National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Wearable Technologies and Internet of Things in Life and Health Insurance 2 13 FA Mitra Ghanbarzadeh Insurance Research Center, Tehran, Iran Asma Hamzeh Insurance Research Center, Tehran, Iran Nasrin Hozarmoghadam Insurance Research Center, Tehran, Iran Advances in technology and user acceptance have led to the production and launch of wearable devices by startup companies over the years, as well as the spread of the Internet of Things, which can create amazing opportunities, especially for insurers. The purpose of this article, while introducing the Internet of Things and wearable technologies and explaining the reasons for their importance in life and health insurance, is to introduce and review the insurance companies that use these technologies in presenting their products in order to provide a clear picture of their application and capabilities. This research, using a qualitative method of descriptive-exploratory type, examines the applications, capabilities and challenges of using wearable technologies in life and health insurance. The research results show that there are different technologies for assessing the insured risk and the insurer’s awareness of the insured health status, each of which considers different indicators. The results indicate that the use of health wearables from various dimensions such as risk assessment, insurance processes, damage control and cost and time reduction is effective in designing life insurance and treatment products. Therefore, life and health insurers, in addition to considering these technologies in the design and delivery of products, must be prepared to face challenges such as data management, building the necessary infrastructure, privacy and data security. In this regard, it is necessary in the early stages of planning these technologies, strategies such as increasing awareness and encouraging customers to use these technologies, partnerships with companies in the field of health, data security, product innovation, damage control and insurance processes.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Legal System Governing Organizations Providing Health Insurance Services 14 29 FA Seyed Reza Hosseini Department of Public Law, Faculty of Humanities, North Tehran Branch, Islamic Azad University, Tehran, Iran Bijan Abbasi Department of Public Law, Faculty of Law and Political Science, University of Tehran, Tehran, Iran Ehsan Aghamohammadaghaee Department of Public Law, Faculty of Humanities, North Tehran Branch, Islamic Azad University, Tehran, Iran Health is one of the most basic needs of all human beings. The main function of the health system of any country is to provide services in this field. The purpose of this research is to find out how services are provided by which institution and according to what principles. After the victory of the Islamic Revolution, the expansion of social security became a public right in Article 29 of the Constitution, relying on the enjoyment of social security benefits by all people. Accordingly, the main institutions, organizations, institutes and funds in the areas of insurance, protection and relief of this system are obliged to carry out their executive affairs and tenure in the field of production and provision of services and related legal obligations in accordance with contracts proposed by the Ministry of Cooperatives. Social welfare and the approval of the High Council of Welfare and Social Security will be determined to be delegated to brokerage firms. In the Iranian legal system, various institutions are responsible for providing health services to different segments of society, but the main institutions providing insurance services are the Health Insurance Organization of Iran and the Social Security Organization. Each of these organizations, according to their duties and responsibilities, provide health services in the community.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 The Impact of Health Transformation Program on Per Capita Referrals and the Cost of Inpatient Services for the Insured of the Iran Health Insurance Organization 30 39 FA Mehraneh Shamshirbandi Program and Budget Integration Group, Office of Administrative Renovation and Transformation, Iran Health Insurance Organization, Tehran, Iran Sara Emamgholipour Sefid-Dashti Department of Health Management and Economics, School of Health, Tehran University of Medical Sciences, Tehran, Iran Introduction: Introduction: The implementation of Health Transformation Plan (HTP) with the aim of expanding the quality of inpatient services and financial protection of inpatients in order to reduce out-of-pocket payments and provide the services required by inpatients by the hospital has increased hospitalization rate and costs in hospitals. The purpose of this study was to investigate the impact of the implementation of this program on the service costs, hospitalization of the insured of Iran Health Insurance Organization (IHIO). Methods: This cross-sectional study was conducted to investigate the hospitalization rate and cost of the insured of IHIO by implementing HTP in the period of April 2012 to March 2016. The data sources were