Stakeholders analysis of merging social health insurance funds in Iran: what kind of interests they may gain or lose?

Abstract

Iran passed a Law in 2010 to merge all existing health insurance funds physically together. This stakeholder analysis aimed at revealing that what benefits the stakeholders might lose or gain as a result of merging health insurance schemes in Iran, which make them to oppose or support it. This was a qualitative study conducted in 2014. Sixty semi-structured face-to-face interviews were conducted. Purposive and snowball samplings with maximum heterogeneity samples were used for selecting interviewees. Government is not willing to undertake more financial commitment. Existing health insurance schemes like Social Security Organization and minor well-resourced health insurance funds and also worker unions are unwilling to lose their financial and organizational autonomy, to share their benefits with other less privileged groups, or face likely financial challenges in running their health facilities like hospitals. Top managers and workforces are worried to lose their job, salary, or organizational positions. Ministry of Cooperation, Labour, and Social Welfare does not want to lose its control on health insurance schemes. Ministry of Health and Medical Education and Iran Health Insurance Organization are among actors that support the insurance funds merging policy. Successful implementing of consolidation requires taking into account the interests of different stakeholders.

Combining health insurance funds in a fragmented context: what kind of challenges should be considered?

“…The current study showed that implementation of merging in Iran was not an easy decision considering the fact that it faced strong oppositions from its opponents. Resistance of top managers of health insurance schemes to lose organizational autonomy and try to avoid transparency in organizational statistics, information, and activities, concerns about paying more contribution rates after merging, resistance of better-off SHI schemes to share advantages with less privileged groups as a result of merging, concerns of personnel and top managers about their organizational and financial status are among some of the reasons why opponents are against the merger [32]. Therefore, there should be adequate, acceptable and convincing advantages for merging.…”

The Experiences of Merging Health Insurance Funds in Turkey, Thailand, South Korea and Indonesia: What lessons can be learned?

“…In contrast in some OECD countries with multiple risk pools such as the Slovak Republic, the Czech Republic, Switzerland and France the performance of the health insurance system in terms of equity in above indicators is satisfactory as health insurance schemes are mandated to provide the same benefit package by getting the same contribution rates, so no matter which scheme the beneficiaries belong to, they access to the same health services 19 . It is not astonishing that bigger gaps in the above areas make moving towards merging more difficult as the experience of countries like Iran shows that those schemes with better financial resources and benefit packages concern about sharing these benefits with other underprivileged groups of population 20,21 , so it can be said when the situation is not satisfactory, although it makes addressing the fragmentation more justifiable, it would be more challenging. In the following sections we try to review the experience of the selected countries individually regarding merger referring to the above criteria as much as feasible to see how these countries managed to solve the problems, why they failed and what made the process of merging easier or more difficult.…”

“…Employers and employees enjoying low premium rates may concern about paying more contribution rates and those who work in health insurance organizations or even work agencies may oppose merger as it may jeopardize their job stability. Experience from Iran shows that apart from technical issues, the interests that actors may lose or gain due to merging matters a lot too which should be noticed carefully if policy makers are going to merge health insurance together 20 . These concerns can be more challenging where the health insurance scheme which is going to be center of merger is weaker than others in terms of benefit package, contribution rates, or even the amount of salary it pays to its employees.…”

Future Development through the Past: Pathology of the Financing Dimension of Iran’s Health Transformation Plan

“…Iran has four main public health insurance organizations; Social Security Organization (SSO)as one of the largest health insurance organization in the country, Iran Health Insurance Organization (IHIO), the Armed Forces Medical Services Insurance Organization (AFMSIO) and Imam Khomeini Relief Foundation Health Insurance(IKRF) [23]. All of these basic insurance organizations benefit from government support at various levels [24]. The SSO (established in 1975) is a non-governmental organization and provides health insurance coverage for those officially employed in the private sector and their dependents, as well as self-employed persons via additional voluntary insurance [25,26].…”