Reforming Nursing Reimbursement: Direct Payment Models Under Iran’s Nursing Service Act in a Global Context

Abstract Introduction: Conventional healthcare payment systems often integrate nursing services within broader physician or institutional billing structures, inadvertently diminishing the recognition and motivation of nurses. In 2007, Iran introduced the Nursing Services Tariff and Adjustment of Nursing Costs Act, a pioneering legislative effort that diverged from traditional payment frameworks by establishing a direct reimbursement model for nursing services. This study evaluates Iran’s Nursing Services Tariff Act as a novel direct reimbursement approach, comparing its structure and impacts with nursing payment systems in the United States, United Kingdom, Australia, Canada, Denmark, Japan, and Norway. The analysis focuses on professional empowerment and systemic outcomes. Methods Employing a qualitative comparative design, this research integrated semi-structured interviews with six key stakeholders in Iran and a thematic analysis to uncover central insights. A cross-national comparison examined reimbursement mechanisms, legislative contexts, and health system performance across the eight countries. Secondary data were systematically analyzed, complemented by a SWOT framework to assess strengths, weaknesses, opportunities, and challenges. Results Iran’s tariff-based model distinctively compensates nursing services independently, contrasting with bundled payment systems (e.g., United States) or salaried structures (e.g., United Kingdom). Qualitatively, two themes emerged: Professional Development (strengthened identity, satisfaction, justice) and Health System Productivity (cost optimization, patient satisfaction, care quality). However, sustained success demands robust infrastructural support. Conclusion Iran’s Nursing Services Tariff Act presents an innovative model that elevates nursing visibility and optimizes healthcare delivery. Though challenges such as funding allocation persist, the framework offers valuable insights for global healthcare reform. Future studies should explore its scalability and economic viability to inform broader adoption.