scholarly journals What Kinds of Advantages and Disadvantages May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Insurance ◽  
Negative Consequences ◽  
Health Insurance System ◽  
Face To Face ◽  
Insurance System ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background In countries with health insurance system, the number, the size of insurance funds and the amount of risk distribution among them is a major concern. One possible solution to overcome problems resulting from fragmentation is combining risk pools together to create fewer and larger ones, ideally a single pool. This study aims to realize what kind of advantages and disadvantages merging health insurance funds together may bring about to the health insurance system in particular and health system in general. Methods In this qualitative study, nesting purposive sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. Documentary review was used as supplementary source of data collection. Content analysis using the ‘framework method’ was used to analyze the qualitative data. For assuring the quality of results, four trustworthiness criteria including credibility, transferability, dependability and confirmability were used. Results The results of this study indicated that there are diverse positive and negative consequences for merging of health insurance funds in Iran which are categorized into seven categories including governance/stewardship, financing, population, benefit package, structure, operational procedures and interaction with providers. These themes are subdivided further into thirty-seven sub-categories which represent a wide range of different policy aspects which need close attention to deal with the merging of health insurance funds. Conclusions Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks, so to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

scholarly journals What Kinds of Advantages and Disadvantages May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Insurance ◽  
Negative Consequences ◽  
Health Insurance System ◽  
Face To Face ◽  
Insurance System ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background: In countries with health insurance system, the number, the size of insurance funds and the amount of risk distribution among them is a major concern. One possible solution to overcome problems resulting from fragmentation is combining risk pools together to create fewer and larger ones, ideally a single pool. This study aims to realize what kind of advantages and disadvantages merging health insurance funds together may bring about to the health insurance system in particular and health system in general. Methods: In this qualitative study, nesting purposive sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. Documentary review was used as supplementary source of data collection. Content analysis using the ‘framework method’ was used to analyze the qualitative data. For assuring the quality of results, four trustworthiness criteria including credibility, transferability, dependability and confirmability were used. Results: The results of this study indicated that there are diverse positive and negative consequences for merging of health insurance funds in Iran which are categorized into seven categories including governance/stewardship, financing, population, benefit package, structure, operational procedures and interaction with providers. These themes are subdivided further into thirty-seven sub-categories which represent a wide range of different policy aspects which need close attention to deal with the merging of health insurance funds. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks, so to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

scholarly journals What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Expenditures ◽  
Advantages And Disadvantages ◽  
Care Services ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

scholarly journals What Kinds of Advantages and Disadvantages Is May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Financing ◽  
Health Care Expenditures ◽  
Negative Consequences ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Health Insurance Funds

Abstract Background: Fragmentation in health insurance system is a major concern in health financing. One possible solution to overcome problems resulting from fragmentation is combining risk pools together. This study aims to realize the potential advantages and disadvantages of merging health insurance funds. Methods: In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. The documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the qualitative data. Results: The results of this study indicated that there are diverse positive and negative consequences for merging health insurance funds in Iran. These are categorized into seven categories, including governance/stewardship, financing, population, basic benefit package, structure, operational procedures, and interaction with providers. Control of total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database and reducing fraud and controlling the volume of health care services provided by the providers; interaction of hospitals with single insurance with a single set of instructions for contracting, claiming review and reimbursement; reducing administrative and overhead costs were among the main benefits of merging mentioned by interviewees. The following drawbacks were raised as well: the unwillingness of the social security organization to collect insurance premiums from private workers actively as before; increasing dissatisfaction among population groups enjoying generous basic benefits package at the current situation; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on the providers in case of delay in reimbursement by the single-payer. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

scholarly journals What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Expenditures ◽  
Advantages And Disadvantages ◽  
Care Services ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

scholarly journals Combining health insurance funds in a fragmented context: what kind of challenges should be considered?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Minoo Alipouri Sakha ◽  
Mohammad Reza Vaez Mahdavi ◽  
Leila Doshmangir
Keyword(s):  
Health Insurance ◽  
Health Service Delivery ◽  
Health Insurance System ◽  
Snowball Sampling ◽  
Implementation Barriers ◽  
Consolidation Process ◽  
Key Informants ◽  
Insurance System ◽  
Insurance Funds ◽  
Health Insurance Funds

Abstract Background Iran’s Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. Methods A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. Results This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to “the justification of the consolidation process” in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. Conclusions Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.

scholarly journals The Experiences of Merging Health Insurance Funds in Turkey, Thailand, South Korea and Indonesia: What lessons can be learned?

