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Mohammadreza Rezaee, Saeid Daei Karimzadeh, Mehdi Fadaei, Akbar Etebarian,
Volume 1, Issue 4 (2-2019)
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: The Iran Health Insurance Organization (IHIO) was established to develop the Iran Health Insurance Sector. Currently, this organization lacks the adequate funding and faces challenges in providing the required resources due to the imposed unilateral sanctions; therefore, it is necessary that this organization take proper measures within the framework of state policies regarding the resilience economy in order to finance itself and cover more population in accordance with the Iranian operating laws. The objective of the present study was to propose a financing model for the IHIO based on the resilience economy.
Methods: This was a qualitative study based on the Grounded Theory (GT), and the data were collected from framework documents, open and in-depth interviews, and a review of the lectures given by 31 experts. The validity was first examined by the interviewees and then approved by the experienced professors. The reliability was determined to be 73% via process auditing. The data were analyzed through a GT-based methodology and constant comparison over three stages of open, axial, and selective codings.
Results: The examination of the qualitative date revealed that there are many factors in action in the IHIO’s financing process and this organization needs to review and revise its structure and methodology. Taking into consideration the current sanctions and lack of funds, the IHIO should change the following seven components within the framework of notified resilience economy policies: organizational management, financial management, research, structural change, cultural revision, and regulatory procedures.
Conculsions: There has been a remarkable increase in the IHIO’s insured parties recently, and more people have been receiving healthcare services. Thus, it is highly essential to propose a model to change the IHIO’s approach towards commercialization and make it produce more revenues and finance in accordance with the current economic situation in Iran.
Methods: This was a qualitative study based on the Grounded Theory (GT), and the data were collected from framework documents, open and in-depth interviews, and a review of the lectures given by 31 experts. The validity was first examined by the interviewees and then approved by the experienced professors. The reliability was determined to be 73% via process auditing. The data were analyzed through a GT-based methodology and constant comparison over three stages of open, axial, and selective codings.
Results: The examination of the qualitative date revealed that there are many factors in action in the IHIO’s financing process and this organization needs to review and revise its structure and methodology. Taking into consideration the current sanctions and lack of funds, the IHIO should change the following seven components within the framework of notified resilience economy policies: organizational management, financial management, research, structural change, cultural revision, and regulatory procedures.
Conculsions: There has been a remarkable increase in the IHIO’s insured parties recently, and more people have been receiving healthcare services. Thus, it is highly essential to propose a model to change the IHIO’s approach towards commercialization and make it produce more revenues and finance in accordance with the current economic situation in Iran.
Jafar Yahyavi Dizaj, Jalal Saeidpour, Faroogh Na'emani, Kamran Irandoust,
Volume 2, Issue 2 (9-2019)
Volume 2, Issue 2 (9-2019)
Abstract
Introduction: Inequalities in the health system that are defined as the differences between individuals in the enjoyment of health and its facilities, is one of the determinants of health among individuals and groups. The purpose of this study was evaluate the inequality in payment of health insurance in Iran during 2011 to 2017.
Methods: The present descriptive-analytical study was designed and conducted as cross-sectional study in 2018 year, using the National Household Expenditure Survey data which is done annually by the Iranian Statistics Center. In the present study, inequality in payment of Iranian health insurance during 2011-2017 was measured. For this purpose, the average household expenditures for health insurance and average household expenditures were calculated, and by the Lorenz curves, the Gini coefficient of these expenditures was calculated. Then, in order to assess the fairness of insurance payments, the Kakwani index was calculated.
Results: The average Gini index for health insurance payments between urban and rural households during the whole study period was 0.34 and 0.47, respectively. Kakwani index values were always positive for rural areas throughout the study period, while urban areas were negative for 2012-2014. In addition, the trend of average changes in the Kakwani index across the country declined from 2011 to 2013, indicating an uneven trend in insurance payments in those years. But in the years 2014-2016 the trend of these changes was incremental.
Conclusions: The findings of the present study showed that the equity status of Iranian households' insurance payments was not favorable especially in urban areas; and it is necessary to achieve equity in the payments of family health insurance, planners and policymakers while reviewing the redistribution of resources in the country's insurance sector by redistributing resources in urban areas, along with improving the quality of covered health services. Proper insurance provides adequate financial protection for Iranian households.
