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

Int J Health Policy Manag. 2016;5(4):253–258. doi:10.15171/ijhpm.2016.12

6 Pages Posted: 3 Mar 2016

See all articles by Mohammad Bazyar

Mohammad Bazyar

Tehran University of Medical Sciences

Arash Rashidian

Tehran University of Medical Sciences

Sumit Kane

Royal Tropical Institute

Mohammad Reza Vaez Mahdavi

Shahed University

Ali Akbari Sari

Tehran University of Medical Sciences

Leila Doshmangir

Tabriz University of Medical Sciences

Date Written: March 1, 2016

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.

Keywords: Fragmentation; Health Insurance Funds in Iran; Integration of Policies; Consolidation; Risk Pooling

Suggested Citation

Bazyar, Mohammad and Rashidian, Arash and Kane, Sumit and Vaez Mahdavi, Mohammad Reza and Akbari Sari, Ali and Doshmangir, Leila, Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran (March 1, 2016). Int J Health Policy Manag. 2016;5(4):253–258. doi:10.15171/ijhpm.2016.12, Available at SSRN: https://ssrn.com/abstract=2741065

Mohammad Bazyar

Tehran University of Medical Sciences ( email )

Number 21, Dameshg St.
Vali-e Asr Ave.
Tehran, 14195
Iran

Arash Rashidian (Contact Author)

Tehran University of Medical Sciences ( email )

Number 21, Dameshg St.
Vali-e Asr Ave.
Tehran, 14195
Iran

Sumit Kane

Royal Tropical Institute ( email )

Mauritskade 63
Amsterdam, 1092 AD
Netherlands

Mohammad Reza Vaez Mahdavi

Shahed University ( email )

Persian Gulf Freeway
Tehran
Iran

Ali Akbari Sari

Tehran University of Medical Sciences ( email )

Number 21, Dameshg St.
Vali-e Asr Ave.
Tehran, 14195
Iran

HOME PAGE: http://ijhpm.kmu.ac.ir

Leila Doshmangir

Tabriz University of Medical Sciences ( email )

Tabriz
Iran

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
23
Abstract Views
349
PlumX Metrics