Document Type : مقاله کوتاه

Authors

• Efat Mohamadi ¹
• Ahmad Reza Raeisi ²
• Mojtaba Nuhi ³

¹ MSc Student, Student Research Committee, Health Services Management, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran

² Assistant Professor, Health Information Management, Health Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran

³ MSc Student, Health Economics, Tehran University of Medical Sciences, School of Health, Tehran, Iran

Abstract

Introduction: Insurance agencies are the most influential organizations in the health system so that they can enhance the effectiveness, efficiency and patient satisfaction through eliminating the financial relationship between provider and client services. Given the current health organizations in Iran and different definitions and higher goals, this study aimed to provide solutions to enhance the quality and quantity of health insurance in Iran. Methods: The present study was conducted in two stages. The first stage was done through literature review of databases related to insurance organizations, articles and study of laws and regulations related to various types of health insurance and the weaknesses and vulnerabilities in Iran. After identifying the factors in organized the checklist, they were discussed with experts. Results: Existence of many uncoordinated insurance agencies, lack of universal coverage, problems related to resource costs and problems related to lack of actual tariff were identified as a major weakness of current health insurance. Integration of health insurance law and defining a clear pattern, correct formulation of the basic health insurance package and a clear line between basic and supplementary insurance, expansion insurance coverage, legislation for the financial disconnect between the service provider and the recipient, and ultimately creating social cohesion in a way to provide cross-subsidies between low income and high income groups were the qualitative and quantitative approaches to enhance the health insurance system in Iran. Conclusion: Ministry of Health and Welfare and Social Security have to solve problems related to the health insurance system, enforcement action based on several studies done in this area and does not suffice to the rules provided in the development of multi-year program; because more damage of the process ultimately impact the weakest class of the society (patients, people with low income, etc.). Keywords: Insurance; Health Insurance; Qualitative Research