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Health Insurance Benefit Package in Iran: A Qualitative Policy Process Analysis Publisher Pubmed



Mohamadi E1 ; Takian A1, 2, 3 ; Olyaeemanesh A1, 4 ; Rashidian A2, 5 ; Hassanzadeh A6 ; Razavi M7 ; Ghazanfari S2
Authors
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Authors Affiliations
  1. 1. Health Equity ResearchCenter (HERC), Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. National Institute of Health Research, Tehran University of Medical Sciences, No. 70, Bozorgmehr Ava., Vesal St., Keshavars Blvd, Tehran, 1416833481, Iran
  5. 5. Information, Evidence and Research Department, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
  6. 6. Health Insurance Organization of Iran, Tehran, Iran
  7. 7. Brandeis University, Waltham, MA, United States

Source: BMC Health Services Research Published:2020


Abstract

Background: Insufficient transparency in prioritization of health services, multiple health insurance organizations with various and not-aligned policies, plus limited resources to provide comprehensive health coverage are among the challenges to design appropriate Health Insurance Benefit Package (HIBP) in Iran. This study aims to analyze Policy Process of Health Insurance Benefit Package in Iran. Method: Data were collected through semi-structured interviews with 25 experts, plus document analysis and observation, from February 2014 until October 2016. Using both deductive and inductive approaches, two independent researchers conducted data content analysis. We used MAXQDA.11 software for data management. Results: We identified 10 main themes, plus 81 sub-themes related to development and implementation of HIBP. These included: lack of transparent criteria for inclusion of services within HIBP, inadequate use of scientific evidence to determine the HIBP, lack of evaluation systems, and weak decision-making process. We propose 11 solutions and 25 policy options to improve the situation. Conclusion: The design and implementation of HIBP did not follow an evidence-based and logical algorithm in Iran. Rather, political and financial influences at the macro level determined the decisions. This is rooted in social, cultural, and economic norms in the country, whereby political and economic factors had the greatest impact on the implementation of HIBP. To define a cost-effective HIBP in Iran, it is pivotal to develop transparent and evidence-based guidelines about the processes and the stewardship of HIBP, which are in line with upstream policies and societal characteristics. In addition, the possible conflict of interests and its harms should be minimized in advance. © 2020 The Author(s).
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