Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

Mohammad Bazyar,Arash Rashidian,Leila Doshmangir,Sumit Kane,Ali Akbari Sari,Mohammad Reza Vaez Mahdavi

doi:10.15171/ijhpm.2016.12

Abstract

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.

Highlights

Policy Context Iran has enjoyed a universal coverage of primary healthcare services since 1990s, due to the effective health system structure.[1]
Three possible options were introduced for reducing fragmentation in health insurance system in Iran
Even though we explained them independently, they are to a large extent interrelated; they can be considered as prerequisites for each other

Summary

Introduction

Policy Context Iran has enjoyed a universal coverage of primary healthcare services since 1990s, due to the effective health system structure.[1]. Because the basic benefit package was not comprehensive enough, and the financial and organizational autonomy of the insurers, each health insurance organization has tried to raise additional resources to extend the basic benefit package for their beneficiaries and in practice there are differences between their packages In addition to these main insurers, there are about 17 smaller ‘institutional’ health insurance funds such as those offered by some banks, the Tehran Municipality, the National Broadcasting Organization, private insurance companies, the Petroleum Industry Health Organization which have launched health insurance coverage for their own employees and dependents outside of the main health insurance organizations.[6,7,10] These institutions are generally small in population size and, compared to the population coverage, enjoy abundant financial resources. Some countries such as Turkey,[15,16,17] South Korea,[18,19] Brazil, Thailand, Ghana, Peru,[20] Estonia, Lithuania,[21] and Indonesia[22,23,24] have adopted this policy to expand the size of the risk pool, and to improve the equity, efficiency, and redistribution of cross-subsidization throughout the entire health insurance system.[14,20]

Methods

17 Well-Resourced Fundsa

Findings

Conclusions and Recommendations