Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Glob Health Res Policy. 2023 May 22;8(1):16. doi: 10.1186/s41256-023-00302-5.
The policy-making process in health reform is challenging due to the complexity of organizations, overlapping roles, and diversity of responsibilities. The present study aims to investigate and analyze the network of actors in the Iran health insurance ecosystem regarding the laws before and after the adoption of the Universal Health Insurance (UHI).
The present study was done by sequential exploratory mixed method research, consisting of two distinct phases. During the qualitative phase, the actors and issues pertaining to the laws of the Iranian health insurance ecosystem from 1971 to 2021 were identified through a systematic search of the laws and regulations section of the Research Center of the Islamic Legislative Assembly website. Qualitative data was analyzed in three steps using directed content analysis. During the quantitative phase, in order to draw the communication network of the actors in Iran's health insurance ecosystem, the data related to the nodes and links of the networks was collected. The communication networks were drawn using Gephi software and the micro- and macro-indicators of network were calculated and analyzed.
There were 245 laws and 510 articles identified in the field of health insurance in Iran from 1971 to 2021. Most of the legal comments were on financial matters and credit allocation, and the payment of premiums. The number of actors before and after the enactment of the UHI Law was 33 and 137, respectively. The Ministry of Health and Medical Education and the Iran Health Insurance Organization were found the two main actors in the network before and after the approval of this law.
Adopting a UHI Law and delegating various legal missions and tasks, often with support to the health insurance organization, have facilitated the achievement of the law objectives. However, it has created a poor governance system and a network of actors with low coherence. Based on the results of the study, it is suggested to reduce actor roles and separate them for better governance and to prevent corruption in health insurance ecosystem. Introducing knowledge and technology brokers can be effective in strengthening governance and filling the structural gaps between actors.
健康改革的决策过程具有挑战性，这是由于组织的复杂性、角色重叠和职责的多样性所致。本研究旨在调查和分析伊朗健康保险生态系统中行为者的网络，涉及在采用全民健康保险（UHI）前后的法律。
本研究采用顺序探索性混合方法研究，包括两个不同的阶段。在定性阶段，通过对伊斯兰立法大会研究中心网站的法律和法规部分进行系统搜索，确定了 1971 年至 2021 年期间伊朗健康保险生态系统法律的行为者和问题。使用定向内容分析对定性数据进行了三个步骤的分析。在定量阶段，为了绘制伊朗健康保险生态系统中行为者的沟通网络，收集了与网络节点和链接相关的数据。使用 Gephi 软件绘制沟通网络，并计算和分析网络的微观和宏观指标。
从 1971 年至 2021 年，伊朗在健康保险领域共制定了 245 项法律和 510 条法规。大多数法律评论是关于财务事项和信用分配以及保费支付。在 UHI 法颁布前后，行为者的数量分别为 33 人和 137 人。在该法律获得批准前后，卫生和医疗教育部以及伊朗健康保险组织被发现是网络中的两个主要行为者。
采用 UHI 法并委托各种法律任务和职责，通常支持健康保险组织，有助于实现法律目标。然而，这导致了一个糟糕的治理体系和一个行为者网络，其一致性较低。根据研究结果，建议减少行为者的角色并将其分离，以改善治理并防止健康保险生态系统中的腐败。引入知识和技术经纪人可以有效地加强治理并填补行为者之间的结构性差距。
