Stakeholders Analysis of Health Insurance Benefit Package Policy in Iran

Abstract

Background: Formulation of cost efficiency of health insurance benefit package requires an evidence-based policy making, with efficient management of stakeholders, therefore, identifying the stakeholders and considering their characteristics and interests and also the position and power of the main actors involved in policies seems to be necessary. For this purpose, this study aimed at analyzing the stakeholders of health insurance benefit package in Iran to specify their position in the assessed policy. Methods: This was done on a qualitative basis during years 2015 and 2016. Data was collected from semi-structured interviews, document analysis, and participation in decision-making meetings of the Supreme Council of Health Insurance, to identify the stakeholders, and their power, situation, interests, opportunities, and challenges. The data was analyzed with the content analysis approach using the MAXQDA software. Results: Overall, 23 stakeholders were identified and categorized in 6 groups, including policy makers, service providers, payers, suppliers of medicines and equipment, service recipients, and others. Sixteen stakeholders were at the national level, 3 stakeholders of regional, and 4 stakeholders of local level, however most stakeholders were owned by the public sector. Furthermore, 78% of stakeholders supported the policies of health insurance benefit package, and 48% had moderate power. Stakeholders had different interests and various opportunities and challenges to health insurance benefit package. Conclusions: The findings show that multiple stakeholders directly and indirectly affect the formulation and implementation of HIBP policies. Meanwhile, the members of supreme council of health insurance, legally being authorized to apply for entry of service and drug into the HIBP, have the most important role in decision making related to HIBP. Establishment of a systematic approach, considering the role of all stakeholders and alignment of their interests leads to a positive outcome of the stakeholders' power and finally effective formulation and implementation of policies, and facilitates the ultimate goal of this policy, which promotes public health.

Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

“…The article 10 of UHI Law formally stipulated the need for defining the basic health insurance benefit package (BHIBP) to be provided by the basic health insurance organisations (including medical, pharmaceutical, emergency, general, specialised inpatient and outpatient medical services), as opposed to the supplementary benefits package for the commercial health insurance organisations. Before the UHI Law, there was a lack of clarity regarding which health care services should be covered by health insurance organisations [33].…”

“…However, the definition of the BHIBPs content did not seem to be based on the evidence-based process or real prioritisation. Instead, BHIBPs content expansion was determined mainly by politics and the negotiations among the policy actors [33]. For example, during 2009 and 2012, multiple drug categories including 108 expensive medicines, 17 new shapes of insulin and herbal drugs became available through BHIBPs, and some copayments of prescription drugs for some specific patients were reduced.…”

Health insurance benefit package in Iran: a qualitative policy process analysis

“…Cost-effective and efficient development of a HIBP may face many challenges, particularly in the context of low and middle-income countries (LMICs). Similar to other settings, Iran's health system has been facing a series of challenges in developing and implementing appropriate HIBP, i.e., lack of shared perspectives among policy-makers, insufficient transparent prioritizing criteria, ambiguous and unclear organizational structures and unsustainable resources [8,9]. The Iranian Supreme Council of Health Insurance (ISCHI) is in charge of the process of decision-making for inclusion of a specific healthcare service into the basic insurance package.…”

Health Insurance Benefit Package in Iran: A Qualitative Policy Process Analysis

“…Cost-effective and e cient development of a HIBP may face many challenges, particularly in the context of low and middle-income countries (LMICs). Similar to other settings, Iran's health system has been facing a series of challenges in developing and implementing appropriate HIBP, i.e, lack of shared perspectives among policy-makers, insu cient transparent prioritizing criteria, ambiguous and unclear organizational structures and unsustainable resources (8,9). The Iranian Supreme Council of Health Insurance (ISCHI) is in charge of the process of decision-making for inclusion of a speci c healthcare service into the basic insurance package.…”

“…Conventionally, such decisions have been taken based on the bargaining power of various parties attending the ISCHI's meetings. For instance, the insurance corporations mainly take into account the nancial burden of services (10,11).…”