What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran
What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran
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DOI：
10.1186/s12889-020-09417-7
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发表时间：
2020-08-31
影响因子：
4.5
通讯作者：
Rashidian, Arash
中科院分区：
文献类型：
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作者：
Bazyar, Mohammad;Yazdi-Feyzabadi, Vahid;Rashidian, Arash
背景在有健康保险制度的国家，保险基金的数量和规模沿着它们之间的风险分配量是一个主要问题。克服分散造成的问题的一个可能的解决办法是将风险池联合收割机合并为一个池。本研究旨在探讨潜在的优势和劣势合并健康保险基金在Iran.MethodsIn本定性研究中，有目的的抽样与最大的变化，以获得代表性和丰富的数据。为此，进行了67次面对面访谈。此外，文件审查被用作数据收集的补充来源。内容分析使用“框架法”来分析数据。四个可信度标准，包括可信度，可转移性，可靠性和可确认性，被用来保证质量的results.ResultsThe潜在的后果被分为七个类别，包括管理，融资，人口，福利包，结构，操作程序，和与供应商的互动。据受访者称，控制保健总支出;改善战略采购;消除人口覆盖方面的重复;将提供者的概况集中在一个单一的数据库中;控制所提供的保健服务的数量;使医院与单一的保险互动，使用单一的一套订约、索赔审查和报销指示;和减少行政费用是合并健康保险基金的主要好处之一。受访者还列举了以下缺陷：社会保障组织不愿意像以前那样积极向私营部门工人收取保险费;享受慷慨的基本福利的人口群体越来越不满;由于将所有保险费集中在一家银行，存在金融欺诈和腐败的风险;和风险，把更多的财政压力的情况下，在偿还延迟与单一付款人system.ConclusionMerging医疗保险计划在伊朗的潜在优点和缺点广泛的影响。因此，为了促进这一进程并减少反对者的反对，政策制定者应发挥中间人的作用，考虑到背景因素，采取有针对性的政策，分别最大限度地扩大和减少伊朗合并的潜在好处和缺点。
BackgroundIn 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.MethodsIn 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.ResultsThe 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.ConclusionMerging 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.