Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
Health Res Policy Syst. 2023 Sep 11;21(1):94. doi: 10.1186/s12961-023-01041-2.
Iran is host to one of the world's largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection.
This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees.
Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees.
A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.
伊朗是世界上最大和存在时间最长的难民群体之一的所在地。尽管自 2015 年 9 月以来，伊朗已在全国范围内为难民启动了一项基本医疗保险计划，但该计划的人口覆盖率非常低，各种因素导致很大一部分难民仍然缺乏保险覆盖，在接受卫生服务时经常面临经济困难。有鉴于此，本研究旨在了解伊朗难民获得保险的障碍，并提出能够解决财政保障方面持续存在差距的有效政策。
本定性研究分两个阶段进行。首先，对政策文件进行审查并对参与者进行访谈，以调查伊朗难民获得有效保险覆盖的常见障碍和促进因素。然后，应用系统思维方法来可视化实现难民财政保障的共同变量和相互作用。
研究结果表明，各种因素，如（1）难民家庭为保费，（2）考虑有等待期才有资格获得保险福利，（3）为非弱势群体确定高保费，以及（4）伊朗公共和私营服务提供部门之间的医疗服务费率存在巨大差异，导致非弱势群体难民的健康保险覆盖难以实现。此外，还发现了一些政策解决方案来改善伊朗难民的健康保险覆盖范围。这些包括从保费计算中删除家庭规模，降低当前保费费率，并从非弱势群体难民那里获得每月保费。
许多因素导致难民无法获得医疗保险，特别是伊朗的非弱势群体难民。因此，有必要采取有效政策来改善难民的健康融资，以确保财政保障，同时考虑到不同的行为者及其相互作用。
