National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 Inequality in Health Financing Policies: A Fundamental Challenge of Social Equity in Iran 2 5 FA Amirhossein Takian Tehran University of Medical Science Alireza Olyaeemanesh Tehran University of Medical Science Efat Mohamadi Tehran University of Medical Science

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 Health Financing Systems in Selected Countries 6 17 FA Seyed Morteza Alizadeh Razavian National Center for Health Insurance Research, Tehran, Iran 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.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 Determining and Prioritizing the Factors Affecting the Financing of Services in the Health System in Iran 18 31 FA Parivash Heidari Orejlo Department of Health Services Management, Shiraz Branch, Islamic Azad University, Shiraz, Iran Shaghayegh Vahdat Department of Health Services Management, Faculty of Management, South Tehran Branch, Islamic Azad University, Tehran, Iran Hassan Soltani Management Department, Shiraz Branch, Islamic Azad University, Shiraz, Iran 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.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 Effect of COVID-19 Pandemic on the Country's Insurance Industry in the Vector Autoregression Model: A Secondary Study 32 43 FA Behrooz Nazemi Isfahan Branch, Islamic Azad University, Isfahan, Iran Yazdan Gudarzi Farahani Department of Economics, Faculty of Economics and Management, Qom University, Qom, Iran Introduction: With the outbreak of Covid-19 in China and its spread to other countries, financial markets around the world were severely affected by this crisis. The global effects of the Covid-19 outbreak include rising global unemployment, severe shocks to the world economy, declining crude oil prices, declining global trade in most of the countries involved, and the closure of the world to foreign trade. The aim of this study was to investigate the effect of Covid-19 pandemic on the performance indicators of the country's insurance industry. Methods: This study was a secondary study. In addition, in this study, the statistical data of 1991-2020 and the autoregression vector model were used to investigate the effect of the Covid-19 pandemic on the insurance industry. In this study, the Covid-19 pandemic is included in the model as an exogenous shock. Results: The findings of this study indicated that the release of Covid-19 leads to an increase in production premiums and claims paid in the life and non-life insurance sector. The results showed that the impact of the Covid-19 pandemic on the life insurance sector was greater than non-life insurance. Conclusion: In countries with lower inflation rates and stable economies, the effects of Covid-19 on production premiums are negative, but in countries that experience high inflation with economic instability, the effects of Covid-19 on production premiums are positive. In fact, in the country, due to the annual increase in the ransom rate, which increases the third-party insurance premium, exchange rate fluctuations and inflation also lead to the growth of insurance companies' production premiums. For this reason, the recession and economic growth of the country in recent years has not had a negative effect on the growth of premiums and only the growth rate of premiums has increased or decreased.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 The Impact of COVID-19 Pandemic on Written Policy Number and Claim Number of Life Insurance in Iran 44 51 FA Maryam Ghafoor Boroujerdi Department of Economics, Faculty of Social and Economic Sciences, Al-Zahra University, Tehran, Iran Mir Hossein Mousavi Department of Economics, Faculty of Social and Economic Sciences, Al-Zahra University, Tehran, Iran Introduction: One of the insurance disciplines that is closely related to Covid-19 and its deadly consequences is life insurance. Accordingly, in order to make appropriate decisions and policies, a comprehensive study of this disease and its effects on life insurance is essential. The purpose of this article is to investigate the effect of Covid-19 pandemic on the number of insurance policies issued and life insurance claims in Iran. Methods: The present study was performed qualitatively and quantitatively in 2021. In the qualitative part, comparative study and qualitative analysis (content analysis) were used. In a small part, the studied data were collected from Sanhab system and central insurance statistical yearbook. The sample studied in this section includes information of the first 9 months of 2018 to 2020 in 26 insurance companies. Data were categorized using Excel software version 2016 and this data was analyzed using E-Views software version 11. Results: The results of the revealed statistical facts show that the number of life insurance claims has increased in most countries of the world due to the Covid-19 pandemic, but the effect of this virus on people's willingness to buy life insurance and life insurance policy issued is different. Also, the results of the regression model show that in Iran, the average of both variables, the number of life insurance policies issued and the number of life insurance claims with the prevalence of Covid-19 has increased significantly. Conclusion: Since the prevalence of Covid-19 has increased the number of life insurance claims and this issue can be to the detriment of insurance companies, it is necessary for insurance companies in interaction with related centers and institutions to take the necessary measures regarding self-care training for individuals. Insurers can also diversify their activities to control the adverse effects of the epidemic.