Volume 7, Issue 1 (Spring 2024)
Iran J Health Insur 2024, 7(1): 22-41 |
Back to browse issues page
Ethics code: IR.TUMS.NIHR.REC.1401.014
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Mohamadi E, Bakhtiari A, Nasehi M M, Effatpanah M, Rezaei M, Shahali Z, et al . Performance Evaluation Indicators of Iran Health Insurance Organization Based on Macro Policies. Iran J Health Insur 2024; 7 (1) :22-41
URL: http://journal.ihio.gov.ir/article-1-303-en.html
URL: http://journal.ihio.gov.ir/article-1-303-en.html
Efat Mohamadi1 
, Ahad Bakhtiari1 , Mohammad Mehdi Nasehi2 , Mohammad Effatpanah2 , Mehdi Rezaei2 , Zahra Shahali2 , Amirhossein Takian1 , Alireza Olyaeemanesh * 3
, Ahad Bakhtiari1 , Mohammad Mehdi Nasehi2 , Mohammad Effatpanah2 , Mehdi Rezaei2 , Zahra Shahali2 , Amirhossein Takian1 , Alireza Olyaeemanesh * 3
1- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
2- National Center for Health Insurance Research, Tehran, Iran
3- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran ,arolyaee@gmail.com
2- National Center for Health Insurance Research, Tehran, Iran
3- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran ,
Abstract: (841 Views)
Introduction: The performance evaluation of the Iranian Health Insurance Organization (IHIO), considering the responsibilities, objectives, and duties outlined in the higher-level documents and laws, is an important issue that has received less attention. Given the importance of systematic monitoring and evaluation to facilitate planning based on overarching domestic policies, it is necessary to adopt a suitable approach to monitor programs and policies and to respond to higher-level authorities to fulfill assigned tasks. The present study aims to identify performance indicators for IHIO based on the analysis of relevant higher-level documents and laws.
Methods: This study was conducted qualitatively and based on content analysis of documents, policies, and executive activities related to monitoring the performance of IHIO, from the year the Universal Health Insurance Law of the country was passed (1373) until 1402, in the year 1402 (Solar Hijri calendar, equivalent to 2023/2024 Gregorian calendar). The Scott method was used to examine the validity of the documents, and qualitative content analysis and the deductive approach were employed to analyze the data.
Results: Nine policies related to monitoring the performance of the IHIO were identified, with 11 themes and total of 188-indicators identified as follows: Population indicators (8 indicators), National Health Accounts (NHA) (13-indicators), Covered population (25-indicators), Covered health services (19-indicators), Covered costs/financial participation status (11-indicators), Organization’s financial resources (26-indicators), Contracted centers (11-indicators), Cost trends, cost burden, and visit burden (23-indicators), Monitoring indicators (11-indicators), Operational efficiency of the organization (30-indicators), Access to services and health outcomes (11-indicators).
Conclusion: In order to conduct a thorough and comprehensive evaluation of the Iranian Health Insurance Organization's performance, which aims to enhance transparency and public trust in the organization, it is imperative to take into account a diverse range of indicators that encompass all operational and performance aspects of a health insurance entity. Additionally, national macro indicators, including population metrics and national health accounts, play a crucial role in this process. Failing to consider these indicators may lead to challenges and biases when assessing the organization's performance.
Methods: This study was conducted qualitatively and based on content analysis of documents, policies, and executive activities related to monitoring the performance of IHIO, from the year the Universal Health Insurance Law of the country was passed (1373) until 1402, in the year 1402 (Solar Hijri calendar, equivalent to 2023/2024 Gregorian calendar). The Scott method was used to examine the validity of the documents, and qualitative content analysis and the deductive approach were employed to analyze the data.
Results: Nine policies related to monitoring the performance of the IHIO were identified, with 11 themes and total of 188-indicators identified as follows: Population indicators (8 indicators), National Health Accounts (NHA) (13-indicators), Covered population (25-indicators), Covered health services (19-indicators), Covered costs/financial participation status (11-indicators), Organization’s financial resources (26-indicators), Contracted centers (11-indicators), Cost trends, cost burden, and visit burden (23-indicators), Monitoring indicators (11-indicators), Operational efficiency of the organization (30-indicators), Access to services and health outcomes (11-indicators).
Conclusion: In order to conduct a thorough and comprehensive evaluation of the Iranian Health Insurance Organization's performance, which aims to enhance transparency and public trust in the organization, it is imperative to take into account a diverse range of indicators that encompass all operational and performance aspects of a health insurance entity. Additionally, national macro indicators, including population metrics and national health accounts, play a crucial role in this process. Failing to consider these indicators may lead to challenges and biases when assessing the organization's performance.
Keywords: Performance Evaluation, Macro Policies, Health Insurance Organization, Indicator, Health Policy
Type of Study: Research |
Subject:
Special
Received: 2024/01/7 | Revised: 2024/08/10 | Accepted: 2024/03/16 | ePublished: 2024/08/6
Received: 2024/01/7 | Revised: 2024/08/10 | Accepted: 2024/03/16 | ePublished: 2024/08/6
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