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Vahid Yazdi-Feyzabadi ◽  
Anahita Behzadi
Keyword(s):  
Health Insurance ◽  
South Korea ◽  
Health System ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Health Insurance System ◽  
Insurance Funds ◽  
The Subject ◽  
Health Insurance Funds ◽  
Universal Health

Abstract Background : Fragmentation in health insurance system can obstruct reaching universal health coverage’ objectives and may lead to inequity in financial and organizational access to health care services. One possible option to overcome this challenge is merging the existing insurance funds together. This article aims to review the experience of Turkey, Thailand, South Korea and Indonesia regarding merging which can be very useful for other countries which are looking for ways of enhancing their health systems. Methods: The present study is a cross-country comparative analysis. The first criterion to choose these countries was with experience of the policy of merging. The second criterion was diversity in health insurance systems. To find the most relevant documents about the subject, different sources of information were searched including books, scientific papers, reports, policy documents and documents published by international organizations such as WHO and World Bank. We followed snowball sampling method to reach out for further documents by checking the reference list of the most relevant documents. We also contacted the authors with the most relevant articles in the selected countries to introduce and provide us with more articles or publications about the subject. Results: The experience of Turkey, Thailand, South Korea and Indonesia show that different reasons may force policy makers to move towards merging and reducing the number of health insurance funds; different stakeholders may support or oppose merging based on the interests they may have in the current fragmented health insurance system; various positive and negative consequences may occur in the health system as the result of merging. The experience of these countries also emphasize that in order to accelerate and facilitate implementation process of merger and face less operational challenges, there should be some prerequisites such as experiencing reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging. Conclusions: Merging is not the panacea to all problems of health system and other contributing health reforms should be implemented simultaneously or sequentially in other aspects of health system if merging is going to pave the way reaching universal health coverage.

scholarly journals The Experiences of Merging Health Insurance Funds in Turkey, Thailand, South Korea and Indonesia: What lessons can be learned?

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Arash Rashidian ◽  
Anahita Behzadi
Keyword(s):  
Health Insurance ◽  
South Korea ◽  
Health System ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Health Insurance System ◽  
Insurance Funds ◽  
The Subject ◽  
Health Insurance Funds ◽  
Universal Health

Abstract Background: Fragmentation in health insurance system can obstruct reaching universal health coverage’ objectives and may lead to inequity in financial and organizational access to health care services. One possible option to overcome this challenge is merging the existing insurance funds together. This article aims to review the experience of Turkey, Thailand, South Korea and Indonesia regarding merging which can be very useful for other countries which are looking for ways of enhancing their health systems. Methods: The present study is a cross-country comparative analysis. The first criterion to choose these countries was with experience of the policy of merging. The second criterion was diversity in health insurance systems. To find the most relevant documents about the subject, different sources of information were searched including books, scientific papers, reports, policy documents and documents published by international organizations such as WHO and World Bank. We followed snowball sampling method to reach out for further documents by checking the reference list of the most relevant documents. We also contacted the authors with the most relevant articles in the selected countries to introduce and provide us with more articles or publications about the subject. Results: The experience of Turkey, Thailand, South Korea and Indonesia show that different reasons may force policy makers to move towards merging and reducing the number of health insurance funds; different stakeholders may support or oppose merging based on the interests they may have in the current fragmented health insurance system; various positive and negative consequences may occur in the health system as the result of merging. The experience of these countries also emphasize that in order to accelerate and facilitate implementation process of merger and face less operational challenges, there should be some prerequisites such as experiencing reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging. Conclusions: Merging is not the panacea to all problems of health system and other contributing health reforms should be implemented simultaneously or sequentially in other aspects of health system if merging is going to pave the way reaching universal health coverage.

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