Key points
- Iran runs a mixed system: public insurance covering about 95% of the population, built on a primary health care network of health houses staffed by community health workers (behvarz).
- Coverage is near-universal: about 95% of the population is enrolled in public insurance plans, through four main insurers led by the Social Security Organization.
- Care is delivered by health houses, health posts and comprehensive health centres for primary care, and by district and specialist hospitals.
- Patients typically pay 10% of inpatient costs and 30% of outpatient costs, and households still paid 43.1% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 77.7 years in 2023, and health spending was 6.0% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
Direct answer: Iran runs a mixed system: public insurance covering about 95% of the population, built on a primary health care network of health houses staffed by community health workers (behvarz). Coverage is near-universal: about 95% of the population is enrolled in public insurance plans, through four main insurers led by the Social Security Organization. Care is delivered by health houses, health posts and comprehensive health centres for primary care, and by district and specialist hospitals. Patients typically pay 10% of inpatient costs and 30% of outpatient costs, and households still paid 43.1% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 77.7 years in 2023 — and healthy life expectancy 65.6 years — and health spending was 6.0% of GDP in 2023 (WHO Global Health Estimates, October 2026; World Bank, WHO Global Health Expenditure Database).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — public insurance + primary health care network |
| Who pays | Payroll contributions to the public insurers (Social Security Organization, Iran Health Insurance Organization, Armed Forces Medical Services Insurance Organization), government funding, and out-of-pocket payments on top |
| Who delivers | Health houses, health posts and comprehensive health centres for primary care; district and specialist hospitals, public and private, for the rest |
| What is free at the point of use | Primary care, maternal care and child services including immunisation; treatment for children under 7 in public facilities since early 2024; care at Social Security Organization-owned facilities for its members |
| Life expectancy at birth | 77.7 years (2023, WHO Global Health Estimates) |
| Health spending | 6.0% of GDP (2023, World Bank, WHO Global Health Expenditure Database) |
| Source for the model and coverage | Commonwealth Fund — Iran country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Iran’s system is centrally overseen by the Ministry of Health and Medical Education, which since 1985 has combined health care delivery with medical education — a combination that is relatively rare internationally. In the same year the primary health care network was set up: rural health houses (khaneh behdasht), each serving 1,000 to 1,500 residents and staffed by trained community health workers (behvarz), with health posts and urban comprehensive health centres as the urban equivalent. The network improved vaccination rates and maternal and child health outcomes, particularly in rural areas. The Health Transformation Plan of 2014 then aimed to expand insurance coverage, cut out-of-pocket payments and improve hospital quality (Commonwealth Fund).
The first point of contact is the health house in rural areas and the health post or urban comprehensive health centre in cities, staffed by behvarz and GPs, with dentists, nutritionists, psychologists and occupational health experts in many centres. Secondary care is provided at district health centres and general and specialist hospitals, and tertiary care at specialist hospitals, many of which also train health professionals. Referral runs through the primary care tier, and the Each Home a Health Post initiative, launched in 2019, mobilised volunteers for health literacy and, during COVID-19, for triage and contact tracing.
Who pays, and what people pay
Four main organisations make up the public insurance system. The Social Security Organization, the largest, covers over 50% of the population — private-sector employees, the self-employed and some government-affiliated workers — on contributions of 9% of salary (2% employee, 6% employer, 1% government). The Iran Health Insurance Organization covers rural residents, civil servants, students and informal-sector workers; civil servants contribute 2.3% of salaries, and cover for rural residents and marginalised groups is government-funded. The Armed Forces Medical Services Insurance Organization covers military personnel and their families on 7% of wages. Under most plans patients pay 10% of inpatient costs and 30% of outpatient costs; rural residents using the referral system pay 3% for inpatient care, and Social Security Organization members pay nothing at its own facilities. In 2022 total health expenditure was USD 19 billion, or USD 221 per person. What people still pay is substantial: households paid 43.1% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database), mostly for private-sector and outpatient care — and international economic sanctions have restricted access to health care services and essential medicines.
What is free, and what is not
Primary care, maternal care and child services including immunisation have long been free through the primary care network, and in early 2024 the government extended free outpatient and inpatient treatment in public facilities to children under age 7. The Health Transformation Plan cut inpatient co-payment caps in public hospitals to 6% for urban residents and 3% for rural residents, and extended insurance to about 10 million previously uninsured people. What is not free is the margin: the typical 10% inpatient and 30% outpatient shares, dental and optical services outside the basic plans, rehabilitation only partly covered, and private care — the private sector delivers about 80% of outpatient services and 30% of inpatient services, and patients pay directly for about 35% of the cost of private health services. About 20% of the population holds private insurance to fill those gaps.
How it compares
Iran spends 6.0% of GDP on health (2023), below the OECD average of 9.3% (2024), and its life expectancy of 77.7 years is 3.4 years below the OECD average of 81.1 years (2023). Iran is not in the OECD tables, so its figures come from WHO and World Bank sources for 2023 rather than the OECD’s 2024 dashboards. Its distinguishing feature is the primary care network: health houses and behvarz reaching into villages since 1985, under a single ministry that runs both health services and medical education, carrying near-universal insurance enrolment — while sanctions squeeze medicines and household payments of 43.1% show the cover still leaves a large bill with patients. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
What is a behvarz?
A trained community health worker staffing a rural health house (khaneh behdasht) in Iran's primary health care network, set up in 1985. Each health house serves 1,000 to 1,500 residents with immunisations, maternal and child health care and chronic disease management.
What is the Health Transformation Plan?
Iran's 2014 reform (Tarh-e Tahavol-e Salamat), aimed at expanding insurance coverage, reducing out-of-pocket payments and improving hospital quality. It extended health insurance to about 10 million previously uninsured people and cut inpatient co-payment caps in public hospitals to 6% for urban residents and 3% for rural residents.
What do patients pay?
Typically 10% of inpatient service costs and 30% of outpatient costs under most insurance plans — less for rural residents using the referral system, and nothing at facilities owned by the Social Security Organization. Households still paid 43.1% of health spending out of pocket in 2023, mostly for private and outpatient care.