Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran
Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran
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DOI：
10.15171/ijhpm.2016.12
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发表时间：
2016-04-01
影响因子：
3.5
通讯作者：
Doshmangir, Leila
中科院分区：
文献类型：
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作者：
Bazyar, Mohammad;Rashidian, Arash;Doshmangir, Leila
伊朗的医疗保险体系存在着支离破碎的现象。存在多个健康保险基金，但没有为它们之间的交叉补贴转移或再分配提供充分的规定。多个风险池，包括若干私人二级保险计划，造成了分层医疗保险制度，不同阶层人口的福利待遇不公平。此外，分散也可能导致健康保险系统效率低下，对被保险人医疗保健支出的财务保障不足，共同保险费率高，保险重复率高，资金充足的机构对公共健康保险计划的贡献低，福利待遇丰厚，公共基金资金不足和严重的财政短缺。缺乏透明度和可靠的决策数据和统计数据。我们进行了一项政策分析研究，包括对关键线人的定性访谈和文件分析。因此，我们提出了三种政策选择：保持社会健康保险（SHI）计划的现有结构碎片化，但实施全面的“政策整合”战略；整合现有健康保险基金，建立单一的国家健康保险计划；并通过合并资源丰富的小基金和在现有组织的保护伞下创建两到三个大型保险基金来减少分裂。本文对这些政策选择及其优缺点进行了阐述。
There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI) schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.