بیمه

One of the most important pillars of improving healthcare services is the state of supplementary medical insurances, which increase people's access to healthcare. The accurate and scientific assessment of the risks of issuing a medical insurance policy is one of the most sensitive and important stages of risk assessment, and performing it leads to the identification of high-risk customers and the determination of the health insurance policy rate, in accordance with the customers' risk. Therefore, the present study aimed to classify and rate health insurance beneficiaries using a risk matrix approach.

In order to assess the risk of insured persons, a two-step model has been presented along with the risk assessment matrix approach, which can be used to classify the insureds into different risk classes. For this purpose, in the first step, the probability of claiming damages using logistic regression based on age, gender and geographical location risk factors are predicted and in the next step the severity of the damage is predicted using quantile regression.

Finally a risk assessment model is presented with a risk matrix approach, which presents three risk class; critical (R_1), moderate (R_2) and acceptable (R_3) risk class.

Using the results of the risk matrix approach, insurance premiums have been determined for the insurance policies according to their risk class. This can help increase people's satisfaction, move towards justice, achieve fair insurance premiums, expand the security environment, and take a scientific look at the country's insurance industry.

Attention to supporting and treating infertile couples is of great importance in the context of Iran's population policies. Infertility treatment means identifying and addressing the health issues of couples that have caused their inability to conceive. Supporting infertile couples not only helps improve their chances of fertility but also enhances all aspects of their health and well-being. Facing infertility can be considerably challenging for couples, inducing feelings of loneliness, anxiety, and depression. Social and psychological support, through counseling services and mental health assistance, can help couples better cope with these challenges and prevent isolation and depression. Attention to the needs and problems of infertile couples can assist policymakers and relevant organizations in designing cultural and health policies and programs tailored to address this challenge and implement necessary improvements in this field. It is essential to establish a culture that upholds respect for couples experiencing infertility and prevents discrimination against them. By promoting the dissemination of accurate information and fostering a culture of empathy and compassion towards infertility, this culture may reduce social tension and lessen the burdens experienced by those coping with infertility. However, attention to supporting and treating infertile couples is not just one aspect of population policy. Instead, it should be one of the important priorities within the framework of a comprehensive program to strengthen population health. Supporting couples struggling with infertility should also be a significant priority within such a program.

Medical artificial intelligence has a very positive effect on the prediction and treatment of diseases. The use of artificial intelligence, apart from its very positive effects, due to the existence of challenges and issues such as black box, lack of transparency and predictability, is faced with a legal gap in relation to the attribution of responsibility in the event of causing damage. The occurrence of injury and damage to the body and life of people, to which person or persons can be attributed the responsibility is investigated in this research.

This article is descriptive-analytical and has been written using library resources, referring to books, articles and laws in this field.

Ethical Considerations: 

This research was written based on ethical principles, trustworthiness and honesty.

Th In identifying the person or persons responsible in situations caused by the use of artificial intelligence, applying traditional methods of attribution of responsibility will be unfair and impractical.

The difficulties of proving fault and attributing liability and on the other hand the necessity of respecting the rule of respect and compensating the victim reveal the importance of considering insurance or compensation fund in this regard.

Insurance deductions are among the most important causes of hospital resource waste. Insurance deductions cause financial problems for hospitals and create tension between insurance organizations and hospitals. This study, done by the University of Social Welfare and Rehabilitation Sciences, investigates the reasons for deductions of inpatient bills covered by Social Security Insurance in Rofeideh Rehabilitation Hospital

The study was conducted cross-sectionally on 776 cases admitted to Rofeidah Rehabilitation Hospital in 2021. All invoices for inpatient services sent to Social Security Insurance were reviewed using the census method. To collect data, invoices sent to Social Security, inpatient records and checklists, and a 31-question questionnaire of Mohammadkhani et al. were used. The collected data were analyzed by descriptive (frequency and percentage) and analytical statistics (the Spearman correlation coefficient) in SPSS software, version 23.

