Abstract
BackgroundEquity, 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.MethodsThis 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of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media.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.ResultsHealth 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.ConclusionTo 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.
Highlights
The Sustainable Development Goals (SDGs) Summit during the opening week of the 74th session of the United Nations General Assembly gave a clear message that many countries are off-track to achieve many of the SDGs by 2030
The synthesised evidence and findings regarding the evolution of the Iranian health insurance system fell into six major periods, based on the main steps undertaken to reach universal health coverage (UHC): introduction of the first insurance scheme for workers (1930–1972); the birth of national health insurance organisations (1973–1983); organisational solidarity in health services stewardship (1984–1993); passing universal health insurance bill (1994–2003); extending health insurance coverage to all rural residents (2004–2013); and extending health insurance coverage to all residents (2014–2020) (Fig. 1)
Conclusion and policy recommendations There is no single way of providing universal health insurance coverage for all population
Summary
The Sustainable Development Goals (SDGs) Summit during the opening week of the 74th session of the United Nations General Assembly gave a clear message that many countries are off-track to achieve many of the SDGs by 2030. Many LMICs contemplate adopting SHI as it is one of the essential routes towards achieving UHC, besides general tax revenue as the primary source of financing health services. Contextual factors include, but are not limited to, existing population coverage and population needs, size of formal and informal healthcare sectors, cultural and political context, access or lack thereof to health care services, dependency ratios, demographics, population and geo-spatial characteristics, income-level differentials, administrative capability, political commitment and allocated or available financing [9]. Despite being known, these factors remain vastly understudied. 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
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