Designing a model for universal health insurance coverage in Iran using the balanced scorecard approach

This study aimed to develop an effective model for achieving universal health insurance coverage in Iran utilizing the Balanced Scorecard (BSC) approach.  This mixed-method study was conducted between 2022 and 2023. A literature review and comparative analysis were performed to design a researcher-developed questionnaire. A total of 400 participants, including insurance program executives and health insurance managers from across the country, were selected using a convenience sampling method. Data analysis was conducted using SPSS-26 and AMOS-24 software, employing exploratory and confirmatory factor analysis methods, as well as goodness-of-fit indices such as chi-square, relative chi-square, mean square error of estimation, and other relevant metrics.  The financial factors had the highest impact, while customer factors had the lowest impact in the proposed model for universal health insurance coverage based on the BSC approach in Iran, with standard coefficients of 0.680 and 0.601, respectively. The final model for achieving universal health insurance coverage in Iran was deemed suitable across four dimensions: activity/process, financial, growth/learning, and customer.  To successfully achieve universal health insurance coverage, policymakers and planners in the country's health sector should prioritize factors related to the financial dimension. However, it is essential not to overlook the other three dimensions, given the overall suitability of the proposed model.