Health insurance benefit package in Iran: a qualitative policy process analysis

Abstract Introduction: Insufficient transparency in prioritization of health services, multiple health insurance organizations with various and not-aligned policies, plus limited resources to provide comprehensive health coverage are among the challenges to design appropriate Health Insurance Benefit Package (HIBP) in Iran. Method: Data were collected through semi-structured interviews with 25 experts, plus document analysis and observation, from February 2014 until October 2016. Using both deductive and inductive approaches, two independent researchers conducted data content analysis. We used MAXQDA.11 software for data management. Results: We identified 10 main themes, plus 81 sub-themes related to development and implementation of HIBP. These included: lack of transparent criteria for inclusion of services within HIBP, inadequate use of scientific evidence to determine the HIBP, lack of evaluation systems, and weak decision-making process. We propose 11 solutions and 25 policy options to improve the situation. Discussion: The design and implementation of HIBP did not follow an evidence-based and logical algorithm in Iran. Rather, political and financial influences at the macro level determined the decisions. This is rooted in social, cultural, and economic norms in the country, whereby political and economic factors had the greatest impact on the implementation of HIBP. Conclusion: To define a cost-effective HIBP in Iran, it is pivotal to develop transparent and evidence-based guidelines about the processes and the stewardship of HIBP, which are in line with upstream policies and societal characteristics. In addition, the possible conflict of interests and its harms should be minimized in advance. Key words: Benefit package, Policy process analysis, Iran.

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Health Insurance Benefit Package in Iran: A Qualitative Policy Process Analysis

10.21203/rs.2.14368/v3 ◽

2020 ◽

Author(s):

Efat Mohamadi ◽

Amirhossein Takian ◽

Alireza Olyaeemanesh ◽

Arash Rashidian ◽

Ali Hassanzadeh ◽

...

Keyword(s):

Health Insurance ◽

Policy Process ◽

Process Analysis ◽

Scientific Evidence ◽

Cost Effective ◽

Evidence Based ◽

Health Coverage ◽

Benefit Package ◽

Structured Interviews ◽

Insurance Benefit

Abstract Background : Insufficient transparency in prioritization of health services, multiple health insurance organizations with various and not-aligned policies, plus limited resources to provide comprehensive health coverage are among the challenges to design appropriate Health Insurance Benefit Package (HIBP) in Iran. This study aims to analyze Policy Process of Health Insurance Benefit Package in Iran. Method: Data were collected through semi-structured interviews with 25 experts, plus document analysis and observation, from February 2014 until October 2016. Using both deductive and inductive approaches, two independent researchers conducted data content analysis. We used MAXQDA.11 software for data management. Results: We identified 10 main themes, plus 81 sub-themes related to development and implementation of HIBP. These included: lack of transparent criteria for inclusion of services within HIBP, inadequate use of scientific evidence to determine the HIBP, lack of evaluation systems, and weak decision-making process. We propose 11 solutions and 25 policy options to improve the situation. Conclusion: The design and implementation of HIBP did not follow an evidence-based and logical algorithm in Iran. Rather, political and financial influences at the macro level determined the decisions. This is rooted in social, cultural, and economic norms in the country, whereby political and economic factors had the greatest impact on the implementation of HIBP.To define a cost-effective HIBP in Iran, it is pivotal to develop transparent and evidence-based guidelines about the processes and the stewardship of HIBP, which are in line with upstream policies and societal characteristics. In addition, the possible conflict of interests and its harms should be minimized in advance.

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Health Insurance Benefit Package in Iran: A Qualitative Policy Process Analysis

10.21203/rs.2.14368/v1 ◽

2019 ◽

Author(s):

Efat Mohamadi ◽

Alireza Olyaeemanesh ◽

Amirhossein Takian ◽

Arash Rashidian ◽

Ali Hassanzadeh ◽

...

Keyword(s):

Health Insurance ◽

Process Analysis ◽

Cost Effective ◽

Evidence Based ◽

Health Coverage ◽

Benefit Package ◽

Structured Interviews ◽

Insurance Benefit ◽

Comprehensive Health ◽

Evidence Based Guidelines

Abstract Introduction The lack of transparency in prioritization of health services, multiple health insurance organizations with various and not-aligned policies, plus limited resources to provide comprehensive health coverage are among the challenges to design appropriate Health Insurance benefit Package (HIBP) in Iran.Method data collection was done through semi-structured interviews with 25 experts, plus document analysis and observation, from February 2014 until October 2016. Using both deductive and inductive approaches, two independent researchers analyzed data and used MAXQDA.11 software for data management.Results We identified 10 main themes, plus 81 sub-themes related to development and implementation of BP, including: lack of transparent criteria for inclusion of services within BP, inadequate use of scientific evidences in determination of BP, lack of evaluation systems, and weak decision-making process. We propose 11 solutions and 25 policy options to improve the situation.Discussion Design and implementation of HIBP did not follow evidence-based and logical algorithm in Iran. Rather, political and financial influences at the macro level determined the decisions. This is rooted in social, cultural and economic norms in the country, whereby political and economic factors have the greatest impact on the implementation of HIBP.Conclusion To define a cost-effective HIBP in Iran, it is pivotal to develop transparent and evidence-based guidelines about the processes and the stewardship of BP, which are in line with upstream policies and societal characteristics. Worse still, the possible conflict of interests and its harms need to be minimized in advance.

