Designing a Supplementary Health Insurance Model for Iran

Considering the importance of complementary health insurance and the necessity of designing a supplementary insurance model for the health system of the country, the purpose of this study is to design a complementary health insurance model appropriate to the health system in Iran.

This is a comparative-qualitative study. In the first stage, the selected countries were identified and compared in comparative matrices in a comparative study on the various dimensions of complementary treatment insurance in these countries. Based on matrix results, questionnaire interviewing questions in dimensions (organization and management, population coverage, method of determining the premium, method of reimbursement of expenses, number of insured, and method of financing the insurance) was designed, and qualitative section was done by content analysis method of contract type. After conducting the interviews, the data were analyzed through content analysis method and MAXQDA V. 10 software.

Major challenges mentioned by the experts are organization and management, oversight mechanisms, information system, cultural issues, economic issues, the basis for population coverage, covered services, the method of determining the premium, and the method of reimbursement.

Paying attention to the challenges posed by the experts and determining the details of implementing a complementary health insurance model for Iran, and based on the experiences of lightweight countries in this field, the views of national experts can help supplement health insurance in the country.