According to the findings, the highest frequency of inpatient prescriptions was related to November 2021 (7.48%). The most frequent deductions of inpatients’ bills were related to medicine and consumables to the amount of 310815448 Rails and surgeon’s fees in 187728448 Rails. Also, the most common reasons were requesting a surcharge and wrong coding. In this study, there was a significant relationship between the documentation of nurses and doctors and the amount of deductions (P<0.0001).

Multiple causes affect the reduction of insurance deductions. By teaching insurance rules and the book on the relative value of health services to medical and nursing staff groups, electronic documents to Social Security Insurance and creating warning mechanisms in it, continuous interaction with Social Security Insurance to justify the managers of the organization regarding the way of providing services to rehabilitation patients and the reason for the prolonged hospitalization time of such patients could be the potential solutions for preventing patients records deductions and help hospitals achieve financial goals.

 Today, the insurance industry is considered one of the most essential factors in wealth and social well-being production. This industry is based on economic service and has a critical and sensitive position in economic growth and development, especially in developing countries. Since human resources are the most valuable capital to realize the goals of this industry, therefore, it is necessary to examine the factors related to the psychological empowerment of employees. Based on this, the current research was conducted to compare the quality of work life and job embeddedness based on the life orientation of optimistic-pessimistic nature in Kermanshah insurance offices.

 This study was a causal-comparative study in terms of goals and descriptive in terms of the data-gathering procedure. The sample size of the research was 280 people (62 women and 218 men) from the employees of Pasargad Insurance in Kermanshah city in 1401, which were selected by convenience sampling. To collect data, Walton's Quality of Work Life (QWL), Ardalan et al.'s Job Embeddedness (JEQ), and Sheyer & Carver's Life Orientation (LOT) questionnaires were used. The research data were analyzed using SPSS-27 software and multivariate analysis of variance.

 The results of the MANOVA test showed that all the dimensions of the quality of work life are different based on the life orientation of optimistic-pessimistic nature. This claim is also true about the six components of occupational institutionalization and shows, that the dimensions of job embeddedness are based on the life orientation of optimistic-pessimistic nature have a significant difference.

 Optimism as a hopeful expectation in a specific situation can play a significant role in the quality of working life, and the desire to continue working and creating attachment to organizational tasks. As a result, it is suggested that managers prepare training programs for employees to adopt an optimistic orientation in life to reduce job abandonment and attachment to the organization, which is a consequence of job embeddedness.

Considering the important issue of hospital deductions and the benefits of reducing them which increase the satisfaction of physicians, hospitals and patients, increase hospital income and efficiency, increase the quality of health care and prevent waste of hospital financial resources, this study was conducted to compare the insurance deductions of inpatient records of Shahid Rahnemoon Hospital in Yazd province in 2021 and 2022.

This descriptive study was performed on all records of hospitalized patients in Shahid Rahnemoon Hospital, affiliated to Shahid Sadoughi University of Medical Sciences, Yazd.

The highest deductions in 2020 were in June (13.8%) and the lowest was in February (0.09%) and February (0.06%). Also, the highest deductions in 1400 were in September (10.37%) and the lowest was in April (7.97%). The findings showed that there was no significant relationship between occupied beds, number of discharged and length of stay with deductions in 2020 and 1400 (p>0.05), however, there was a significant relationship between bed occupancy percentage and deductions in 2020 and 2020 (p<0.05).

According to the principle of parting and in order to effective intervention in order to reduce deductions, it is suggested that special attention be paid to the main causes of deductions identified and codified programs including solutions to reduce deductions of bills and hospital dissatisfaction with payment of receivables.

Today, health insurance plays an important role in improving the health of society and the level of well-being of people. Moreover, the World Health Organization also pursues important goals to improve the state of health and public health in countries. In our country, health insurances have shortcomings, many of which are related to policy issues and defects in the strategic management of such insurances, which require correction and improvement. In this regard, this article has been prepared with the aim of presenting and explaining a strategic model for the promotion of insurance policies in Iran’s health system.

which is developmental-applicative in terms of its purpose and is placed in the group of analytical and cross-sectional studies. In the qualitative phase, using the topic analysis method to design the research model, 26 academic and executive experts in the field of health insurance were interviewed in a targeted manner, and in the quantitative phase, structural equation modeling and Smart PLS software were used. The sample size was calculated using Cochran’s formula and 186 managers and professionals active in the field of health insurance were randomly asked for their opinions with a questionnaire.

