Without insurance coverage and fair tariffs, rehabilitation services are being devalued and auctioned. Therapists routinely discount up to 50% against official Ministry of Health rates simply to keep their patients.
By Young Journalists Club – Health and Medical Section
The lack of insurance coverage for rehabilitation services and the absence of fair and logical tariffs have led to the devaluation and “auctioning” of healthcare services.
According to Dr. Nader Alirezaloo, Ph.D. in Cognitive Neurosciences, occupational therapy services are among the most expensive in the field of rehabilitation. The high number of therapy sessions imposes a heavy financial burden on families in need. As a result, many therapists, despite the official tariffs announced by the Ministry of Health, are often forced to offer up to 50% discounts in order to retain their patients.
He explained that occupational therapy, as one of the core rehabilitation sciences alongside physiotherapy and speech therapy, is taught under the supervision of the Ministry of Health, Treatment, and Medical Education at rehabilitation faculties of several medical universities across the country.
Dr. Alirezaloo emphasized that this field provides a holistic approach—ranging from prevention to community-based rehabilitation—addressing issues and disorders occurring before, during, and after birth, from childhood through adulthood and into old age. However, despite the broad scope of its services, occupational therapy has not yet achieved its rightful position within the national healthcare system.
He added that in most developed countries—such as Germany, the UK, and the United States—occupational therapy is among the most widely used medical and human service professions in the health sector.
Analyzing the current situation in Iran, Dr. Alirezaloo pointed out several major issues:
The absence of official job classifications and hiring positions in public or private hospitals,
Lack of insurance coverage for occupational therapy services,
Unequal distribution of facilities and services between large cities and other regions,
Insufficient number of trained professionals across the country,
Lack of awareness among physicians regarding the role of occupational therapy in rehabilitation,
Limited public knowledge of its benefits, and
Absence of media programs introducing this relatively new field within the healthcare system.
He warned that these factors together have hindered the development of occupational therapy in Iran’s healthcare system and must be addressed seriously.
Dr. Alirezaloo further compared the field to physiotherapy, which, thanks to broader institutional support and better access to developmental resources, has successfully positioned itself on par with other medical specialties and attracted both public and private funding for growth. He noted that implementing logical rehabilitation tariffs would promote equity in healthcare and strengthen the overall health system.
Declining Income of Occupational Therapy Clinics: A Barrier for New Graduates
Occupational therapy is one of the costlier rehabilitation services. The lack of insurance support and the need for multiple treatment sessions impose heavy costs on families. Consequently, therapists often provide significant discounts—up to 50%—below the official Ministry of Health tariffs. Over time, this reduces clinic revenue and discourages new graduates from entering or continuing in the field.
Dr. Alirezaloo added that graduates at the bachelor’s, master’s, and doctoral levels can establish private occupational therapy offices with a license from the Medical Council. However, despite these opportunities, they still face numerous challenges in practice.
Referral System Needs Reform
He pointed out that another key issue is the referral system from physicians. Many doctors fail to refer patients who need rehabilitation, resulting in increased complications and higher treatment costs in the long term.
Currently, occupational therapy offices can only operate under a license from the Medical Council, which requires therapists to work under physician supervision. These offices are classified merely as “therapy offices,” not clinics or institutions. However, rehabilitation is inherently multidisciplinary, and combining different fields produces far more effective results for patients.
Due to limited awareness among many physicians about the breadth of occupational therapy services and the absence of an organized national referral system, many private offices are forced to shut down because of high rent and equipment costs combined with a low patient volume.
Tariff Regulation Still Lacking Despite Ministry Efforts
In recent years, following the establishment of the Rehabilitation Office in the Ministry of Health and under the leadership of Dr. Mohammad Taghi Joghatai, the process of tariff-setting for occupational therapy has become more structured. However, despite official announcements of tariffs each year, they are not being properly implemented.
Dr. Alirezaloo noted that while tariffs are calculated based on service value and time spent, many families cannot afford to pay these official rates. Consequently, therapists are compelled to charge significantly less.
He stressed that the absence of clear and practical tariffs causes difficulties for both therapy centers and the patients in need of these services. Since promoting justice and equity in health is a declared goal of health policymakers, this issue must not be ignored.
According to Dr. Alirezaloo, the most crucial solution is the timely establishment of fair and reasonable rehabilitation tariffs. After the right to set private-sector medical tariffs was removed from the Medical Council, it was mandated by law that the High Council of Insurance announce and enforce them annually. Therefore, the first step toward reform is to implement the law correctly by announcing tariffs on time, and the next step is to adjust them according to inflation and public affordability.