A growing number of Iranians are financing healthcare with debt as medical costs rise beyond household incomes, a new Eghtesad Online report found, while authorities prioritize medical preparations for the Shiite pilgrimage, Arbaeen.
Iranians are increasingly borrowing money, delaying treatment and bargaining over medical bills as healthcare costs outpace household incomes, according to a new report by Eghtesad Online, while authorities say medicines and medical supplies are fully secured for Arbaeen, the annual pilgrimage commemorating the 40th day after the death of third Shiite imam.
The report describes a healthcare system where treatment increasingly begins not with a doctor's diagnosis but with offers to activate credit, pay in installments or use discount codes. From dental care and physiotherapy to psychotherapy, prescription drugs and online consultations, households are increasingly financing healthcare with future income.
"The issue is not just the growth of a few startups or advertisements by a few clinics; the issue is the shrinking liquidity of households, where a patient is forced to borrow from next month's income to pay for today's pain," the report said.
When treatment depends on payday
Conversations in doctors' offices, the report said, increasingly focus on affordability rather than treatment. Patients ask whether insurance will cover consultation fees or whether doctors can charge less, while physicians report seeing people who postpone laboratory tests, imaging scans and prescriptions after paying for the initial visit.
"Is this charged at the private rate? Doesn't insurance cover it? Can't you charge a little less?" are now common questions at reception desks, according to the report, which said patients bargain "not out of habit, but out of necessity."
Long-term treatment is particularly vulnerable. Patients stop physiotherapy midway, discontinue psychotherapy after only a few sessions or ration medication so it lasts longer, turning what the report called "a shortage of cash into a shortage of treatment."
Official figures for the current Iranian year have not yet been released, but the latest available data showed healthcare accounted for 8.7% of urban household spending and 9.8% of rural household spending in 2024.
Mental health becomes a luxury
Financial pressures are especially visible in mental healthcare, where patients increasingly align appointments with payday.
"Can I pay for this session at the end of the month?" is among the requests therapists now hear regularly, according to the report. Others ask, "My salary is deposited on the 10th. Can I pay for two sessions together?" or explain, "I can't come every week for now. I'll come twice a month."
The report said psychotherapy is intended to help people cope with anxiety, exhaustion and the pressures of daily life, yet "the cost of the session itself has become one of those anxieties." Social media users quoted in the report described calculating rent, loan payments, medicine and food costs before deciding whether they could afford therapy.
Dental care has become another symbol of the trend. Clinics increasingly advertise installment plans for implants, orthodontics and root canals, while online pharmacies and health platforms now offer credit for medicines and health-related products.
"Toothache does not wait for next month's paycheck," the report said, describing installment payments as both an opportunity to obtain treatment and a warning that essential healthcare costs are increasingly becoming future debt.
Officials warn of shortages
The financial pressures coincide with warnings from lawmakers about Iran's pharmaceutical sector.
Salman Es’haqi, spokesperson for parliament's Health and Treatment Committee, described medicine shortages as a "serious and critical" issue, citing sanctions, the recent war and disruptions to imports of pharmaceutical raw materials. He warned that unstable access to medicines could cost lives.
Other lawmakers have linked shortages to delays in foreign currency allocations and cash shortages affecting imports, while pharmacists have said weak oversight has allowed some medicines to be diverted from official distribution channels into the unofficial market.
Medical support for Arbaeen
Despite those concerns, officials have repeatedly emphasized that healthcare resources for Arbaeen will be fully available.
Jafar Miadfar, head of Iran's Emergency Organization, said authorities had no concerns about supplying medicines and intravenous fluids for pilgrims. He said around 300,000 units of intravenous fluids had been allocated and medicine stocks positioned at six border crossings ahead of the pilgrimage.
Earlier, Iranian Red Crescent chief Pirhossein Kolivand said medicines and medical equipment had been dispatched for Arbaeen and that five hospitals in Iraq along the Najaf-Karbala route would provide care for Iranian pilgrims.
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