Can Iran's Health-House Model Help Mississippi Reduce Disparities?
Health-care stakeholders are watching Mississippi's experience with a system created in Iran in the 1980s closely to see if it's worth promoting nationwide.
This past summer, The New York Times published a fascinating article about an agency in Mississippi called HealthConnect that is working to reduce admissions to the Central Mississippi Medical Center in Jackson, where most of the region’s poor go for basic, and costly, primary medical care. The agency models itself after a health-care system created in the 1980s by, of all places, the Republic of Iran.
As it turns out, the Southern state and Middle Eastern country aren’t all that different, at least in terms of providing health care for the urban and rural poor. In both places, doctors are hard to come by. But in the early ’80s, the Iranians created “health houses” to care for their poor. Anyone who lived within an hour’s walking distance of a large city or village had access to these houses, which had examination rooms and employed community health workers trained in preventive health care. When people required more complex care, they were referred to a regional health center, and if that wasn’t enough, then to the hospital. When they returned home, the community health aides monitored their care to make sure they were doing what their doctors told them to do.
Today, according to the Times, “17,000 health houses serve 23 million rural Iranians. Health disparities between rural and urban Iranians have narrowed; the Iranians have reduced rural infant mortality by 75 percent and lowered the birthrate. Iran’s reforms won praise from the World Health Organization, which has long advocated preventive, primary care.”
This system of care came to the attention of Dr. Aaron Shirley, chairman of the Jackson Medical Mall Foundation, a health-care complex that serves the urban poor. Shirley created HealthConnect in 2010 because “poor people in Mississippi still have health problems, even if they have Medicaid or health insurance, even if there are clinics in their communities, even if they get home health services,” he told the Times. “They don’t get better, and the diseases born of poverty and obesity are not prevented; thousands of people frequent emergency rooms for illnesses that could have been tackled by primary care. They need something more.”
In an interview with Governing, Shirley explained that the “driving force” behind HealthConnect is Mohammad Shahbazi, a professor at Jackson State University. Shahbazi recognized Iran had similar health disparities, and that conditions were also similar: uncontrolled diabetes, hypertension, stroke, heart disease, asthma and infant mortality. Shahbazi saw how Iran had been able over a 20-year period to completely eliminate the disparities between urban and rural areas, and argued that the same model could be used to eliminate racial disparities in Mississippi.
Community-based care is not a new idea, of course, but what makes this program different is the way primary care and public health are integrated. “What was so intriguing was the simplicity,” Shirley says. “The rural areas in Iran consisted of a typical village of 2,250 people, similar to a rural area in the Mississippi Delta. Community health workers became members of the health-care team that provided health services in the village. So if the villager ended up in the hospital, the community health worker at the village level was aware of that patient’s diagnosis, treatment and needs for follow-up. And if the patient was discharged on a certain medication, or with certain instructions, then the community health worker would be aware.”
Health-care organizations around the country are watching this model closely, Shirley says. The Affordable Care Act addresses hospital costs from readmissions, and if Shirley’s model reduces readmissions by 15 percent over a year, he says, “they’ll be promoting this model nationwide.”
The main difference between Iran and Mississippi, explains Shirley, is the motivation. “Over there, the primary reason was health. Over here, the primary interest is saving money, which is all right, as long as it also improves health.”