Showing 5 results for Health Insurance
Mohammad Amin Bahrami , Mohsen Pakdaman, Leila Chehreghani , Ahmad Rahbar ,
Volume 3, Issue 3 (12-2018)
Abstract
Background: The benefits of health services are affected by several factors. The possible consequences of such factors affect the utilization rate of health services and may lead to higher costs of health care induced by the increased use of medical care services. Therefore, this study was conducted to investigate the effect of patient-related factors on the utilization rate of health services among the selected hospitals of Qom city in 2017.
Methods: The present cross-sectional descriptive-analytic study was carried out in 2017. Data were collected using Goldberg standard health questionnaire and a checklist completed by 400 patients who referred to the selected hospitals of Qom city. Data were analyzed by Stata 13 and the logistic regression test was run to determine the effect of independent variables (effective factors on the use of services) on the dependent variable (service usage). Later, we analyzed results of the regression tests and investigated the relationship of the independent factors and the demographic information on the use of services.
Results: The results of logistic regression tests showed the utilization rate of services by investigating the relationship among demographic, independent, and dependent variables. We found that utilization rate of health services increased by the following factors: older age, female gender, higher number of family members, higher family income, higher education level of the head of household, higher education level of patients, and residence in urban areas of Qom city. Further factors included being native of the city, being under the basic and supplementary insurance coverage, and having poor health status. Moreover, married head of family, employment of family members in the medical care system, near distance to the hospital, and more leaves from work led to more application of services. In addition, patients who spent more days to take the doctor's visit, spent more time in the clinic to visit the doctor, and had longer visit duration by the physician used the services more frequently. Furthermore, utilization rate of services had a statistically significant relationship with the health status of the individual, the marital status of the family head, and the visit duration by the physician.
Conclusion: Considering the effective factors on utilization rate of services by patients, health system administrators can analyze the risk factors and make practical suggestions to control and reduce the false use of services by patients and physicians. In this regard, they can implement incentive and punitive mechanisms, create awareness among people about the challenges and risks of the induced demand, change the strategies, modify the insurance payments, rate the level of services for different classes of the society, and maintain the financial resources to meet the needs.
Mohammad Ranjbar, Ali Kazemi Karyani, Milad Shfiei, Elham Tayefi,
Volume 5, Issue 1 (6-2020)
Abstract
Background: Health insurance is one of the financing mechanisms in the health sector that reduces expensive and unforeseen costs of the health care for households and converts these costs into predictable premiums. The purpose of this study was to identify the appropriate attributes and levels using the discrete choice experiments for health insurance, which can describe health care services appropriately.
Methods: The present study is the result of a qualitative phase of the simultaneous analysis that was conducted in 2017 in Yazd and included several stages. First, the literature was reviewed through a search on valid websites to identify the related features. Later, 8
health insurance and health policy makers, sampled by snowball method, were interviewed and specific health insurance weighting characteristics were assessed. Eventually, the research team decided to include the traits and levels in the final design after several panel meetings with the experts.
Results: The findings of this study showed that the most important attributes of health insurance included: public hospitals, and private hospitals benefits, outpatient services, drug service coverage, dental insurance coverage, Para clinical services, medication and medical equipment cost coverage, and monthly premium.
Conclusion: Policymakers and health insurance organizations need to focus on health and premium benefit packages appropriate to people's ability to pay and community inflation to improve insurance coverage in this area. These attributes can help individuals to pay for health insurance and lead to changes in the insurance system of the country. They also enhance planning to improve basic insurance and increase the benefits of insurance packages.
Azam Delavarinejad , Elahe Hooshmand , Javad Moghri , Ali Vafaeenjar ,
Volume 7, Issue 1 (6-2022)
Abstract
Abstract
Background: The health insurance extent of coverage was decided by the Health Insurance Organization in order to manage costs. In this plan, to determine the extent of payment by each medical center, the performance of the year 2017 was considered the base point. Furthermore, it should not cost more than the performance of the year 2017 or 10 % less. This issue had caused challenges in public hospitals; so, the purpose of this study is to explain the challenges of health insurance extent of coverage from the perspectives of the experts from Mashhad University of Medical Sciences and propose solutions.
Methods: This was a qualitative study conducted through content analysis method in 2022. In-depth and semi-structured interviews were used to collect data. The research population included experts such as staff and hospital managers, Medical group managers, and insurance managers and experts. It was done through purposeful sampling. Data collection continued until the codes were completed, and finally 17 people were interviewed. In each phase, data analysis and data collection were performed simultaneously, using content analysis method and MaxQDA10 software.
Results: In this study, the 2 main concepts were management challenges (including sub-concepts of motivation, performance evaluation, patient admission, and hospital costs), and planning challenges (including sub-concepts of education, infrastructures, cross-sectional coordination, and foresight).
Conclusion: Based on the findings of this study and the challenges expressed, Health Insurance Organization can take steps toward upgrading the plan by considering the necessary prerequisites and providing solutions such as performance monitoring evaluation system, cost management, training the target groups, and appropriate clarification and announcements.
Ebrahim Jaafaripooyan , Farnoosh Azizi , Aida Asghari, Maryam Babaei Aghbolagh ,
Volume 7, Issue 2 (9-2022)
Abstract
One of the serious challenges regarding interactions between Iran’s social security system and health system is basic health insurance stewardship. It has existed for a long time and has been given a special place concerning the related laws and policies in recent years. In this regard, it seems that approving of rules conflicting with upstream laws and policies has increased existing conflicts. This is done by creating ambiguity in the position of basic health insurance. But, it should not be forgotten that the main goal is universal health coverage and effective insurance protection against financial risks caused by illness. Therefore, any decision in these areas should be made with respect to the social, cultural, economic and political conditions of the country and according to the historical experiences and structural characteristics.
Farshid Aslani, Hassan Dehghani , Hamed Tasdighi ,
Volume 9, Issue 3 (11-2024)
Abstract
Background: The policy of removing the preferred drug currency (Daruyar plan) has been with the approach of increasing the coverage ratio and insurance obligations and paying attention to patients' out of pockets, especially incurable, chronic and low-income patients. Therefore, the purpose of this research is to investigate the effect of this plan on price and consumption ,and ultimately, the out of pocket payments after its implementation.
Methods: The research method of this study was descriptive-analytical. Primary sampling included 5 pharmacies selected non-randomly and purposefully. After extracting the drug data of the insured persons related to these pharmacies from the database of the Health Insurance Organization, a sample of 384 people determined from the Morgan table was determined randomly and the number of 1803 items of medicine received by them was checked. Then the data was analyzed using SPSS 17 software and Mann-Whitney test.
Results: The survey of 1803 items of medicine in the two periods of November 2021 and 2022 showed that the maximum amount of out-of-pocket payment in November 2021 was equal to 184,000,000 Rials and the average of this variable was 1,357,000 Rials and the median was 177,250 Rials. This number in 2022 was 92,000,000 Rials, 1,805,000 Rials respectively and 181,050 Rials. The results of the analysis of these data showed that after the implementation of Daruyar plan, due to the allocation of compensatory subsidies, there has been no significant change in the total out-of-pocket payment of the patients.
Conclusion: This study investigated the effect of Daruyar plan on price changes, consumption and out-of-pocket payments of patients. The comparison of out-of-pocket payment data in the two time frames of November 2021 and 2022 showed that eliminating the preferred drug currency and implementing the drug subsidy plan has not made a significant change regarding patients' out-of-pocket payments.