Methods: The present descriptive-analytical study was designed and conducted as cross-sectional study in 2018 year, using the National Household Expenditure Survey data which is done annually by the Iranian Statistics Center. In the present study, inequality in payment of Iranian health insurance during 2011-2017 was measured. For this purpose, the average household expenditures for health insurance and average household expenditures were calculated, and by the Lorenz curves, the Gini coefficient of these expenditures was calculated. Then, in order to assess the fairness of insurance payments, the Kakwani index was calculated.
Results: The average Gini index for health insurance payments between urban and rural households during the whole study period was 0.34 and 0.47, respectively. Kakwani index values were always positive for rural areas throughout the study period, while urban areas were negative for 2012-2014. In addition, the trend of average changes in the Kakwani index across the country declined from 2011 to 2013, indicating an uneven trend in insurance payments in those years. But in the years 2014-2016 the trend of these changes was incremental.
Conclusions: The findings of the present study showed that the equity status of Iranian households' insurance payments was not favorable especially in urban areas; and it is necessary to achieve equity in the payments of family health insurance, planners and policymakers while reviewing the redistribution of resources in the country's insurance sector by redistributing resources in urban areas, along with improving the quality of covered health services. Proper insurance provides adequate financial protection for Iranian households.
Mohammadreza Rezaee, Said Daei-Karimzadeh, Mehdi Fadaei, Akbar Etbarian,
Volume 2, Issue 4 (12-2019)
Volume 2, Issue 4 (12-2019)
Abstract
Introduction: Having an insured population of 39 million, Iran Health Insurance Organization is one of the largest entities in health insurance sector of Iran. The organization needs to monetize in order to equate its resources with its costs due to economic conditions imposed on the country following sanctions as well as the aging trend of the society. That is, the organization needs to take appropriate measures to finance the coverage of health insurance for every Iranian, for which it is responsible in accordance with current law. This study aims at studying modern monetizing methods in Iran Health Insurance Organization.
Methods: First, the new monetizing methods were extracted using grounded theory and employing field’s experts’ opinion. Given the lack of finance experts in health insurance sector, the statistical population was consisted of 21 academic and administrative experts of health and insurance economy. Then the analytic hierarchy process was employed to analyze and rank findings.
Results: The nine main monetizing methods for Iran Health Insurance Organization were compared based on absorption rate, and revenue volume, sustainability, and endogeneity. According to the paired comparison matrix, the monetizing from individuals was ranked 1 with a weight of 0.314, internal monetizing was ranked 2 with a weight of 0.264, monetizing from subsidiaries was ranked 3 with a weight of 0.221, business
and non-insurance activities was ranked 4 with a weight of 0.209, training and knowledge transfer was ranked 5 with a weight of 0.199, funding from other organizations was ranked 6 with a weight of 0.188, receiving public funds was ranked 7 with a weight of 0.176, and public donations and other monetizing measures were ranked last with weights of 0.165 and 0.163, respectively. For monetizing from individuals, receiving direct payments from recipients of services revealed to be far more significant than other options including selling a variety of insurance policies, introducing complementary insurance, and selling services to regional customers.
Conculsions: Results show that the insured need to carry the main burden of health insurance costs. The government and other relevant agencies are no longer able to finance Iran Health Insurance Organization. This is somewhat different from what other researchers suggest. However, experts believe that the Health Insurance Organization should be financed by service recipients. In order to prevent too much pressure on the insured clients, the organization can take various measures, which are of equal significance to receiving direct fees from service recipients. These include selling various insurance policies, introducing supplementary insurance policies, and selling services to regional clients as an insurance and investment organization.
Narges Asadi Janati, Khalil Alimohammadzade, Seyd Mojtaba Hosseini, Ali Maher, Mohammadkarim Bahadori,
Volume 3, Issue 1 (4-2020)
Volume 3, Issue 1 (4-2020)
Abstract
Introduction: Donors participation in the health sector is one of the sources of financing in the healthcare system. According to rising costs of the healthcare system in recent years and consequently increase in out of pockets of people, more attention has been paid to the charitable donations. In order to maintain and increase good support and participation in the health system, the need to identify and remove the barriers they face is essential for Efficient and effectiveness participation.
