Challenges of Implementation of Insurance Coverage Program for Infertility Services in Iran

Population has long been known as the most important pillar of governments and societies. However, in recent years, the rate of infertility is increasing rapidly due to various reasons.

This study aimed to identify the factors and challenges affecting the implementation of insurance coverage program for infertility services in Iran for the policymakers and implementers of the program. Accordingly, the correct implementation of this program provides the possibility for infertile couples to benefit from the services of this program.

This qualitative study was conducted in 2022. Purposive sampling was used for selecting a total of 20 Iranian scientific and executive experts of health system with work experience, especially in the field of infertility. The interviews were conducted in a semi-structured manner and analyzed using the content analysis method and MAXQDA 2020 software.

The results showed that the challenges of this program include 6 main themes along with 39 sub-themes. The main themes are challenges of upstream laws and legal requirements; provision of health services; human resources; the service package and its pricing; financial issues, budgets, and methods of service cost reimbursement; and information technology challenges.

Although the service package is defined and announced, the implementation of this plan faces many challenges due to not taking into account the implementation conditions and requirements. By examining the problems of infertility insurance coverage, the present study provides a comprehensive and practical picture of these problems. Accordingly, the factors that can make the program successful in the future consist of inclusion of a part of the services related to infertility treatment in the package of insurance services, the awareness of managers and policy makers about the challenges of implementing this program, providing financial, electronic, and human resources needed by the program, and development and modification of standards of the program.