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 Investigating the Factors Affecting Catastrophic Costs With Emphasis on the Role of Insurance 52 59 FA Samira Motaghi Department of Economics, Payame Noor University, Tehran, Iran Minoo Amini Milani Department of Economics, Payame Noor University, Tehran, Iran Mehdi Keshavarz Department of Economics, Payame Noor University, Tehran, Iran Moien Zabeti Department of Political Science, Payame Noor University, Tehran, Iran Alireza Fathizadeh Department of Management, Payame Noor University, Tehran, Iran Introduction: Nowadays, providing household health expenses is an important challenge in the health system and increasing the costs of health services have created problems in financing health expenses on families facing illness. In this regard, insurance seems to play a key role in such costs for households. Accordingly, the main purpose of this study is to investigate the factors affecting the devastating costs of health with emphasis on the role of insurance. Methods: The present study is a descriptive-analytical and cross-sectional study that was conducted in medical hospitals of Tehran. 170 patients (households) were selected as the research sample and finally 165 patients (households) were included in the study. Data were collected using a questionnaire of the World Health Organization and finally analyzed using SPSS software. Results: In 2019, about 31% of our statistical population were exposed to staggering health costs. The results of the Logit econometric model show that households with more members under the age of 11 and over 65, whose head is unemployed, or who have a low level of education, or who are chronically ill, are more likely to incur staggering health costs. Meanwhile, the percentage of catastrophic health costs in households without insurance protection is very high. Conclusion: Insurance protection along with economic indicators is one of the factors affecting the staggering costs of household health in Tehran.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 Designing a Comprehensive Model of Human Resource Management in the Health Sector of the Country in Conditions of Health Crisis 60 67 FA Azadeh Ashrafi Department of Public Administration, North Tehran Branch, Islamic Azad University, Tehran, Iran Mahmoudreza Mohaghegh Dolatabadi School of Medicine, Iran University of Medical Sciences, Tehran, Iran Javad Faghihipour Department of Human Resources Management, University of Tehran, Tehran, Iran Kobra Mafi Iran University of Medical Sciences, Tehran, Iran Fatemeh Darbandi Iran University of Medical Sciences, Tehran, Iran Introduction: Human resources is one of the most important sources of the health system, because the use of health technologies in the management and provision of services to improve health is the responsibility of this sector. The main purpose of this study was to design a comprehensive model of human resource management in the health sector in the context of health crisis. Methods: The research method was qualitative based on grounded theory method (without structure). Data analysis was performed using triple coding of grounded theory technique (open, axial and selective coding) in MAXQDA software environment. Results: The findings showed that the most effective measures regarding the first function should be in pre-crisis conditions, the second function in pre-crisis conditions, the third function in pre-crisis and post-crisis conditions, the fourth function in pre-crisis conditions, the fifth function in pre-crisis conditions, and the sixth function should be done in the post-crisis situation. On the other hand, in this study, 4 models including the model of human resource management in the pre-crisis, during the crisis, after the crisis, as well as a comprehensive model of human resource management in the context of health crisis were developed. Conclusion: Based on the findings of the study in the pre-crisis time should be the main focus on hiring, manpower, training and organizational communications. In times of crisis, the reward system, benefits, safety and welfare of employees should be considered. In the post-crisis situation, the payment system and benefits and retirement are important.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 5 1 2022 3 1 The Trend of Changes in the Support Ratio in Iranian Pension Funds 68 77 FA Reza Kiani Department of Population and Health, National Population Research Institute, Tehran, Iran Majid Kosheshi Department of Demography, University of Tehran, Tehran, Iran Introduction: A study of the situation of Iranian pension funds shows that these funds have faced significant financial challenges in the last two decades and have reached a state of instability in the pension system. This raises serious questions about the ability of funds to meet their obligations for the benefit of beneficiaries. One of the tools for measuring the balance of resources and expenditures and the stability of pension funds is the support ratio. The purpose of this study is to examine this ratio in pension funds with an emphasis on social security and its developments over the past 50 years. Methods: The present study is a descriptive-analytical research through secondary analysis of organizational registration data. The data used were obtained from statistical and information sources of pension funds and the Statistics and Information Office of the Ministry of Labor Cooperation and Social Welfare. Results: State Pension Funds, Steel, Central Bank, Radio and Television, National Copper and Ports and Shipping have a support ratio below one. By classifying this ratio with the following group of 2 employees retired, to this list can be added banks, Homa Airlines, Central Insurance and Oil. Also, the support ratio in the Social Security Fund has been decreasing in recent years, so that in the last ten years it has decreased from 6.81 in 2010 to 4.5 in 2019. Conclusion: The crisis in pension funds is so important that any neglect of it can create a national challenge in the country. The results obtained in this study show that the support ratio in pension funds has a decreasing trend and the continuation of this trend poses major risks to the Iranian economy.