Developing a policymaking model for empowering the insured of the Iran Health Insurance Organization

The present study seeks to design an empowerment model for health insurance policyholders to achieve an acceptable level of capability. The reason for choosing this group of insured is their large and considerable population including about 50% of Iranian. The methodological approach is qualitative and of the grounded theory, deep and semi-structured interview data retrieval techniques. For data mining, theoretical coding method was used, which aims to achieve the main and sub-categories to set the theoretical model. The sample number is 15 specialists and experts in the field of health insurance and empowerment who have been purposefully selected. The results show that the central phenomenon is community-based empowerment, which is based on causal conditions, contextual conditions, intervening conditions and strategies. The most important strategies are the right of the insured to access insurance services and opportunities. In discussing the underlying conditions, important components such as: agency, sense of equality and inclusion (integration) and capacity building are emphasized. Findings also show that components such as protecting the rights of the insured, empowering and efficient resources and the quality of insurance services are considered as causal conditions. According to the findings of the present study, the three main categories of education and information, social participation and social support have been proposed as intervening conditions. Complementing the chain paradigm model of the present study is based on the data theory method of the Consequences Foundation, which has examined empowerment in four main sections: social empowerment, cultural empowerment, economic empowerment and psychological empowerment of the insured