howard Zinn, ‘Marx in Soho: A Play on History’). Health is considered as one of the major rights of humans and thus all people should have access to resources needed for health care. “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity” (WHO, 1947). Health systems are complex entities with many different stakeholders, including patients, clinicians, health care providers, purchaser organizations, regulators, the government and the broader public. The UK and the Persia health care services are great examples of publicly funded and privately funded health care systems respectively. By looking back on history, assessing and analyzing key findings from a branch of economics concerned with single factors and the effects of individual decisions, we can see the significant difference between the two approaches to health care structures.
Iran’s health care network started since 1985 with the aim of ensuring equitable access to care for all members of society especially for rural and deprived areas. For example, health houses are village-based units or rural health care groups that cover 1500 people in average in deprived areas. In November of last year, the General Health Insurance Law of the country was approved by the Islamic Consultative Assembly, which was followed by the establishment of the health insurance organization in the country. The purpose of the organization is to address the need for health and medical care for accidents in the form of universal insurance for government employees and optional insurers. On average, every Iranian visit a general practitioner twice a year and a specialist doctor 1.8 a year. Also, 3 out of every 7 Iranians are hospitalized annually, and 6.5 percent of gross national income is spent on medicine. Accordingly, the average number of referrals to general medicine in Iran is lower than in similar countries, but the rate of referral to specialist medicine and the cost of medication for medicine are higher than in similar countries. However, the waiting queue is very low, for example, you can see the doctor today and get surgery tomorrow, which is so quick.
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Mental problems and smoking are among the major problems that WHO facing with. Cigarette smoking is the largest preventable cause of death worldwide. According to WHO, tobacco related death was 5 million people in the year 2008, and would reach 8 million a year by 2030. Currently, one person is killed every six seconds by tobacco. Cigarettes in Iran are extremely cheap compared to Europe. A pack of local cigarette cost less than a euro, and in big cities you will also be able to find tobacco, papers and filters for those who like to roll their own cigarettes. The main reason for all of that is that Iran is one of the 14 countries in the world that don’t impose any special tax on tobacco so 50 to 55000 people per year die in Iran from tobacco-related illnesses. The cost of treatment of related disease in Persia is estimated at about 20tri Reals annually which is something around £1 billion.
In Iran, the actual statistics of people with mental health problems and other social problems that need treatment are not properly stated, but the question is what is the actual number of people with mental and psychological problems in Iran? Mental health disorders, refers to a wide range of mental health conditions that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function. The most common mental illness is depression among women and addiction among men in Iran. After cardiovascular disease and road traffic accidents, mental illness s most prevalent in Iran, with one in four families suffering from mental illness. According to a survey by the American Gallup Institute, which surveyed a number of citizens in 140 different countries, in 2018, Iran was one of the world's saddest countries. The Ministry of Health has reported that 23.6 percent of the population in Iran has one type of mental disorder, which is in line with the global average. The problem is Iran facing a severe shortage of hospitals for neuropsychiatric patients for this reason, there is no improvement in the treatment of this number of psychiatric patients. “When 30 percent of people in the community have a mental illness, 30 percent of hospitals should also be dedicated to treating these patients”, said Dr. Khosronia, head of Iranian Society of Internal Specialists, about the shortage of hospitals for mental diseases.
The British health care system is dominant by the National Health Service, which came into existence on 5 July 1948 as part of the post-war welfare settlement. The NHS is the UK's largest provider of healthcare and the largest integrated healthcare system in the world which provides publicly funded health services that are available to the whole population. The majority of funding comes from taxation rather than compulsory state insurance. However, the option remains available for people to purchase private health insurance if they wish. Since all of these costs have been paid by the government reforming and improving, the NHS has always been the focus of governments and consequently the media. The NHS has changed in all ways, when it treated his first patient, 13-year-old Silvia Digory. At that time, the government budget was around £14billion, which this amount increased up to £144.3billion in 2016-2017. However, the NHS still faces series problems. One of the main grievances of the NHS is the long waiting time for treatment. Last May, 4.2 million people were waiting in line for non-emergency treatment, of which about 3,000 were waiting more than a year. Emergency statistics are also worrying. While the goal is to have 95 percent of people examined in the emergency department within four hours, in winter the figure has fallen below 80 percent in some months.
