Background: To achieve the objectives of social security and health system, it is essential to enhance the level of efficiency of social insurance funds. To hit this target, the challenges of regulation improvement should be identified and addressed in these funds. Therefore, the present study aimed at identifying the key challenges of regulation and modeling the network of management and its effective factors.
Methods: This was a cross-sectional qualitative study. In the qualitative part, a systematic review and thematic analysis were conducted using MaxQDA ₁₀ software. Qualitative data were collected by reviewing the relevant documents and related studies. In the quantitative part, the structural-interpretative modeling and Mick-Mac analysis methods were employed. The data were collected by referring to the 14 experts selected by targeted sampling method using a questionnaire.
Results: 9 factors were identified as the key challenges in regulation of social insurance funds, including 1) management inconsistency; 2) non-clear insurance approach in population coverage; 3) multiplicity of insurance funds; 4) failure to organize the funds; 5) lack of integrity of rules and regulations; 6) weakness of regulatory authority; 7) weak policy making in management of financial resources; 8) inconsistencies in the country’s insurance tariff system; and 9) insurance cover for informal jobs. The content network was formed in a 4-level model by structural- interpretative modeling method.
Conclusion: Regulation challenges of the social insurance funds include a combination of factors showing the need for the formation of a unit regulator to organize these funds. The aim is to meet the key challenges in 4 layers of the proposed model and modify the regulatory and supervisory structure with a comprehensive, impartial, and specialized approach.