Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage.
Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage.
复制标题
转型中的伊朗医疗保险制度：公平问题和实现全民健康覆盖的步骤。
DOI：
10.1186/s12939-020-01372-4
复制
发表时间：
2021-01-14
影响因子：
4.8
通讯作者：
Gordeev VS
中科院分区：
文献类型：
--
作者：
Doshmangir L;Bazyar M;Rashidian A;Gordeev VS
公平、效率、可持续性、客户和提供者的可接受性以及质量是全民健康覆盖的基石。没有一个国家有一个单一的方法来实现有效的全民健康覆盖。在这项研究中，我们记录了伊朗的医疗保险改革，重点是如何以及为什么引入和实施某些政策，以及保持可持续的UHC仍然面临哪些挑战。这项回顾性政策分析使用了三个数据来源：对文献的全面和按时间顺序的范围审查，对伊朗医疗保险政策参与者和利益相关者的采访，以及对已发表和未发表的官方文件和当地媒体的审查。所有数据均采用专题内容分析法进行分析。健康保险改革，特别是2014年的健康转型计划（HTP），通过扩大人口覆盖面，福利计划和加强财务保护，帮助实现全民健康覆盖和健康公平。然而，一些挑战可能会危及维持这一进展。没有适当的机制向没有固定收入的人收取缴款。强制性健康保险覆盖法没有得到充分执行。私人和公共医疗收费之间的巨大差距导致自付医疗费用高昂。此外，控制卫生保健总支出并不是使全民健康覆盖更具可持续性的主要优先事项。为了在伊朗实现全民健康覆盖，卫生和医学教育部和医疗保险计划应制定并遵循控制医疗保健支出的政策。应建立工作机制，扩大免费医疗保险对有需要者的覆盖范围。需要更多的研究来评估医疗保险改革在健康公平性、可持续性、覆盖范围和可及性方面的影响。
Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.
登录
查看更多内容
影响因子：
2.8
作者：
Doshmangir, Leila;Moshiri, Esmaeil;Assan, Abraham
通讯作者：
Assan, Abraham
影响因子：
4.5
作者：
Do N;Oh J;Lee JS
通讯作者：
Lee JS
影响因子：
2.7
作者：
Bazyar, Mohammad;Rashidian, Arash;Olyaeemanesh, Alireza
通讯作者：
Olyaeemanesh, Alireza
DOI：
10.15171/ijhpm.2016.12
发表时间：
2016-04-01
影响因子：
3.5
作者：
Bazyar, Mohammad;Rashidian, Arash;Doshmangir, Leila
通讯作者：
Doshmangir, Leila
影响因子：
4.5
作者：
Bazyar, Mohammad;Yazdi-Feyzabadi, Vahid;Rashidian, Arash
通讯作者：
Rashidian, Arash