Summary
Background
Sustainable health financing is one of the main challenges of policy makers and planners. This study aimed at comparing the experiences of countries in using the sin tax policies for sustainable health financing resources.
Methods
This qualitative study was conducted in two phases. First, a comparative study was carried out by searching databases from 1990 to 2017, and six countries (Thailand, England, Australia, the Philippines, South Africa, and Vietnam) were selected. Second, the existing Iranian high policy documents from 2005 to 2017 were reviewed deeply by using the content analysis method.
Results
The sin tax, such as taxes on tobacco and alcohol, was one of the main policies to provide sustainable health financing in all selected countries. The Iranian health system had no significant‐related legal and political gap, but there were limitations in enforcing and implementing them. Finally, it is necessary to evaluate the policy and follow its effects up.
Conclusions
The main financial resources in the selected countries included health promotion funds with different names and goals which took taxes on harmful goods, tobacco, and alcohol. Weaknesses in implementing laws and monitoring them were the main reasons for the lack of sustainable financing.
Resources allocated to health promotion are not sustainable and change according to the country's budget policies and priorities. The accumulation of taxes/ sin tax of harmful goods and services and allocating them to health promotion can improve the public health and reduce the burden of diseases and imposed costs on the health system.
→What this article adds:There are a variety of approaches to sustainable financing of health promotion services in Iran: taxes/sin tax on unhealthy foods, sweetened beverages & services; using the capacities of social insurance funds; and relying on government's budget.
Objectives
This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view.
Results
All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.
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