After analyzing and coding the responses, findings including five strategies for improving macro management in health insurance, improving insurance services, improving insurance justice, managing resources and using a sustainable approach were identified, which form the basis of the designed model of variables related to drivers, factors They are contextual, strategies and consequences. The data analysis of these findings with the structural equation modeling method showed that the components of the research model were approved and all the estimated path coefficients were significant.

In the end, the results obtained from the different stages of the research indicate that by providing the interests of the beneficiaries and also considering all the variables influencing the policy making, it is possible to take a path towards improvement and improvement in the policy making process of health insurance in the country.

Medical tourism industry is one of the most lucrative industries in world. Insurance increases the comfort of tourists. The development of the tourism industry is accompanied by the growth of insurance services. Increasing the country's foreign exchange earnings through the medical tourism industry; is essential. In this research, we intend to present all the effective components of insurance in the marketing model of medical tourism of the Social Security Organization.

This research is based on the purpose of applied research, in terms of how to collect data is descriptive-survey and in terms of research approach, is a mixed exploratory method. Which was done in 2021. In qualitative approach using Delphi technique, effective components in medical tourism are identified. In quantitative approach, the research model was finalized using exploratory and confirmatory factor analysis.

The insurance factor affects the marketing of medical tourism. And this factor has five components; Fast and effective redemption of insurance, Full health insurance coverage, Other supplementary insurance services such as travel and theft and Acceptance of international health insurance and the transferability and validity of health insurance in other countries were identified.

Results of this research help the health policy makers of the country to increase their foreign exchange earnings by using this research model. And with regard to the insurance components of the model and effective measures by the government, Insurance companies will reduce the financial and security threats of tourists and ultimately increase the attraction of medical tourists from other countries.

The e-prescribing system is one of the basic technologies in the health system structure which was developed with the aim of properly managing healthcare resources and services, preventing common manual prescribing errors, and increasing patient safety. Given that the user interface of e-prescribing system is considered as the main factor of user acceptance, the purpose of the present study was to evaluate the user interface usability of the e-prescribing systems of  Iran Health Insurance Organization (IHIO) and Social Security Organization (SSO) in Iran.

This descriptive-cross-sectional  study  was conducted in 2022. The research sample consisted of 150 physicians working in educational-therapeutic centers of Urmia University of Medical Sciences who were selected through stratified sampling with proportional allocation. The data collection tool was a researcher-made questionnaire The validity and reliability o f which were verified. The data were analyzed by means of descriptive statistics and independent t-test using SPSS software.

No statistically significant difference was found between the user interface SSO and IHIO in general (terms, letters, icons and navigation) and specific (alert display, personalization, entering and displaying information, guidance and interactions) areas. However, there was a statistically significant difference in "color" (P=0.047) and "visibility" (P=0.049).

The user interface of two e-prescribing systems in Iran has an average status in terms of usability. Therefore, it seems necessary for system developers to use aesthetic elements, interaction in the user's language, presentation of useful information in a simple and clear format in the design of the user interface according to the principles of human-computer interaction.

Information plays a very effective role in the insurance contract. According to the information received from the insured, the insurer measures the contractual risk and decides whether or not to conclude the contract or the quality of the contractual terms. The sum of these cases has placed the provision of information as a separate obligation in the field of insurance rights. This article tries to examine the pillars of this obligation in two insurance laws of 2012 and 2015 in England.

The article is descriptive-analytical and library method is used.

Ethical Considerations:

In all stages of writing this article, the authenticity of the texts and trustworthiness have been observed.

