نوع مقاله : مقاله مروری نظام مند

نویسندگان

1 دانشجوی دکتری تخصصی، مدیریت فن‌آوری اطلاعات، گروه مدیریت فن‌آوری اطلاعات، دانشکده مدیریت و اقتصاد و مرکز ملی تحقیقات بیمه سلامت، دانشگاه تربیت مدرس، تهران، ایران

2 دانشیار، مدیریت فن‌آوری اطلاعات، گروه مدیریت فن‌آوری اطلاعات، دانشکده مدیریت و اقتصاد، دانشگاه تربیت مدرس، تهران، ایران

3 استادیار، مهندسی صنایع، گروه مهندسی صنایع، دانشکده فنی و مهندسی، دانشگاه یزد، یزد، ایران

چکیده

مقدمه: نظارت در بیمه سلامت، نقش مهمی در تحقق مأموریت و اهداف بیمه سلامت و نظام سلامت دارد، اما با این وجود، مورد بررسی ویژه‌ای قرار نگرفته ‌است. هدف از انجام پژوهش حاضر، مرور مطالعات مرتبط با نظارت در بیمه سلامت و دسته‌بندی موضوعی و منابع داده‌ای مورد استفاده در آن‌ها بود.روش بررسی: این تحقیق با استفاده از روش نگاشت نظام‌مند انجام گردید. با جستجوی پایگاه ‌داده‌های مرتبط، 316 پژوهش انتخاب شد و با استفاده از نرم‌افزار Atlas.ti و تکنیک یافتن واژگان کلیدی، دسته‌بندی موضوعی و منابع داده‌ای صورت گرفت.یافته‌ها: با استفاده از واژگان کلیدی یافته شده، 7 دسته موضوع نظارتی شامل «نظارت بر طرح و سیاست‌های بیمه سلامت، هزینه، پوشش بیمه‌ای و محافظت مالی، عدالت در سلامت، داده‌ها و اسناد بیمه سلامت، تأمین‌کنندگان خدمات سلامت، بیمه‌شدگان و مردم» و 9 منبع داده‌ای به دست ‌آمد.نتیجه‌گیری: دو موضوع «نظارت بر طرح و سیاست‌های بیمه سلامت» و «نظارت هزینه» مطالعات بیشتری را به خود اختصاص دادند، اما دو موضوع «بیمه ‌شدگان و مردم» و «تأمین‌کنندگان خدمات سلامت» کمتر مورد بررسی قرار گرفته‌ بود.

کلیدواژه‌ها

عنوان مقاله [English]

Supervision and Control in Health Insurance

نویسندگان [English]

  • Leila Izadi 1
  • Shaban Elahi 2
  • Alireza Hasanzadeh 2
  • Masoud Abessi 3

1 PhD Student, Information Technology Management, Department of Information Technology Management, School of Management and Economics AND National Center for Health Insurance Research, Tarbiat Modares University, Tehran, Iran

2 Associate Professor, Information Technology Management, Department of Information Technology Management, School of Management and Economics, Tarbiat Modares University, Tehran, Iran

3 Assistant Professor, Industrial Engineering, Department of Industrial Engineering, School of Engineering, Yazd University, Yazd, Iran

چکیده [English]

Introduction: Health insurance supervision and control has important role in achieving the health insurance and health system mission and goals, but it has not received much attention. This study aimed to review the researches related to health insurance supervision and control, and categorize the used topics and related data sources.Methods: The study was conducted using systematic mapping method. A total of 316 research papers (published until the end of 2018) were investigated in related databases. Atlas.ti8 software and keywording technique were used for analysis and data extraction.Results: Seven health insurance supervision (health insurance program/policy monitoring, cost control, coverage and financial protection, equity in health, health insurance data and claims assessment, and people/insured and health service supplier and control topics) as well as nine data sources were identified.Conclusion: Health insurance program/policy monitoring and cost control topics had the most research number, and people/insured and health service supplier topics were the least related researches.

کلیدواژه‌ها [English]

  • Insurance
  • Supervision
  • Systematic Review
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