Effect of the Health Transformation Plan (HTP) on Implementation Processes, Rules and Regulations of Basic Health Insurance Organizations in Iran

From the first year of implementation, the Health Transformation Plan (HTP) has had many effects on the practice of health system actors. The present study was designed to investigate the effect of the HTP on the implementation processes, rules, and regulations of the basic health insurance organizations. This qualitative study was conducted using semi-structured interviews and document analysis. Data were analyzed using qualitative content analysis with an inductive approach. The interviews were analyzed using MAXQDA version 11 software. The research population consisted of experts and senior managers of the health insurance sector selected using purposive sampling. Four topics and 11 themes were identified, including population coverage, service coverage, cost of services, process of arranging and manipulating documents, the process of paying claims, the impact of HTP packages, the interactions of insurance companies with the Ministry of Health and hospitals, rules and regulations, structures, and workload of insurance agencies. They all constituted 75 subthemes. The experience of implementing the HTP in Iran shows that primary access to healthcare services for all is an achievable goal for any middle-income country although there are always questions about their sustainability and quantity. Major reforms in the financing of plans need changes that require government investment and long-term commitment to overcome challenges.