England has a rich and long history in the field of insurance rights. The first insurance contracts were concluded in the busy and turbulent ports of this country, and later the laws that were concluded in the course of property protection and risk insurance were widely accepted and imitated by other countries. In such a way, this welcome, along with its strategic location and legislative experience, has gradually turned England into a leading system in the field of insurance rights. In this regard, one of the most recent legislations is related to the years 2012 and 2015, which created innovations in two groups of consumer and non-consumer insurance contracts, respectively. The central point of these laws is the obligation to provide information in the pre-contract stage, which shows the concern of the legislator in the field of covering the necessary information before concluding the contract. In this article, with a comparative study between the above two laws, the elements of the notification obligation in consumer and non-consumer contracts are compared.

The Insurance Law of 2012 considers the responsibility of providing the information of the insured to be limited only to the cases where the necessary questions have been raised by the insurer. Therefore, in other cases, the provision of information by the insured is voluntary. In contrast to the Insurance Law of 2015, by removing the voluntary provision, it first places the responsibility of providing information on the policyholder, and in the next step, to adjust this duty; it adds certain limits and loopholes.

Nowadays, providing household health expenses is an important challenge in the health system and increasing the costs of health services have created problems in financing health expenses on families facing illness. In this regard, insurance seems to play a key role in such costs for households. Accordingly, the main purpose of this study is to investigate the factors affecting the devastating costs of health with emphasis on the role of insurance.

The present study is a descriptive-analytical and cross-sectional study that was conducted in medical hospitals of Tehran. 170 patients (households) were selected as the research sample and finally 165 patients (households) were included in the study. Data were collected using a questionnaire of the World Health Organization and finally analyzed using SPSS software.

In 2019, about 31% of our statistical population were exposed to staggering health costs. The results of the Logit econometric model show that households with more members under the age of 11 and over 65, whose head is unemployed, or who have a low level of education, or who are chronically ill, are more likely to incur staggering health costs. Meanwhile, the percentage of catastrophic health costs in households without insurance protection is very high.

Insurance protection along with economic indicators is one of the factors affecting the staggering costs of household health in Tehran.

Since doctors have professional and ethical responsibilities (for their actions) in criminal, civil, and administrative issues, if in a specific situation they do not follow standard care while doing their job, something may go wrong. Therefore, liability insurance is the most appropriate solution that covers any damage in such a situation. Professional liability insurance pays a sum of money for the defense cost of a compensation claim. So if a doctor does not have professional liability insurance to cover him, he must cover all the costs by himself. Thereof, doctors are faced with some impediments and problems to apply for insurance coverage. Since this is a significant issue, in the current study, we aim to identify and prioritize the impediments regarding medical professional liability insurance (MPLI) and provide suitable solutions to deal with the impediments.

In this study, Multi-Criteria Decision-Making (MCDM), Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Analytical Network Process (ANP) method was used.

Ethical Considerations:

 During all the stages of the current paper, the authenticity of the text, honesty, trusteeship, and moral codes were followed.

The results gained in the study approve that legal impediments have the highest priority (0.2569), then cultural impediments (0.2493), miscellaneous impediments (0.2478) and impediments related to equipment and facilities (0.2458) have the next highest priority. In regard to legal impediments, the lack of reform of the law related to medical practice based on the requirements of society has the highest priority (0.0692).

Having professional liability insurance coverage is a must for doctors. Since damage/ medical malpractice may occur during treatment by a doctor, hospital managers should take the necessary actions to arrange for doctors’ insurance coverage.

Since doctors have professional and ethical responsibilities (for their actions) in criminal, civil, and administrative issues, if in a specific situation they do not follow standard care while doing their job, something may go wrong. Therefore, liability insurance is the most appropriate solution that covers any damage in such a situation. Professional liability insurance pays a sum of money for the defense cost of a compensation claim. So if a doctor does not have professional liability insurance to cover him, he must cover all the costs by himself. Thereof, doctors are faced with some impediments and problems to apply for insurance coverage. Since this is a significant issue, in the current study, we aim to identify and prioritize the impediments regarding medical professional liability insurance (MPLI) and provide suitable solutions to deal with the impediments.