Methods: the present study according to purpose is applied, Descriptive research in terms of data collection and In terms of type of research data is qualitative. Required data were collected through semi-structured interviews with 41 health experts and beneficiaries using snowball sampling method.Conventional Content analysis was used to analyze the data.
Results: Surveying and categorizing the interviews showed that Efficient and effectiveness participation of Donors in the healthcare system involves four main barriers: Lack of legal mechanisms, Lack of proper and continuous communication with the beneficiary, barriers in the field of management and effective allocation of resources, Lack of awareness of Donors from needs and barriers of the healthcare system and 18 subtheme.
Conclusion: By recognizing and solving these barriers, it has channeled the funds and contributions of the Donors towards the needs of the healthcare system with maximum effectiveness. Can be enhanced by strengthening institutions, structures and processes, Developing facilitator laws, Correct and constant communication with beneficiary and identifying priorities and needs and transferring them to the beneficiaries of health, can be facilitated and encouraged maximum donation.
Keywords: Healthcare Financing, Donors, Barriers,Conventional Content Analysis.
Sanaz Zoghtalab Hassas, Leila Riahi, Leila Nazarimanesh, Seyed Jamaledin Tabibi,
Volume 4, Issue 3 (12-2021)
Volume 4, Issue 3 (12-2021)
Abstract
Introduction: The growth of the elderly population is one of the most important and prominent issues in today’s societies. One of the consequences of an aging population is the effects it has on health spending, which in some countries accounts for a significant portion of government spending. The purpose of this study is to compare the elderly services management system in the selected countries of this study with Iran in terms of policy, planning, financing and organizational structure in providing elderly services.
Methods: The present study was a review-comparative study on qualitative studies in 1399. Library method was used to collect data. The study population is all articles related to the research topic. In order to conduct information research by reading texts from the library, the websites of related organizations in selected countries in line with research questions and systematic search based on keywords based on aging, aging services management, aging management strategies and financing from reputable databases and Specializations in English and Persian languages were collected between 1998 and 2019 and were evaluated and compared in a comparative table of areas. Systematic search based on related keywords Scopus, Science Direct, PupMed and Google scholar along with national databases including SID, IRANDOC, ISC. Out of 128 identified sources, the researcher reviewed and evaluated their content according to the research strategy, and finally, after removing 81 of them for reasons such as duplication, irrelevance, etc., 47 articles remained for final analysis.
Results: Aging system policy in all selected countries (US, UK, Japan, Korea and Italy) has been centralized in a way that using regional, provincial or state-based planning using public tax financing systems, funds Insurance, the national medicine system, by defining the target population and specific service packages, plays an effective role in providing quality and accessible services to the elderly. The provision of services in these countries is integrated (health, medical and social welfare) and Providing care services for them is free.
Conclusion: It is suggested to use the experiences of successful countries in the field of aging management, by creating an integrated and centralized policy system in the dimensions of health and social welfare; Relying on sustainable financing from public taxes, labeled taxes and old-age insurance premiums and reforming planning structures in providing and receiving services, the level of effectiveness and efficiency of old-age management can be improved.
Methods: The present study was a review-comparative study on qualitative studies in 1399. Library method was used to collect data. The study population is all articles related to the research topic. In order to conduct information research by reading texts from the library, the websites of related organizations in selected countries in line with research questions and systematic search based on keywords based on aging, aging services management, aging management strategies and financing from reputable databases and Specializations in English and Persian languages were collected between 1998 and 2019 and were evaluated and compared in a comparative table of areas. Systematic search based on related keywords Scopus, Science Direct, PupMed and Google scholar along with national databases including SID, IRANDOC, ISC. Out of 128 identified sources, the researcher reviewed and evaluated their content according to the research strategy, and finally, after removing 81 of them for reasons such as duplication, irrelevance, etc., 47 articles remained for final analysis.
Results: Aging system policy in all selected countries (US, UK, Japan, Korea and Italy) has been centralized in a way that using regional, provincial or state-based planning using public tax financing systems, funds Insurance, the national medicine system, by defining the target population and specific service packages, plays an effective role in providing quality and accessible services to the elderly. The provision of services in these countries is integrated (health, medical and social welfare) and Providing care services for them is free.
