National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 Examining the Challenges of the Right to Health in Social Security Laws 181 192 FA Arezoo Malekshah Department of Law, ST.C., Islamic Azad University, Tehran, Iran Ahmad Ommi Department of Law, ST.C., Islamic Azad University, Tehran, Iran Marzieh Maleki Department of Islamic Education, Farhangian University, Tehran, Iran The right to health is among the fundamental human rights and has always been emphasized in Islam. It guarantees access to the highest level of physical and mental health for every individual. This means that every person is entitled to benefit from medical services, public health, adequate food, proper housing, and a healthy work environment, and this is given special support in human rights documents and social security laws. Iran's social security system, consisting of both insurance and support sectors, provides extensive medical and healthcare services. Fair and affordable access to these services, especially for vulnerable groups, is essential. Promoting social health requires providing basic prerequisites such as education, housing, food, and employment. Although social security laws emphasize the right to health, challenges such as resource shortages and limited access to quality services hinder the full realization of this right. On the other hand, government institutions are obligated to provide healthcare and protect public health in accordance with national and international laws. Therefore, fully realizing this right requires identifying challenges and offering solutions to improve the social security and healthcare system. These solutions may include increasing access to education, achieving equity in resource distribution, and improving environmental conditions.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 Priority Demographic, Clinical, and Lifestyle Factors Influencing the Prevention of Metabolic Syndrome in Adults 193 214 FA Mohsen Farboud Department of Health Service Administration, ST.C., Islamic Azad University, Tehran, Iran Somayeh Hessam Department of Health Service Administration, ST.C., Islamic Azad University, Tehran, Iran Shaghayegh Vahdat Department of Health Service Administration, ST.C., Islamic Azad University, Tehran, Iran Shahram Tofighi National Center for Health Insurance Research, Tehran, Iran Introduction: Metabolic syndrome represents a major public health challenge due to its strong association with cardiovascular disease, type 2 diabetes, and obesity. This scoping review aimed to identify the key factors influencing the prevention of metabolic syndrome. Methods: Guided by the Arksey and O’Malley framework, we conducted a comprehensive search of PubMed, ProQuest, Google Scholar, SID, and Magiran for studies published between 2010 and 2025. Relevant data were extracted using a standardized data extraction form. Results: A total of 94 articles met the inclusion criteria and were included in the final analysis. The identified determinants were classified into demographic, clinical, and lifestyle categories. Hypertension, weight gain, abdominal obesity, physical inactivity, smoking, alcohol, unhealthy dietary patterns, and low HDL levels were found to have the strongest impact on the incidence of metabolic syndrome. Conclusion: Controlling blood pressure, blood glucose, and obesity—together with lifestyle modifications—represents the most essential preventive strategies.The findings highlight the need for multidimensional health policies, improved public awareness, healthier dietary patterns, and expanded access to healthcare services. Implementing comprehensive interventions at both individual and policy levels may help reduce the prevalence of metabolic syndrome and its related complications.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 The Relationship Between Physical Activity and Chronic Diseases Among the Elderly Insured of the Iran Health Insurance Organization 215 222 FA Masoumeh Faghfouriazar Iran ,Garmsar ,University Azad Islamic .,C.Ga ,Education Physical of Department Introduction: Chronic non-communicable diseases are major public health challenges in Iran and the burden of these diseases is growing with the increase in the elderly population. A sedentary lifestyle is a key factor in these diseases. Regular physical activity can play an important protective role in the prevention and control of chronic diseases. Given the role of health insurance in covering medical costs, examining the relationship between physical activity and chronic diseases is important. Methods: This was a cross-sectional descriptive-analytical study conducted on 275 elderly people aged 60–70 years covered by health insurance in Tehran. Sampling was done in a multi-stage cluster method. Data collection tools included a demographic questionnaire, the International Physical Activity Questionnaire (IPAQ) and a chronic disease checklist. Data were analyzed using SPSS software and Chi-square and logistic regression tests. Results: Findings indicated a significant association between physical activity levels and chronic disease incidence (P=0.000). Elderly with low physical activity reported the highest prevalence of chronic disease, while over half of those with high physical activity were disease-free. Logistic regression also showed that physical activity as an independent factor after controlling for age and gender, reduces the likelihood of chronic diseases. Conclusion: Promoting physical activity among the elderly is an effective strategy for preventing and reducing chronic diseases. Educational programs and supportive interventions aimed at promoting regular, light physical activities will not only improve the quality of life of the elderly, but will also reduce medical costs and the financial burden on the health system.