Recommendations to improve insurance coverage for physiotherapy services in Iran: A multi-criteria decision making approach

Abstract

Background: High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and prioritized potential policy recommendations to improve insurance coverage for physiotherapy services in Iran.Methods: This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time. Results: Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g. informing policy-makers about physiotherapy services), collection of funds (e.g. placing value-added taxes on luxury goods and services), pooling of funds (e.g. moving allocated resources towards insurance [viz. third-party] mechanism), purchasing (e.g. using strategic purchasing), and benefit package (e.g. considering preventive interventions) as the main components of insurance coverage. Conclusion: The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.

Physical rehabilitation financing in Iran: a policy analysis using Kingdon’s multiple streams

“…Relative high cost of PRS, insufficient financial resources, inadequate and inefficient budget allocation, weak insurance coverage, and the increasing prevalence of cases requiring PRS were considered as the evident indicators of the problem. Given the growing demand for PRS [ 27 ], on the one hand, and the fact that financial issues are currently hindering equitable access to these services for those who need them [ 14 , 25 ], the attention of politicians and policy-makers should be captured to adopt some appropriate measures promptly. A major issue inferred from some stakeholder interviews, including policy-makers and insurers, was the fact that they were unaware of the role and position of PRS in the health system as such they considered it insignificant and expensive compared to the other health services.…”

“…Reduction in oil revenue [ 39 ], economic recession, and international sanctions [ 40 , 41 ] against Iran hinder approaches focusing on new internal or external revenue sources to find their ways to the political agenda. The policy alternatives, which emphasize the more effective and efficient allocation of resources and take advantage of the existing capacities, have higher likelihood of viability and credibility to be brought forth to the agenda-setting process [ 25 ]. PRS comprise a wide range of services dealing with a variety of health conditions and service beneficiaries.…”

“…These disciplines include but are not limited to physical medicine and rehabilitation, physical therapy, occupational therapy, prosthetics and orthotics. The disagreements and conflicts of interest among these disciplines may lead to a lack of consensus, which in turn has a destructive effect on their potential role as influential policy communities outside the government [ 25 ]. The campaigns and NGOs of persons with disabilities were considered to be more influential by the interviewees, especially in recent years, and the role of virtual networks to represent national mood was also highlighted.…”

“…The following institutions and stakeholders are involved in financing of PRS in Iran: Social Security Organization (SSO), State Welfare Organization, the Ministry of Health and Medical Education (MHME), Iran Health Insurance Organization (IHIO), Planning and Budget Organization, the Parliament, Social Security Office of the Armed Forces, Foundation of Martyrs and Veterans Affairs, Iranian Red Crescent Society, government, and private supplementary insurance companies [ 16 , 24 ]. Given that a limited portion of PRS is covered by insurance (especially supplementary insurers), the coverage of costs is very low for all individuals, except for special groups such as veterans [ 25 ]. Furthermore, the adoption of privatization and outsourcing policies in the governmental rehabilitation units has provided a majority of services by the private sector, which usually have higher tariff rates [ 16 ].…”

Prioritizing solutions to incorporate Prosthetics and Orthotics services into Iranian health benefits package: Using an analytic hierarchy process

“…Although evidence suggests that an expert's viewpoint is sufficient in an AHP survey [27], depending on the study objectives, there were attempts to select various relevant experts with different scientific and healthcare backgrounds. A recommended nine-point ratio scale was further utilized to obtain the judgments [27,28]. The levels of preference on this scale were as follows: 1 (equal importance), 3 (moderate importance), 5 (strong importance); 7 (very strong importance), and 9 (extreme importance).…”