Conclusion: It is suggested to use the experiences of successful countries in the field of aging management, by creating an integrated and centralized policy system in the dimensions of health and social welfare; Relying on sustainable financing from public taxes, labeled taxes and old-age insurance premiums and reforming planning structures in providing and receiving services, the level of effectiveness and efficiency of old-age management can be improved.
Seyed Kamal Sadeghi, Elnaz Ghanati, Saeed Rostampour, Majid Mazidabadi Farahani,
Volume 4, Issue 4 (3-2022)
Volume 4, Issue 4 (3-2022)
Abstract
Introduction: The health sector is one of the key sectors of any countries and the value added created in it is one of the criteria for economic growth and development of countries. Therefore, the ultimate goal of all health systems in the world is to achieve public health coverage as one of the most basic economic sectors of any society. Since achieving universal health coverage depends on appropriate financing, aim of this study is to investigate the effect between Iran's human development index and Health system financing model (government, health insurance, people and the private sector).
Methods: This study is a retrospective and analytical study. To describe the long-term relationships between the variables under study, seasonal data from the time series of 2001 to 2018 and the aggregation technique using the Engle-Granger and Johansen -Joselius methods have been used.
Results: The results of model estimation based on the Engle-Granger method confirm that there is a long-term relationship between variables. Also, results of the Johansen -Joselius method show the existence of two cumulative vectors, which overall confirm the positive effect of changes in government share, health insurance share, private sector share of Gross domestic product (GDP) and the inverse relationship of changes in the share of people in GDP to changes in Iran's human development index.
Conclusion: Recent health sector policies, including the implementation of the country's health transformation program, public insurance coverage policies and health tariffs, have been resultful and effective. Therefore, for the further and permanent growth of Iran's human development index and increase the country's development in the region and internationally, special attention should be paid to the country's health insurance sector and its importance in the health system financing model by reviewing basic health insurance packages and improved the quantity and quality of basic and supplementary health insurance.
Methods: This study is a retrospective and analytical study. To describe the long-term relationships between the variables under study, seasonal data from the time series of 2001 to 2018 and the aggregation technique using the Engle-Granger and Johansen -Joselius methods have been used.
Results: The results of model estimation based on the Engle-Granger method confirm that there is a long-term relationship between variables. Also, results of the Johansen -Joselius method show the existence of two cumulative vectors, which overall confirm the positive effect of changes in government share, health insurance share, private sector share of Gross domestic product (GDP) and the inverse relationship of changes in the share of people in GDP to changes in Iran's human development index.
Conclusion: Recent health sector policies, including the implementation of the country's health transformation program, public insurance coverage policies and health tariffs, have been resultful and effective. Therefore, for the further and permanent growth of Iran's human development index and increase the country's development in the region and internationally, special attention should be paid to the country's health insurance sector and its importance in the health system financing model by reviewing basic health insurance packages and improved the quantity and quality of basic and supplementary health insurance.
Parivash Heidari Orejlo, Shaghayegh Vahdat, Hassan Soltani,
Volume 5, Issue 1 (3-2022)
Volume 5, Issue 1 (3-2022)
Abstract
Introduction: In today’s societies, “health” is the inalienable right of all members of society and indicators showing health in society are important factors in showing the level of development of the country. The purpose of this study is to determine and prioritize the factors affecting financing in Iran.
Methods: This descriptive research is a survey method and in terms of implementation process, it has been done qualitatively and quantitatively. In this research, first with a qualitative approach and by theoretical and library studies, the financing model in the world health system was examined and then by comparative comparison and determining the points of difference and commonality, the main factors were identified. Then, using the opinion of experts, the researcher proceeded to prioritize the factors.
Results: To investigate the research hypotheses, because the dimensions and components affecting health financing did not have the same rankings, as a result, prioritization was done in the field of contextual factors, instrumental factors, content factors and structural factors. The results showed that the central tax system with 4.451 points, the budgeting system with 4.420 points and the formulation of the financing plan with 4.368 points are the most influential components, respectively.