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Measuring Public Preferences for Changes in the Health Insurance Benefit Package Policies in Iran: A Survey Approach

Iranian Journal of Public Health ◽

10.18502/ijph.v49i5.3212 ◽

2020 ◽

Author(s):

Efat MOHAMADI ◽

Alireza OLYAEEMANESH ◽

Arash RASHIDIAN ◽

Abbas RAHIMI FOROUSHANI ◽

Ali HASSANZADEH ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Services ◽

Health Sector ◽

Sample Population ◽

Benefit Package ◽

Term Care ◽

Public Preferences ◽

Insurance Benefit ◽

Trade Offs

Background: This study aimed to identify the public preference in health services, the principles that Iranian people consider important, and the aspects of trade-offs between different values in resource allocation practices. Methods: This quantitative study was conducted to investigate public preferences on Health Insurance Benefit Package (HIBP) in 2017. A structured questionnaire was used for data collection, including the preferences of the people who live in Tehran, were above 18 year, and were covered by basic insurance for the HIBP contents and premium. The sample size was calculated 430 subjects and SPSS Statistics was used for data analyzing. Results: 81.6% of the sample population agreed with government allocating more money to the health sector compared to other sectors and organizations and 55% were willing to pay higher premiums for expanding the HIBP coverage. The highest and lowest score regarding prioritization of budget allocation between health services was related to hospitalization services (28.6%) and rehabilitation services (1.6%), respectively. The first priority of respondents regarding health care and life cycle, was "prevention in newborns" (15.9%), the second priority was "prevention in children" (14.6%), the third priority was "prevention in adults" (9.5%), and the last priority was "short-term care in newborns" (0.9%). Conclusion: Iranian people believe that not only the principle of health maximization but also equal opportunities to access health care and a fair allocation of resources should be considered by authorities for effective health insurance policymaking. In this case, given the scarcity of resources, setting priorities for alternative resources is inevitable.

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PHP43 DEVELOPING A FRAMEWORK FOR THE INCLUSION OF PHARMACEUTICALS IN HEALTH INSURANCE BENEFIT PACKAGE, A COMPARATIVE STUDY ON IRANIAN SOCIAL SECURITY ORGANIZATION

Value in Health ◽

10.1016/s1098-3015(10)73494-x ◽

2009 ◽

Vol 12 (3) ◽

pp. A86

Author(s):

H Beyhaghi ◽

K Basmenji

Keyword(s):

Health Insurance ◽

Social Security ◽

Comparative Study ◽

Benefit Package ◽

Insurance Benefit

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Should Off-Label Medicines Be Included In The Universal Health Coverage (UHC) Schemes? Why, When, and How?

Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan ◽

10.22435/jpppk.v1i1.417 ◽

2018 ◽

pp. 1-5

Author(s):

Ully Adhie Mulyani

Keyword(s):

Health Insurance ◽

Health Coverage ◽

Benefit Package ◽

Insurance Scheme ◽

Off Label ◽

Insurance Benefit ◽

Medicines Use ◽

Us Fda ◽

Approved Drugs ◽

Universal Health

Abstract Off label medicine refers to any medicine that is used to treat any ailment beyond of its approved / licensed indication by National Regulatory Authorities, such us FDA in USA and BPOM in Indonesia. Off-label medicines are used because the available and approved drugs do not have the desired effect, then doctors try medicine that have not been licensed indications. Some other reasons in practice off-label medicines use and prescribing are that drugs in the same category have the same effect (although have not been approved by indication), the expansion to a lighter form than the licensed indication, or extension of use for certain related conditions. At the opposite, the disadvantage of the practice off-label medicine use is generally not included in any health insurance benefit package, also not covered by mandatory insurance scheme (JKN-BPJS). Patients should pay for the price of a drug that has not been assured or proven of its efficacy and safety. It needs strong evidence based on scientific research to ensure the safety and effectiveness of off-label medicines to be included in the list of medications (national formulary) to put it on National Health Insurance (BPJS) benefit package. Abstrak Obat off-label adalah obat yang digunakan di luar indikasi yang disetujui oleh lembaga yang berwenang, kalau di Amerika Food and Drug Administration (FDA), sedangkan di Indonesia Badan POM. Obat off label digunakan karena obat yang tersedia dan approved tidak memberikan efek yang diinginkan, sehingga dokter mencoba obat yang belum disetujui indikasinya. Beberapa alasan lain adalah adanya dugaan bahwa obat dari golongan yang sama memiliki efek yang sama (walaupun belum disetujui indikasinya), adanya perluasan ke bentuk yang lebih ringan dari indikasi yang disetujui, atau perluasan pemakaian untuk kondisi tertentu yang masih terkait. Kerugiannya adalah obat off-label umumnya tidak dicover oleh BPJS sehingga pasien harus membayar sendiri harga obat yang belum terjamin efikasi dan keamanannya. Perlu dukungan penelitian yang kuat terhadap keamanan dan efektivitas obat off label agar dapat dimasukkan dalam daftar obat (formularium nasional) yang ditanggung BPJS.

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