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 Health Insurance Literacy and Its Determinants among Insured Individuals: A Study in Yazd, Iran 223 236 FA Faeze Khaleghi Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Atiyeh Dehghan Niri Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Seyed Masood Mousavi Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Reza Valagohar National Center for Health Insurance Research, Tehran, Iran Nima Ghazal Department Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Ranjbar Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Introduction: Health insurance literacy, as a subset of health literacy, plays a crucial role in empowering individuals to effectively utilize insurance services. A sound understanding of insurance concepts and procedures enables more informed decision-making regarding health and medical care. Given its importance, the present study aimed to assess the level of insurance literacy and identify its determinants among the insured population of the Health Insurance Organization in Yazd in 2025. Methods: This descriptive-analytical, applied, cross-sectional study employed a survey design. Data were collected from a random sample of 249 insured individuals who visited the health insurance contracting offices in Yazd. A standardized insurance literacy questionnaire was used for data collection. Descriptive statistics and analytical tests, including the Mann–Whitney and Kruskal–Wallis tests, were applied using SPSS version 27. Results: Overall, 63.8% of participants demonstrated high or very high levels of insurance literacy. The highest mean score was observed in the “information access” domain, while the lowest pertained to “functional skills.” Men, individuals with higher education, and those with higher income showed significantly greater insurance literacy scores. A significant association was also found between total insurance literacy and marital status. Conclusion: Although the overall level of insurance literacy among the study population was relatively satisfactory, certain subgroups—particularly women and individuals with lower education and income levels—still require targeted educational interventions. Enhancing public education for these groups can substantially improve the effective utilization of health insurance services.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 A systematic scoping review of Artificial Intelligence Role and Functions in Optimizing Health Insurance Processes; Presenting a Framework for Iran's Health Insurance System 237 250 FA Reza Valagohar National Center for Health Insurance Research, Tehran, Iran Marziyeh Hadian Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran Mohammad Ranjbar Health Policy and Management Research Center, Department of Management and Health Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Tahereh Shafaghat Health Policy and Management Research Center, Department of Management and Health Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Introduction: Given the significant advancements in Artificial Intelligence (AI) in the health sector and the growing need to optimize health insurance services, leveraging this technology can lead to improved management processes, reduced fraud, optimized costs, and the provision of personalized services for policyholders. This research aimed to investigate the role and functions of AI in health insurance and to present a practical framework for its use in the Iranian health insurance system. Methods: This applied study was conducted in 2024 using a mixed-methods approach in two main phases: 1) A systematic scoping review to identify the applications of AI in health insurance, and 2) An expert panel to validate the identified components and propose a framework for utilizing AI in Iran's health insurance system. Results: The systematic scoping review identified 30 eligible studies. Expert panel validation yielded a final framework comprising five main domains and 14 sub-domains for AI application in Iran's health insurance system. The key domains are population health management, fraud detection and prevention, operational productivity enhancement, cost optimization, and policymaking. Conclusion: Artificial Intelligence plays a pivotal role in enhancing the efficiency and reducing the costs of health insurance systems by leveraging its capacity to analyze vast amounts of health data, predict treatment costs, detect fraud, and automate administrative processes. However, the implementation of this technology necessitates the development of appropriate infrastructure, the formulation of supportive policies, and enhancing awareness among insurance managers and staff. The framework proposed in this study can serve as a practical guide for insurance organizations on the path to optimally utilizing AI.