Conclusion: In the study of the studied countries and financing models and frameworks, the variables that had the highest frequency in the financing system included the variables of tax axis, integrated financial fund, subsidies, financial participation and protection of investment risks. It shows the emphasis of the mentioned models on the tax view along with investment. The results of this study show that in Iran, despite the existing insurance system, creating a mechanism in the tax system, budgeting system and formulating a financing plan with respect to sanctions and creating restrictions in the investment system in the health sector has the most importance and rank.
Methods: This descriptive research is a survey method and in terms of implementation process, it has been done qualitatively and quantitatively. In this research, first with a qualitative approach and by theoretical and library studies, the financing model in the world health system was examined and then by comparative comparison and determining the points of difference and commonality, the main factors were identified. Then, using the opinion of experts, the researcher proceeded to prioritize the factors.
Results: To investigate the research hypotheses, because the dimensions and components affecting health financing did not have the same rankings, as a result, prioritization was done in the field of contextual factors, instrumental factors, content factors and structural factors. The results showed that the central tax system with 4.451 points, the budgeting system with 4.420 points and the formulation of the financing plan with 4.368 points are the most influential components, respectively.
Conclusion: In the study of the studied countries and financing models and frameworks, the variables that had the highest frequency in the financing system included the variables of tax axis, integrated financial fund, subsidies, financial participation and protection of investment risks. It shows the emphasis of the mentioned models on the tax view along with investment. The results of this study show that in Iran, despite the existing insurance system, creating a mechanism in the tax system, budgeting system and formulating a financing plan with respect to sanctions and creating restrictions in the investment system in the health sector has the most importance and rank.
Seyed Morteza Alizadeh Razavian,
Volume 5, Issue 1 (3-2022)
Volume 5, Issue 1 (3-2022)
Abstract
The limitation of resources in the face of the unlimited needs of society is the origin of economic decisionmaking. The characteristics of health needs and the economic situation and service delivery system have led to the development of different models in prioritizing needs and providing resources for health needs. Knowing the patterns can help you choose the right method. In the UK, Canada, Sweden and Chile the structure is tax-based. The structure in Germany and Turkey is based on two pillars, tax and premium. In the United States, with the exception of government-funded people with disabilities, the rest of society uses private insurance. Sri Lanka, Malaysia and Brazil were forced to provide universal health coverage through tax revenues. Low-income countries are in the same group. In Thailand, Mexico and Kyrgyzstan, premiums from official employees, along with tax revenues, are the basis for the general population's access to health services. In developing countries, financing is mainly through out-of-pocket payments, but due to the injustice created, they are moving to rely on tax resources. In developed countries, the private sector is growing gradually, and even governments with national medical systems have allowed out-of-pocket payments to increase. Financing is related to the level of economic development. In countries with low per capita incomes, high informal employment rates, and unfair wealth redistribution, tax regimes work better. A variety of other methods, such as labeled taxes, special duties, and bond sales, can help provide better financial resources for health.
Amirhossein Takian, Alireza Olyaeemanesh, Efat Mohamadi,
Volume 5, Issue 1 (3-2022)
Volume 5, Issue 1 (3-2022)
Abstract
Irvan Masoudi Asl, Mohammad Moradi-Joo, Tayebeh Moradi,
Volume 5, Issue 4 (12-2022)
Volume 5, Issue 4 (12-2022)
Abstract
Introduction: Evaluating the state of health financing of countries helps to check the efficiency of the health system and the optimal use of the limited resources of their health system. This study was conducted with the aim of reviewing health financing evaluation tools and the functional area of each of them so that more effective and efficient reforms can be applied in the path of achieving universal health coverage.
Methods: This study was a systematic review that used Scopus and PubMed databases and World Health Organization and World Bank databases to find tools and articles related to health financing evaluation. Articles and tools published in English have been reviewed without time limit. Data analysis was done by content analysis method.
Results: A total of 35 articles and 9 tools were included in the study. After a complete review, finally, 6 tools (national health accounts, health system assessment approach, health sector situation analysis, organizational assessment to improve and strengthen health financing, health system review, health financing progress matrix) were analyzed. And all of them were examined from 9 dimensions of health financing assessment.
Conclusion: In this study, the evaluation tools of health system financing were identified and their characteristics were stated. Among the health financing evaluation tools during the last few decades, the health financing progress matrix can provide a more complete and comprehensive road map to identify the dimensions and performance of the health system financing area in the path of achieving universal health coverage.
