Designing a Model for Providing Supplementary Health Insurance in the Social Security Organization

Humans are always at risk of various diseases and inevitably incur high medical costs and hospital expenses for recovery and treatment. In order to help people in such cases, various health insurance plans are offered as basic and complementary, but separately by different insurance organizations and companies. The purpose of this study is to design a model for providing supplementary health insurance by the Social Security Organization of Iran to solve the insurance and medical problems of the target community and the organization in this area.

This research is applied in terms of purpose with a mixed approach, which has implemented based on the data-based method in the qualitative part and focusing on semi-structured interviews, and in the quantitative part based on the exploratory and inferential methods. Its statistical population includes managers and experts in the field of health insurance in the Social Security Organization of the country, whose sampling was done purposefully and continued in the qualitative section until the categories reached saturation (15 samples).

After gathering the data and extracting the concepts (225 concepts) and classifying them into 42 sub-categories and finally 17 main categories, the final model was designed and specified. In the quantitative part, based on the fit indicators, it was found that the data had a good fit with the factor structure of the theoretical basis of the research and were in line with them.

based on the dimensions of the model, the Social Security Organization is in need of implementing this plan, and it can implement the plan based on its unique capabilities and solve many problems of the insured and the organization in the field of health insurance.