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 Identifying Effective Factors in Curriculum Planning Based on Social Responsibility; Case Study: Iranian Health Insurance Organization Employees 251 262 FA Masoud Badkoobeh Department of Curriculum Planning, Faculty of Educational Sciences and Counseling, Roudehen Branch, Islamic Azad University, Tehran, Iran Reza Vala Department of Curriculum Planning, Faculty of Educational Sciences and Counseling, Roudehen Branch, Islamic Azad University, Tehran, Iran Zolfaghar Rashidi Department of Educational Management, Roudehen Branch, Islamic Azad University, Tehran, Iran Introduction: Today, social responsibility has gained special importance as a key principle in organizations, especially in public institutions and services such as the Iranian Health Insurance Organization. Accordingly, many countries are seeking to create comprehensive educational programs to promote social responsibility in public institutions. The aim of the present study was to identify the effective factors in curriculum planning based on social responsibility among the employees of the Iranian Health Insurance Organization. Methods: The research method was applied in terms of purpose; qualitative in terms of data type; and interviewing experts in terms of design (nature). The statistical population included theoretical experts (professors of educational sciences universities) and empirical experts (relevant officials of the Iranian Health Insurance), who were selected as a sample using the saturation principle and a purposeful non-random method, 20 experts. In order to collect data, a semi-structured interview was used, and the validity and reliability of the instrument were examined and confirmed. The data analysis method was qualitative content analysis with a thematic analysis approach using MaxQDA-2018 software. Results: The findings showed that the effective factors in curriculum planning based on social responsibility in the Health Insurance Organization are: the goal includes the components of personal development, organizational development, and social development; the content includes the components of necessary training for personal development, necessary training for organizational development, and necessary training for social development; the method includes the components of necessary training for personal development, necessary training for organizational development, necessary training for social development, and evaluation includes the components of personal development, organizational development, and social development. Conclusion: The components examined in this study show that content, goal, method, and evaluation are the four effective factors in the success of curriculum planning based on social responsibility in the Iranian Health Insurance Organization. 

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 Designing a Training Effectiveness Questionnaire to Assess Perception and Behavior of Employees in Iranian Health Insurance Organization 263 276 FA Mohammadreza Hosseini Department of Sociology, Faculty of Humanities, Ayatollah Boroujerdi University, Boroujerd, Iran Abolfazl Boujari Iran Health Insurance Organization, Tehran, Iran Hadi Zamani University of Tehran, Kish International Campus, Kish, Iran Introduction: Employee empowerment is a fundamental pillar of organizational development, with training recognized as its most influential component. Effective training plays a vital role in enhancing employees’ awareness, behavior, and participation. This study aimed to design and validate a questionnaire for assessing training effectiveness at Level 3 (behavioral–cognitive) within the Iranian Health Insurance Organization. This level focuses on learners’ perception and practical application of acquired knowledge and draws upon Gestalt principles in learning experience design. Methods: The research employed a qualitative–descriptive methodology with an instrumental–developmental approach, using directed content analysis to extract theoretical components. Results: In the first phase, initial items were derived from credible sources and reviewed by five expert evaluators across three dimensions: “topic relevance,” “clarity,” and “importance.” In the second phase, the questionnaire was pilot-tested with 43 provincial training officers. Content validity was assessed using Lashé’s coefficient, revealing that over 85% of items held high validity (coefficient ≥ 0.80). Reliability was confirmed through Cronbach’s alpha (α = 0.981), indicating strong internal consistency and no need for item elimination. Descriptive statistics further demonstrated appropriate item dispersion and balanced scale usage. Conclusion: The findings confirm that the developed questionnaire possesses strong validity and reliability, making it a suitable instrument for evaluating Level 3 (behavioral) training effectiveness among employees of the Health Insurance Organization.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 8 3 2025 12 1 Financial Toxicity: A Policy Approach to Reducing Financial Impacts on Patients in the Iranian Health Insurance System 277 284 FA Maryam Seyed-Nezhad National Center for Health Insurance Research, Tehran, Iran Mohammad Moradi-Joo Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran Financial Toxicity, defined as the economic burden and psychological distress caused by the costs of treating cancer and chronic diseases, has become an increasing challenge in Iran’s health system, placing patients at risk of debt, reduced quality of life, and even treatment discontinuation or incompletion. Despite the implementation of universal health insurance coverage, limited resources, high out-of-pocket payments, and insufficient coverage of drugs and advanced therapies continue to impose substantial financial pressure on patients. A review of international evidence indicates that interventions such as patient financial navigation, direct financial support, expanded and deeper insurance coverage, reduction of out-of-pocket payments, improved cost transparency, and functional integration of insurance organizations can effectively reduce patients’ financial burden and enhance equity in access to health services. This policy brief reviews current challenges and provides practical, evidence-based recommendations, emphasizing the need to adopt comprehensive, sustainable, and multi-dimensional policies to reduce financial toxicity within Iran’s health insurance system.