Social Determinants of Health Research Center, Health Management & Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Health Policy& Management, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management& Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Int J Equity Health. 2021 Jan 14;20(1):37. doi: 10.1186/s12939-020-01372-4.
Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC.
This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis.
Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable.
To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.
公平、效率、可持续性、客户和提供者的可接受性以及质量是全民健康覆盖（UHC）的基石。没有一个国家能够通过单一途径实现高效的 UHC。在本研究中，我们记录了伊朗的医疗保险改革，重点关注某些政策是如何以及为何被引入和实施的，以及为保持可持续的 UHC 仍存在哪些挑战。
本回顾性政策分析使用了三种数据来源：对文献进行全面和按时间顺序的范围审查、对伊朗医疗保险政策参与者和利益相关者进行访谈，以及对已发表和未发表的官方文件和当地媒体进行审查。所有数据均采用主题内容分析法进行分析。
医疗保险改革，特别是 2014 年的健康转型计划（HTP），通过扩大人口覆盖范围、福利包和增强财务保护，有助于向 UHC 和健康公平迈进。然而，一些挑战可能危及这一进展。缺乏从没有固定收入的人那里收取保费的合适机制。强制性医疗保险覆盖法尚未全面实施。私人和公共医疗收费之间存在很大差距，导致医疗费用大量自付。此外，控制总医疗支出并不是使 UHC 更可持续的主要优先事项。
为了在伊朗实现 UHC，卫生部和医疗保险计划应制定并遵循控制医疗支出的政策。应实施工作机制，为有需要的人扩大免费医疗保险覆盖范围。需要进一步研究评估医疗保险改革在健康公平、可持续性、覆盖范围和可及性方面的影响。
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