gathered from the books of performance report of the IHIO from 2012-2016. Data was categorized using Excel software version 2013. Then Data was analyzed by SPSS software version 21 and E-Views version 8 using the Interrupted Time Series (ITS) model. Results: The results of ITS showed a significant increase in hospitalization rate per capita after 4 months of the implementation of HTP. So that every month, on average, for every one million people insured, 156 people werr added to the number of hospitalized referrals of the insured of this organization. Also, the implementation of the HTP has increased the per capita fixed cost of service hospitalization of the insured insurance in the country. The increase in the per capita fixed cost of hospitalization after 4 months from the beginning of the Health Transformation Program and at the same time with the start of the third phase of the program has been the reason for reviewing the book Relative Values of Health Services. The Findings showed that the implementation of the program, on average per month, for each insured person, the amount of 1,544.8 Rials has been added to the cost of each hospital service. Conclusion: The implementation of the HTP has increased the hospitalization rate and cost of per- insured of the IHIO. Also, the implementation of this program has increased the per capita cost of proving the hospitalization of the insured of the organization. Due to the limited financial resources of the organization, in order to control and manage financial resources, policies such as referral system and creating a waiting list for hospital services in the treatment of non-emergency diseases should be adopted immediately.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Forecasting the Trend of Iran's Health Expenditures Growth Using the Equilibrium Function of Households Health Services Demand 40 47 FA Mahmood Kazemian Health Economics Department, Faculty of Medicine, Shahed University, Tehran, Iran Mohammad Meskarpour-Amiri Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Introduction: Predicting the trend of changes in health expenditures in Iran can provide the necessary basis for controlling and managing health expenditures and creating a planned and balanced growth in expenditures. The purpose of this study was to predict the growth trend of health expenditures in Iran until 2025. Methods: The present study was a descriptive-analytical and applied research. To predict the growth trend of total health expenditures, an equilibrium function for household health service demand was fitted using the econometric method. Two-stage least squares (2 SLS) method was used to estimate the equilibrium function of household demand. Before fitting the model, the presence of mania in the studied variables was confirmed using the generalized Dickey-Fuller test (ADF). The absence of serial correlation was also assessed and confirmed by the Watson-D-W camera test. All estimates were performed using Eviews 7 econometric software. Results: The growth of health expenditures during the first 3 years (2017-2019) is between 1.3 to 4.7, after which it will decrease over a period of 4 years (2020-2023) and then pursues its long-term growth again; In 2024 and 2025, it will grow again by 3.3 and 5.6 percent, respectively. Conclusion: Continued long-term growth in health expenditures, in conditions of limited government funding, can lead to an increased risk of households facing catastrophic health expenditures. The country’s health policy makers must allocate new financial resources to finance household health expenses by expanding the financial sector of the health sector.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Predicting Outpatient Contacts of Social Security Insured until 2025 48 57 FA Hossen Joudaki Social Security Organization, Tehran, Iran Bita Hemmat-Boland Social Security Organization, Tehran, Iran Najmeh Sadat Mirshafiei Social Security Organization, Tehran, Iran Introduction: The aim of this study is to predict the per capita outpatient contacts of social security insured from 2020 to 2025. Methods: To perform the prediction, a five-step method including determining the purpose of the prediction, determining the time horizon, selecting the prediction model, performing the prediction and determining its accuracy was used. Results: The number of outpatient contacts of social security insured at the end of 2025 will be equal to 553,124,688. Of these, 157,843,600 will be referred to social security medical centers (28.5%) and 395,281,088 will be referred to public and private centers (71.5%). In 2019, each insured person had an average of 10.92 outpatient contacts. Of this amount, 3.24 referred to the medical centers of the Social Security Organization and 7.68 referred to public and private centers of the contracting party. It is predicted that by the end of 2025, each insured person will have 11 outpatient contacts, of which 3.14 contacts will be to social security medical centers and 7.86 will be to public and private medical centers. Conclusion: The per capita number of outpatient contacts of social security insured will increase by 0.08 by 2025. That is, for every 100 people, there will be 8 more contacts than in 2019. Despite the slight increase in per capita outpatient contacts until 2025, per capita contacts in 2025 will still be 0.74 units lower than the maximum per capita contacts in 2009. The estimated per capita is lower than the actual per capita due to the non-registration of claims outside the insurance coverage.