The health care system in Iran has developed over the last century, largely influenced by Western medicine. The World Bank has cited several significant issues and complexities in Iran's health system. First, with respect to health outcomes, malnutrition is an extremely serious problem for Iran. Second, the onset of the health transition and the population ageing are shifting the burden of disease to treating non-communicable diseases. The modern health insurance scheme began in 1936 with the implementation of the social security organisation to cover work injuries of persons employed in urban areas. The main dilemmas for coverage of the self-employed people are: first, the voluntary nature of the scheme; and, second, the insuring of patients when they are admitted to hospital. The government influences all aspects of national health insurance (NHI) and inevitably makes the NHI hugely dependent on the political and economic situation of the government in office.