In this study, Multi-Criteria Decision-Making (MCDM), Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Analytical Network Process (ANP) method was used.

Ethical Considerations: 

During all the stages of the current paper, the authenticity of the text, honesty, trusteeship, and moral codes were followed.

The results gained in the study approve that legal impediments have the highest priority (0.2569), then cultural impediments (0.2493), miscellaneous impediments (0.2478) and impediments related to equipment and facilities (0.2458) have the next highest priority. In regard to legal impediments, the lack of reform of the law related to medical practice based on the requirements of society has the highest priority (0.0692).

Having professional liability insurance coverage is a must for doctors. Since damage/ medical malpractice may occur during treatment by a doctor, hospital managers should take the necessary actions to arrange for doctors’ insurance coverage.

The relationship between food and human health has led to the adoption of various laws in different countries regarding the effects of civil liability due to production defects in food and also the role of insurance industry and compensation funds in achieving these effects. Research is ahead.

Because this study analyzes the data qualitatively, it lacks a clear statistical population. Obviously, the criterion of data analysis is based on logic and reasoning and based on the study and inference of laws and legal doctrine, we analyze hypotheses and data.

Ethical Considerations:

 In the present study, preserving the originality of texts and fidelity in speech quoting, as the most important ethical requirements have been considered by the authors.

The research findings indicate the effectiveness of the insurance industry in realizing the effects of civil liability due to food production defects by predicting pure liability for producers and also creating a system based on compulsory insurance. In the case of compensation funds, although the special fund for damages caused by food production is not specifically provided for in the legal systems of the United States, European countries and Iran, but similar and close legal mechanisms can be used, which is one of the most important They can be called liability contracts as well as contracts for the intensification of liability.

It seems necessary to use more and more neglected capacities of the insurance industry as well as compensation funds by the Iranian legislator in order to realize the effects of civil liability due to food production defects (customer compensation and punitive damages).

Due to the fact that most of insurance companies have deductions and long delays in the reimbursement of bills. They are causing dissatisfaction in the hospitals of the contracting party. Therefore, the present study was conducted with the aim of determining the causes of prescription deductibles in a teaching hospital in Kermanshah, Iran in 2018.

In this cross-sectional and descriptive-analytical study, all 560 cases related to 2018 year that were covered by the insurance of the hospital were examined. Data were analyzed using the SPSS software version 23. The significant level was set at 5 percent.

The results of the present study showed that the mean and standard deviation of prescription deductibles in the hospital during 2019 were 16596782.90 and 335966366.43 Rails, respectively. The highest amount of prescription deductibles was recorded in January and the lowest was recorded in March. The highest cause of prescription deductibles in the opinion of the participants with a frequency of 44.4% was related to the lack of accurate and precise registration of drugs and equipment in the doctorchr('39')s and nursing notes.

The findings suggest review of medication application forms by at least two people, reminding and educating doctors, inspection by insurance and income personnel regularly, encouraging staff if deductions are reduced, reducing the time interval between shifts of physicians and nurses, increasing cooperation between  insurance companies and income personnel with the pharmacy department, and using specialists to update the price of medicines before entering the pharmacy might help to lessen prescription deductibles