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Online Customer Experience in Health Services: An Interpretive Structural Modeling Approach 58 67 FA Faezeh Mohammadi Department of Business Management, Central Tehran Branch, Islamic Azad University, Tehran, Iran Sina Nematizadeh Department of Business Management, Central Tehran Branch, Islamic Azad University, Tehran, Iran Abbas Heydari Department of Business Management, Central Tehran Branch, Islamic Azad University, Tehran, Iran Hossein Safarzadeh Department of Business Management, Central Tehran Branch, Islamic Azad University, Tehran, Iran Introduction: Covi-19 is the most pervasive crises in recent decades that has caused unmissable changes in customer behavior. Increasing patient numbers has created many challenges for health care providers and their staff, reduced referrals to health insurance and consequently lack of access to the care needed, lockdown and fear of infection have made online customer experience a serious issue for providing better health services. The aim of this study was to present a structural-interpretive model of online customer experience in covid-19 period. Methods: The present study is based on pragmatism. In the qualitative part Meta-Synthesis (MS) which is a kind of review study and in quantitative stage, interpretive structural models have been used and it has done in 2020. In the qualitative section, by systematically reviewing 326 articles, 36 articles were selected and the identified dimensions were used to present the final model, structural-interpretive modeling technique and penetration-dependence analysis. Results: The findings indicate that, the structure has the dimensions of company experience, health safety experience, website experience, emotional experience, payment experience, product/service experience and security experience. Also, the company’s experience is independent component, emotional experience as dependent component and the other are related components. Conclusion: Given that the main goal of the health insurance organization is to protect the patient, it is recommended that by utilizing the findings of this research and focusing on the telemedicine approach, improve the online experience of its customers in the time of covid-19.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Analysis of the Stochastic Mortality Models Based on Lee-Carter Model in Predicting Mortality Rates in Life and Health Insurance 68 79 FA Shirin Shoaee Department of Actuarial Science, Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran Ⅿohaⅿⅿaⅾ Ⅿehⅾi Ghoⅼi Keshⅿarzi Department of Actuarial Science, Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran Introduction: Demographic indicators such as mortality rates play a very important role in health, financial and pension policies. Therefore, the accuracy of mathematical models in predicting death is an important challenge, and a more accurate prediction of life expectancy has an increasing impact on the policy-making of a large part of society. Therefore, the purpose of this study is to predict the mortality rate based on the family of stochastic mortality models and compare the results with each other. Methods: One of the practical methods for predicting mortality is the Lee-Carter model. But this method, like other extrapolation methods, does not include information about the effects of medical, behavioral, or social advances on mortality rates. Among the generalizations of the Lee-Carter model are the Renshaw-Haberman and Currie models, which also apply age-specific cohort effects. In this study, a family of stochastic models is used to estimate model parameters, age-specific mortality rates and predict mortality rates. In this regard, human mortality database (HMD) data is used. But there is no information about our country in this database. Since the French mortality model is very close to the Iranian model and the life tables of this country (TD 88-90) are used in Iranian insurance applications, so the crude death rate of French men in the years 1900-2018 on the ages of 18, 40 and 65 years is used. Results: In this study, three different models of this family were evaluated. Based on the parameter estimation, the models fitted to the data and finally, the mortality rate prediction were found  that the Rinshaw-Haberman model performed better in predicting the mortality rate for all ages under study than the other two models. Conclusion: In this study, by generalizing the Lee-Carter model by applying the applying the age-specific cohort effects, the performance of the model was improved and the optimal method was presented by evaluating these models.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 4 1 2021 3 1 Reconstruction of the Iran’s health insurance system. 80 82 FA Jahanara Mamikhani Department of Economic, Khomeinishahr Branch, Islamic Azad University, Isfahan, Iran