Methods: This study was a systematic review that used Scopus and PubMed databases and World Health Organization and World Bank databases to find tools and articles related to health financing evaluation. Articles and tools published in English have been reviewed without time limit. Data analysis was done by content analysis method.
Results: A total of 35 articles and 9 tools were included in the study. After a complete review, finally, 6 tools (national health accounts, health system assessment approach, health sector situation analysis, organizational assessment to improve and strengthen health financing, health system review, health financing progress matrix) were analyzed. And all of them were examined from 9 dimensions of health financing assessment.
Conclusion: In this study, the evaluation tools of health system financing were identified and their characteristics were stated. Among the health financing evaluation tools during the last few decades, the health financing progress matrix can provide a more complete and comprehensive road map to identify the dimensions and performance of the health system financing area in the path of achieving universal health coverage.
Shaghayegh Vahdat, Asieh Khaleghi, Arsalan Gholami, Korosh Soltanieh Zanjani, Farhad Lotfi,
Volume 5, Issue 4 (12-2022)
Volume 5, Issue 4 (12-2022)
Abstract
Abstract
Introduction: Lack of financial protection in health is known as a disease of health systems. Households suffer not only from the burden of disease but also from the burden caused by the destruction and economic poverty, in other words, facing back-breaking costs and poverty caused by financing their health. The aim of the current research is to investigate the impact of different dimensions of inequality on the financial financing of household health.
method: This is a descriptive, cross-sectional, and applied study, which examines the impact of inequality on the financing of household health expenses. The research tool is the financing inequality questionnaire (2008) by Saito. All out-of-pocket costs related to inpatient care, outpatient care, diagnostic tests, and medical expenses due to illness have been estimated for one year. Experts have confirmed validity and reliability.
Findings: The dimensions of inequality among households in Tehran are higher than the average (1.329), which has a significant impact on the financing of household health expenses. The direct effect of justice on the financing of household health expenses is rejected. With the increase in the back-breaking cost, equal opportunity, economic status, insurance coverage, and financing of household health expenses increases. According to P<0.001 and P=0.005, the age of the head of the household is not related to justice and gender in the financing of household health expenses.
Conclusion: There is a direct relationship between back-breaking expenses, equal opportunity, economic status, insurance coverage, and financing of household health expenses.
Davood Danesh Jafari, Samira Ghanbari, Hamid Amadeh,
Volume 6, Issue 1 (6-2023)
Volume 6, Issue 1 (6-2023)
Abstract
Introduction: Financing is strongly believed to be the main function of any health system and insurance organizations play a critical role in the health financing system of all countries. Accordingly, in order to enable the insurance companies to take steps towards meeting the assigned goals, creation of a balance in the budget and also financial management of their resources and expenses are needed. Therefore, the current research is conducted with the purpose of analyzing the factors affecting the budget balance of health insurance organizations.
Methods: This research which is considered an experimental study has used the monthly data of premium, coinsurance, treatment, and overhead costs, and the number of services purchased by the Iran Health Insurance Organization during 2008 - 2019, and the vector error correction model (VECM) to analyze short and long-run relationships, estimate parameters and predict relationships. In addition, the approach of the present research in the selection of variables is based on the mediating role of this organization in the expenditure reimbursement, behavior management, and the purchasing of healthcare services.
Results: The results indicated that in the long term, the insured's coinsurance and the premium paid to the Iranian Health Insurance Organization have a negative effect on the budget deficit, respectively -0.27 and -0.9. In contrast, the budget deficit is positively impacted by treatment and overhead costs with a coefficient of 2.41 and 0.67 and the number of services purchased by Iran Health Insurance Organization with a coefficient of 139576.
Conclusion: According to the findings of this study, the health insurance organization can use strategies such as increasing premiums and coinsurances, reducing treatment and overhead costs, and also the number of purchased services, to control and minimize its budget deficit.
Methods: This research which is considered an experimental study has used the monthly data of premium, coinsurance, treatment, and overhead costs, and the number of services purchased by the Iran Health Insurance Organization during 2008 - 2019, and the vector error correction model (VECM) to analyze short and long-run relationships, estimate parameters and predict relationships. In addition, the approach of the present research in the selection of variables is based on the mediating role of this organization in the expenditure reimbursement, behavior management, and the purchasing of healthcare services.