Mental health is one of the important axes of health assessment of different communities so that experts attach great importance to the issue of mental health of people, especially young people and believe that the desired mental health can be directly and indirectly affected by various factors (2). In fact, mental health is a state of successful functioning of mental processes, efficient activity, effective and fruitful relationships with people, the ability to adapt to change and adapt to favorable conditions. Which is influenced by many factors in addition to individual, biological, genetic and biological characteristics as well as the conditions in which the person grows up, including occupational factors, group factors, organizational factors, conflicts between Work and life, general job satisfaction, job culture satisfaction, income satisfaction and satisfaction with relationships with colleagues, non-observance of justice, lack of flourishing opportunities for individuals and the existence of irrational discrimination (3). If appropriate mental health policies are designed and implemented, it will have a significant impact on the mental health of the community (5). Existence of a strong and efficient insurance system in economic and social empowerment and expansion of opportunities and the right to choose as components of development can play a fundamental and decisive role in the country. An important part of governments' extensive efforts in the field of health, and accordingly, the World Health Organization, in cooperation with the World Labor Organization in the United Nations, has begun to help countries in these countries comprehensive social security coverage, including a variety of protection problems Financially, develop different ways of substituting income and social support in times of illness (8). In this regard, Iran is no exception to this rule and the issue of health and its promotion has always been one of the main challenges of the government (6). Despite the important functions of mental health insurance, this industry in our country, like most developing countries, remains unknown and its role in the country's economy and household life is negligible. Since not only the general public but also the financial and economic policy makers of the country is unaware of the associated benefits of it. Also, unfortunately, little research has been done on mental health insurance. In this research, the factors that are effective in the development of this insurance in the country are examined in order to help those in charge of life insurance to take positive steps to expand it in the country. Therefore, the researcher seeks to answer the question of what are the factors affecting the development of mental health insurance in Iran?

This research was conducted in two stages: qualitative and quantitative. In terms of purpose, this research is exploratory in the qualitative phase and explanatory in the quantitative phase. The statistical population of the present study in the stage of determining the conceptual model (qualitative phase) included experts, professors, managers and executives of the country's insurance system that 13 people were selected for interview by snowball method. Based on the existing theoretical foundations of Persian and English, the factors affecting the development of mental health insurance were identified and provided to experts, then, in face-to-face meetings, these factors were discussed, corrected and finally, the factors The final was provided to the experts to express their views on the face validity and content of the factors and items related to each factor. Finally, 34 items with a five-point Likert scale (very low to very high) were approved in the form of four structural, cultural, supply, and individual factors. The statistical population in the quantitative sector (exploratory and confirmatory factor analysis) was managers and employees working in the field of health insurance, insurance companies, areas active in the field of health insurance and faculty members in the field of psychiatry. After compiling the questionnaire, the questionnaires were given to a statistical sample of 325 people in various ways such as sending e-mail, face-to-face referral, sending fax, etc. The number of 308 questionnaires was provided to the researcher in full and without any problem for analysis. Data analysis: Extensive factor analysis in SPSS software version 26 was used to identify the factors and confirmatory factor analysis in LISREL software version 9.3 was used to confirm the final model.

The results of exploratory and confirmatory factor analysis of five basic factors including the first factor (structural); The second factor (culture); 18 Third factor (quality of service); Identified the fourth factor (individual) and the fifth factor (supply and support) for the development of mental health insurance (Table 1).

The results of this study showed that 5 structural factors, culture, service quality, individual, supply and support have an important role in the development of mental health insurance. The results of this research in identifying structural factors and financing and services are consistent with the research of Alizadeh et al. (2017), but are not consistent in cultural and personal dimensions (11). The service quality factor included access to professional services, segregation of services according to the type of mental disorders, provision of pharmaceutical and laboratory services. In the cultural factor, socio-cultural changes, fear of stigma, positive attitude towards health insurance, familiarity with different types of insurance and cultural priorities were the decisive items. In the field of individual factors, we can also mention the level of education, income, number of children, understanding the vital role of insurance in providing costs and satisfaction of individuals. Finally, the supply and support agents included the insurer's commitment and guarantee items, the payment of deductibles, NGO grants, and public tax financing. Due to the fact that the insurer is required to fulfill the obligation and guarantee of the insurer towards the insurers, therefore, the insurance operation is delicate and complex and its correct implementation requires the optimal use of statistical, legal, financial, economic, and statistical knowledge. Insurance is investment, marketing and management (14). Finally, identifying important and practical variables in providing health services coverage and their application in the mental health system can help improve the health indicators related to these services. It seems that policy makers in the field of insurance together with companies or insurance systems can rely on education, financial support and services, formulate laws and regulations, familiarize the community with the types of insurance and the need for health insurance, culture and appropriate insurance coverage. Not only will they provide the comfort and well-being of people in the community, but they will also provide adequate financial capital to insurance systems.

