Health Insurance Handbook

Wang, Hong; Switlick, Kimberly; Ortiz, Christine; Zurita, Beatriz; Connor, Catherine

doi:10.1596/978-0-8213-8982-9

Cited by 33 publications

(41 citation statements)

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“…Consequently risks have been distributed unevenly among risk pools, limiting redistribution of risks and cross-subsidization across the pools. 6,11 Inefficiency in health insurance system, high out-of-pocket (OOP) expenditures, fee-for-service (FFS) payments to hospitals and physicians, a low financial protection against health services for the insured persons, considerable coinsurance rates, 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 not reliable data and statistics for health insurance policy-making, are some of insurance system problems that can be attributed to the fragmentation in health insurance funds directly or indirectly. 2,6,8,12 Iran's constitution (Article 2) emphasizes the importance of securing equity and justice among people in general and Article 29 explicitly notes the provision of access to healthcare and insurance as a universal right of the public.…”

Section: Policy Contextmentioning

confidence: 99%

“…Implementation of this policy would require to deal with many operational challenges in different aspects of health insurance organization such as benefit package, financing mechanisms, organizational structure, operational processes, and engagement with providers for purchasing health services. 11 These challenges must be identified and the best solutions must be found to solve them.…”

Section: Option 2: Consolidation Of the Existing Health Insurance Funmentioning

confidence: 99%

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

Bazyar¹,

Rashidian²,

Kane³

et al. 2016

Int J Health Policy Manag

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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.

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Section: Policy Contextmentioning

confidence: 99%

Section: Option 2: Consolidation Of the Existing Health Insurance Funmentioning

confidence: 99%

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

Bazyar¹,

Rashidian²,

Kane³

et al. 2016

Int J Health Policy Manag

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“…In recent years, expanding universal health insurance coverage has been the primary health policy in healthcare reform around the world, including in developed and developing countries, such as the USA, Mexico, and China (Wang et al ., ). Implementing this policy is always costly.…”

Section: Introductionmentioning

confidence: 97%

Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention

2015

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Whether health insurance matters for health has long been a central issue for debate when assessing the full value of health insurance coverage in both developed and developing countries. In 2007, the government-led Urban Resident Basic Medical Insurance (URBMI) program was piloted in China, followed by a nationwide implementation in 2009. Different premium subsidies by government across cities and groups provide a unique opportunity to employ the instrumental variables estimation approach to identify the causal effects of health insurance on health. Using a national panel survey of the URBMI, we find that URBMI beneficiaries experience statistically better health than the uninsured. Furthermore, the insurance health benefit appears to be stronger for groups with disadvantaged education and income than for their counterparts. In addition, the insured receive more and better inpatient care, without paying more for services. Copyright © 2015 John Wiley & Sons, Ltd.

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“…The collection of contributions will be integrated with other social insurance funds as a result of merging. In addition to the improvement of equity in contributions and reduction of administrative costs(34), the single-payer system has more power in bargaining with providers through creating a monopolistic purchaser (22,27). The single insurance has the capacity and inclination to purchase medical care cautiously, which will improve the efficiency of the new system (27,30).…”

Section: Discussionmentioning

confidence: 99%

“…A semi-structured interview guide was used to conduct the interviews. For the purpose of the study, to develop the interview guide questions and finding an appropriate conceptual framework to cover all aspects of merging and to organize the findings, a conceptual framework was derived from the World Bank (22). The World Bank framework includes eight elements to design and establish a health insurance system: feasibility of insurance design, financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, operational processes, and monitoring and evaluation.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

What Kinds of Advantages and Disadvantages May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

Bazyar

Yazdi‐Feyzabadi

Rahimi³

et al. 2020

Preprint

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Background: In countries with health insurance system, the number, the size of insurance funds and the amount of risk distribution among them is a major concern. One possible solution to overcome problems resulting from fragmentation is combining risk pools together to create fewer and larger ones, ideally a single pool. This study aims to realize what kind of advantages and disadvantages merging health insurance funds together may bring about to the health insurance system in particular and health system in general. Methods:In this qualitative study, nesting purposive sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. Documentary review was used as supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the qualitative data. For assuring the quality of results, four trustworthiness criteria including credibility, transferability, dependability and confirmability were used. Results:The results of this study indicated that there are diverse positive and negative consequences for merging of health insurance funds in Iran which are categorized into seven categories including governance/stewardship, financing, population, benefit package, structure, operational procedures and interaction with providers. These themes are subdivided further into thirty-seven sub-categories which represent a wide range of different policy aspects which need close attention to deal with the merging of health insurance funds.Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks, so to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

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Health Insurance Handbook

Cited by 33 publications

References 0 publications

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

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

Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention

What Kinds of Advantages and Disadvantages May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

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