Results: The results indicated that in the long term, the insured's coinsurance and the premium paid to the Iranian Health Insurance Organization have a negative effect on the budget deficit, respectively -0.27 and -0.9. In contrast, the budget deficit is positively impacted by treatment and overhead costs with a coefficient of 2.41 and 0.67 and the number of services purchased by Iran Health Insurance Organization with a coefficient of 139576.
Conclusion: According to the findings of this study, the health insurance organization can use strategies such as increasing premiums and coinsurances, reducing treatment and overhead costs, and also the number of purchased services, to control and minimize its budget deficit.
Saba Karimi, َali Akbari Sari, Ali Akbar Fazaeli, Amir Abbas Fazaeli,
Volume 6, Issue 2 (9-2023)
Volume 6, Issue 2 (9-2023)
Abstract
Equitable financing is an important goal of health systems and protecting the financial risks of health care. Also, equitable financing of health is important both for improving the state of health systems and for achieving universal health coverage (UHC). In this study, with an overview has introduced the indicators of justice in health and the results of the indicators in this field have been examined in the country. The search for articles in the present study is of a review type that was conducted through search engines and databases within the range of 2002-2022. In order to identify the advantages and disadvantages of indicators showing justice in health financing, including out-of-pocket payment indicators, catastrophic health expenditures index, Kakwani index, concentration index and fair financial contribution index, a review of studies was used and the limitations and advantages of each index were extracted and compared. The results of this study showed that in terms of health equity index, the index of back-breaking health costs had the highest frequency in the studies. Each of the indicators had advantages and problems. Also, according to the numerous studies on the calculation of the health justice index, the existence of a health watchdog is necessary to monitor these indicators.
Saed Salehi, Norouz Nourollahzadeh, Seyedeh Mahboubeh Jafari,
Volume 6, Issue 4 (3-2024)
Volume 6, Issue 4 (3-2024)
Abstract
Introduction: One of the fundamental challenges faced by various societies is the easy and affordable access to healthcare services. In this context, a plan known as Universal Health Coverage was proposed by the World Health Organization, prompting diverse countries to implement various measures in response. A critical need for the execution of this plan is the availability of sufficient financial resources. Therefore, this research aims to identify and evaluate financing policies for Universal Health Coverage.
Methods: This study first reviews recent research literature, followed by conducting focused group interviews with research experts. After identifying stakeholders' needs and various policies, the policies were weighted and prioritized using a Fuzzy Quality Function Deployment (QFD) approach. To enrich the data for the Fuzzy QFD questionnaire, insights from 18 experts with at least five years of experience in insurance and macroeconomic policies were utilized.
Results: The research findings indicate that the number of insured individuals and the percentage of services covered by insurance are the most critical needs of the system's stakeholders. Accordingly, reducing the insurance service copayment rate, stratifying the number of insured individuals, and allocating a portion of the base insurance share to private insurance companies are prioritized in the identified policies.
Conclusion: Based on the study's findings, it is concluded that for the government to provide sustainable health services to the public, the private sector should also be involved to bear the service provision costs in exchange for appropriate revenue. Health services should be stratified to meet varied needs effectively.
Methods: This study first reviews recent research literature, followed by conducting focused group interviews with research experts. After identifying stakeholders' needs and various policies, the policies were weighted and prioritized using a Fuzzy Quality Function Deployment (QFD) approach. To enrich the data for the Fuzzy QFD questionnaire, insights from 18 experts with at least five years of experience in insurance and macroeconomic policies were utilized.
Results: The research findings indicate that the number of insured individuals and the percentage of services covered by insurance are the most critical needs of the system's stakeholders. Accordingly, reducing the insurance service copayment rate, stratifying the number of insured individuals, and allocating a portion of the base insurance share to private insurance companies are prioritized in the identified policies.
Conclusion: Based on the study's findings, it is concluded that for the government to provide sustainable health services to the public, the private sector should also be involved to bear the service provision costs in exchange for appropriate revenue. Health services should be stratified to meet varied needs effectively.
