Analysis of Current and Desirable Status of Iran's Basic Health Insurance

With regard to unclear government approach in the insurance sector, multiplicity of rules, high share of households, improper population coverage and lack of cost-effective interventions, this study aimed to analyze the current status of basic health insurance in Iran and its distance from the desirable  status according to upstream documents. In addition, we attempted to propose a strategy in this regard. This qualitative research was performed in 2017 in four stages of analysis of the current status of upstream documents and laws, round-table discussions of policy-makers, and presenting political options. In total, 20 subjects were selected by targeted sampling method with maximum diversity and based on the saturation rule. Data were collected by document analysis and interviews with authorities. Moreover, data were analyzed applying content analysis and the deductive approach. The results were classified into five areas of population coverage, financial resources management, financial protection of insured individuals, strategic purchasing, policy-making, and structure. There was a significant distance between the desirable  status based on upstream documents and laws and the current status. Recommendations: eliminating conflicts of interest in decision-making areas, complying with the public interest in making health decisions, observing the principles of the evaluation of regulatory effects, and assessing the economic and social effects of health decisions. Despite the successful global experiences, the recommendations of the World Health Organization, and the existence of several optimal structures, proper models must be considered by the health system of the country through observing the relevant mechanisms and necessities.