Shahabi Saeed, Skempes Dimitrios, Behzadifar Masoud, Tabrizi Reza, Nazari Behrooz, Ghanbari Mahboubeh Khaton, Heydari Seyed Taghi, Zarei Leila, Lankarani Kamran Bagheri
Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
Independent Researcher, Zofingen, Switzerland.
Cost Eff Resour Alloc. 2021 Dec 11;19(1):80. doi: 10.1186/s12962-021-00333-0.
High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and identified gaps in insurance coverage in order to inform future policy reforms and the design of a more comprehensive and universal benefits package for physiotherapy services in Iran.
This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time.
Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g., informing policy-makers about physiotherapy services), collection of funds (e.g., placing value-added taxes on luxury goods and services), pooling of funds (e.g., moving allocated resources towards insurance (viz. third-party) mechanism), purchasing (e.g., using strategic purchasing), and benefit package (e.g., considering preventive interventions) as the main components of insurance coverage.
The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.
交通事故相关伤害、气候变化、自然灾害、人口老龄化以及慢性病等给伊朗的物理治疗服务带来了巨大需求。然而，此类服务的利用面临着一系列并发症，尤其是保险覆盖不足。因此，本研究调查并确定了保险覆盖方面的差距，以便为未来的政策改革提供参考，并设计出更全面、更普遍的伊朗物理治疗服务福利套餐。
本项目在伊朗开展，采用混合方法（即定性 - 定量）。在第一阶段，完成了一项定性研究以寻找政策建议。然后在第二阶段，通过层次分析法（AHP），根据有效性、可接受性、成本、公平性、可行性和时间对这些建议进行优先排序。
在第一阶段，共完成了对卫生政策制定者、健康保险公司、教职员工、康复专家和物理治疗师的30次半结构化访谈。研究参与者还提出了若干政策建议。在第二阶段之后，提供了优先建议，以促进管理（例如，向政策制定者宣传物理治疗服务）、资金筹集（例如，对奢侈品和服务征收增值税）、资金统筹（例如，将分配的资源转向保险（即第三方）机制）、采购（例如，采用战略采购）以及福利套餐（例如，考虑预防性干预措施）作为保险覆盖的主要组成部分。
研究结果为改善伊朗物理治疗服务的保险覆盖提供了有利依据。此外，决策者和政策制定者可以将这些建议列入卫生部门的议程，以保护民众的健康状况，特别是残疾人群体的健康状况。