Amir Hallaji, Saleh Ghavidel Doostkouei, Masood Soufi Majidpour, Aliabbas Heydari,
Volume 7, Issue 1 (6-2024)
Volume 7, Issue 1 (6-2024)
Abstract
Introduction: Increasing spending on social security resources is one of the country's economic challenges. Since the population structure and its dynamics in any country is considered the axis and center of economic and social planning, on the other hand, this increase in population requires the assurance of prosperity and peace in the future. Therefore, planning and predicting the impact of demographic changes on the resources and expenses of the social security organization until 2050 is of great importance.
Methods: In this research, the estimation of the population based on age groups using the cohort method has been done until 2050, and then the demand and supply of labor in four different scenarios has been predicted until 2050. Using the average ratio of insured persons to employed persons, the number of insured persons has been predicted until 2050. To determine the number of pensioners, the ratio of pensioners to the number of people over 60 years of age is used, and by maintaining the stability of this relationship, the number of pensioners has been estimated until 2050.
Results: One of the scenarios, which is highly likely to happen, shows that since 2035, the gap between the cost and income of the social security organization will increase. Another scenario determines the mentioned year 2040 as an important time for this gap. The results of this research show that by 2050, the expenses of the social security organization will exceed its resources by about 14,016 thousand billion tomans.
Conclusion: The trend of social security organization's resources and expenses, based on a realistic scenario, which is more likely than other scenarios, shows that until 1415, the social security organization's resources are more than its expenses and there is a surplus. In 2035, resources and expenses are equal and there is no deficit. From 2035 onwards, the gap between resources and expenses is increasing in favor of expenses.
Methods: In this research, the estimation of the population based on age groups using the cohort method has been done until 2050, and then the demand and supply of labor in four different scenarios has been predicted until 2050. Using the average ratio of insured persons to employed persons, the number of insured persons has been predicted until 2050. To determine the number of pensioners, the ratio of pensioners to the number of people over 60 years of age is used, and by maintaining the stability of this relationship, the number of pensioners has been estimated until 2050.
Results: One of the scenarios, which is highly likely to happen, shows that since 2035, the gap between the cost and income of the social security organization will increase. Another scenario determines the mentioned year 2040 as an important time for this gap. The results of this research show that by 2050, the expenses of the social security organization will exceed its resources by about 14,016 thousand billion tomans.
Conclusion: The trend of social security organization's resources and expenses, based on a realistic scenario, which is more likely than other scenarios, shows that until 1415, the social security organization's resources are more than its expenses and there is a surplus. In 2035, resources and expenses are equal and there is no deficit. From 2035 onwards, the gap between resources and expenses is increasing in favor of expenses.
Azamsadat Rivandi, Khalil Alimohammadzadeh, Sara Emamgholipour Sefiddashti, Ali Maher, Amin Ghasem Begloo,
Volume 7, Issue 1 (6-2024)
Volume 7, Issue 1 (6-2024)
Abstract
Introduction: Induced demand is a major challenge for financing health promotion. Experts have highlighted the important role of health insurance as a driver of demand for doctors even in emerging and advanced world economies. Therefore, the importance of conducting review studies in the country to obtain methods for identifying induced demand is not hidden from anyone.
Methods: In this study, articles were searched from English PubMed, Scopus, ProQuest, Cochrane and Web of Science databases.
Results: The findings showed that about 90% of the studies proved the induced demand in diagnostic and therapeutic services with statistical analysis methods and investigating the relationship of variables, and the issue of induced demand is still an important issue in the world.
Conclusion: The structure of insurances is quite effective in the formation of induced demand due to the fundamental role they play in paying health service providers, and the research methods of these articles provide effective perspectives for the country's health policy makers in recognizing and controlling induced demand.
Methods: In this study, articles were searched from English PubMed, Scopus, ProQuest, Cochrane and Web of Science databases.
Results: The findings showed that about 90% of the studies proved the induced demand in diagnostic and therapeutic services with statistical analysis methods and investigating the relationship of variables, and the issue of induced demand is still an important issue in the world.
Conclusion: The structure of insurances is quite effective in the formation of induced demand due to the fundamental role they play in paying health service providers, and the research methods of these articles provide effective perspectives for the country's health policy makers in recognizing and controlling induced demand.
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