Human lifestyle is effective on their physical and mental health. Health care education can play an important role in improving peoplechr('39')s behavior and lifestyle. The aim of this study was to investigate the effect of using the health belief model in health care education based on Iranian medicine to the insured of the Iran Health Insurance Organization.

This quasi-experimental single-group study was performed in Tehran during 2017. Participants in this study were trained in face-to-face and virtual health preservation education according to Iranian Medicine resources based on health belief model. In this study, path analysis method, SPSS and AMOS softwares were used to analyze the data.

The study was performed on 51 people (23 men and 28 women). The results of this study showed an explanation of R2=59% behaviors based on model constructs. Also, the results showed that with increasing the time of the study, the behavior of observing the principles of health care in accordance with Iranian medicine increases and the training has an increasing effect on self-efficacy, benefits, sensitivity and perceived severity and has a decreasing effect on perceived barriers. The results of path analysis (RMSEA = 0.031) also showed that the constructs of perceived sensitivity (0.16), perceived benefits (0.29), perceived intensity (0.15), self-efficacy (0.59) and time (0.47) increased behavior and barrier constructs. Perceived (-0.30) decrease behavior (P<0.001).

According to the results of this study, hygiene training can increase the stability of behavior (i.e. observance of hygiene principles) by emphasizing the benefits, barriers, perceived sensitivity and severity and self-efficacy of individuals.

Humans are always at risk of various diseases and inevitably incur high medical costs and hospital costs for recovery and treatment. In order to help people in such cases, various health insurance plans are provided as a basis and complementary, but due to the lack of a single insurer in the presentation, problems have arisen in the field of health insurance. The purpose of this study is to identify the consequences of providing supplementary insurance along with basic insurance by the Social Security Organization of Iran to solve these problems.

This research was applied in terms of purpose with a combined approach, which was conducted in the qualitative part with a focus on semi-structured interviews in the quantitative part based on exploratory and inferential methods. Its statistical population includes managers and experts in the field of insurance-treatment working in the countrychr('39')s social security organization in 1399, which sampling is done purposefully and in the qualitative section until the categories are saturated (15 samples).

Based on the calculated data, extraction concepts (95 concepts) were classified into 27 sub-categories. The sub-categories were also classified into 5 main categories and thus the consequences of providing supplementary insurance by the Social Security Organization were identified. In the quantitative part, due to the fact that the value of the factor load is above 0.5 and the value of CR indicators is less than 0.7, so the data had a good fit with the factor structure of the theoretical basis of the research and were consistent with them.

According to the findings, the implementation of this plan leads to the possibility of special individual insured and no employer with supplementary health insurance, reducing the treatment costs of the insured and the organization, the possibility of discounts on supplementary premiums and consolidation of health insurance will be.

Some of the significant and irreparable financial losses in hospitals are Insurance deficits which for various reasons are not fully reimbursed by the insurance companies. Therefore, the present study was an attempt to determine the amount and causes of insurance deficits in selected Teaching  and non-Teaching hospitals affiliated to Iran University of Medical Sciences.

This cross-sectional descriptive study was performed in six selected hospitals of Iran University of Medical Sciences. The research population included patients’records during the first six months of 2020 for inpatient and outpatient wards. Reports of deficits for Health Care and Social Security Insurance were collected by referring to the revenue units of the hospitals. The data collection tool was a researcher-made form. The deficit amount of each hospital was collected separately for the type of file and teaching and non-teaching hospitals. Data were analyzed by descriptive statistics using Excel software.

The findings showed that the most deductions applied in inpatient records are related to surgery and hospitalization fees, respectively, and in outpatient documents are related to visits, laboratory services, diagnostic and counseling services.

According to the type and causes of deficits identified based on research findings, policy makers and planners in the field of healthcare system are advised to hold workshops for staff in the process of treating patients with insurance rules, using hospital information systems, using relevant graduates, and analyzing files before sending them to insurance companies in order to prevent insurance deficits.