Factors Influencing Basic and Complementary Health Insurance Purchasing Decisions in Iran: Analysis of Data From a National Survey

Abstract

Expanding the coverage of health-care insurance is a tool toward achieving universal health coverage and reducing financial barriers to care. Therefore, understanding the factors that affect the expansion of health insurance is important for policymakers. The study aimed at assessing the variables that affected the decisions to purchase health insurance in Iran. We analyzed data gathered from a national survey of health-care utilization in Iran that covered over 23,000 households. We identified subsets of the data that represented purchasing decisions. Increase in age, education, income, wealth, and the opportunity of working in the governmental sector increased the probability of purchasing BHI and CHI coverage. Past utilization of inpatient and outpatient care increased the probability of purchasing BHI and CHI, respectively. Evidence of adverse selection and wide socioeconomic differences in insurance purchase decisions were observed throughout the study. However, most significant factors were not easily influenced by policy decisions. The findings suggest that it might be very difficult to achieve universal insurance coverage unless nation-wide nonvoluntary policies are implemented.