Another worrying issue is the increasing need for care for people with anxiety, depression and other mental disorders that the NHS is barely able to provide support. One in four adults experiences at least one diagnosable mental health problem in any given year. People in all walks of life can be affected and at any point in their lives. Mental health problems represent the largest single cause of disability in the UK. The numbers of beds in hospitals are insufficient, and patients have to travel hundreds of kilo-meters to receive hospitalization. Also, there is not enough staff of specialist psychiatrists and specialized nurses for the mental health department. For decades the health and care system in England has been stacked against mental health services and stacked against the people who use them. The NHS’s long-term plan to improving problems will deliver the fastest expansion in mental health services in the NHS’s history, with thousands more adults being able to access talking therapies for common disorders and better support being offered to children and young people. Talk therapy approaches are about restoring balance in people’s lives by helping them to challenge false beliefs and assumptions that underpin their judgements and decisions about their lives. Although money is currently very tight in the health systems, the NHS freed up a further £40 million in 2014/15, recognizing that investment now will not only benefit the wider NHS, but lay the groundwork for further improvement in later years.
After all the research confirmed that harmful effects of smoking to health, England introduced smoke free law to protect individuals in publics and in workplace. The legislations introduced on the 2007, which includes smoking ban in public places, but still all areas open to the public including workplaces, are considered smoke free zones where they are enclosed or substantially enclosed. But still, in the UK, 14.7% of people aged 18 years and above smoked cigarettes in 2018, which equates to around 7.2 million people in the population. Smoking is the biggest cause of preventable deaths in England, accounting for nearly 80,000 deaths each year. One in two smokers will die from a smoking-related disease. Every 15 cigarettes that smokes will cause a mutation in body; mutations are how cancers and other problems start. It is estimated that smokers are costing the NHS more than £1.67 million a day in treatment.
With all of these problems, the US-based World Health Forum named England as one of the top 11 countries in healthcare provision last year. The NHS has done better than other similar organizations in making health services more efficient. The NHS budget is lower than the gross national income of other European countries. The health care budget for private institutions in 2016 was only 9.7 percent of gross national income, just above the OECD average. “In the past century the improvement in expectation of life of mature male from all causes has been reduced by at least half by smoking alone. This indicates that in countries behavioral influences are now more important than all other” (Mckeown, 1976, p.99). Best way to reduce the devastating impact that smoking continues to have on our population is to make smoking less affordable, less accessible and less acceptable. Many smokers stop smoking by themselves, but support with advice and information may be helpful to increase the success rate. Health education methods have been shown successful in changing smoking behaviors.
The findings of this study showed, like most countries, primary care services in both England and Iran were provided by the government, but there are many people in the Iran who don’t have medical insurance at all due to the rising costs of treatment, it’s just unaffordable to people. Many employers have also stopped offering insurance due to the very same reason. People with pre-existing health conditions are less likely to be insured by private companies, or if they manage to get insured the insurance, premiums are very likely to be high. Indeed, the NHS and the health care system in Iran have to change, have to modernize to meet the demands of new century. The modernization program provides the means to deliver easier, faster access to more consistent and higher quality care for patients. One of the major problems is that for more than three decades the NHS has been obsessed with notions of better management, but the question is why they need a manager? The manager’s job can be broadly defined as deciding what should be done and then getting other people to do; it makes optimum utilization of all available resources, helps to reduce the wastage of valuable resources and avoids their duplication. “It aims to give the highest returns at the lowest possible cost thus increases the overall efficiency” (Stewart, 1979, p.69). The most important goals of the NHS programs in the UK, in my view, should be reduce waiting time for outpatient and for selected patients requiring hospitalization, encourage the private sector to work more with the NHS and recruitment of specialists, general practitioners and nurses. Although it cannot all be achieved at once, some improvement will begin immediately. The government of both countries want to see the health system getting better every year.
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