Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives
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 no...
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| Format: | Article |
| Language: | fas |
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Shahid Sadoughi University of Medical Sciences
2022-06-01
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| Series: | Rāhburdhā-yi Mudīriyyat dar Niẓām-i Salāmat |
| Subjects: | |
| Online Access: | http://mshsj.ssu.ac.ir/article-1-512-en.html |
| _version_ | 1828103508977516544 |
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| author | Azam Delavarinejad Elahe Hooshmand Javad Moghri Ali Vafaeenjar |
| author_facet | Azam Delavarinejad Elahe Hooshmand Javad Moghri Ali Vafaeenjar |
| author_sort | Azam Delavarinejad |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T09:27:18Z |
| format | Article |
| id | doaj.art-c3dceb9133434a75aed5a01e76764753 |
| institution | Directory Open Access Journal |
| issn | 2476-6879 2538-1563 |
| language | fas |
| last_indexed | 2024-04-11T09:27:18Z |
| publishDate | 2022-06-01 |
| publisher | Shahid Sadoughi University of Medical Sciences |
| record_format | Article |
| series | Rāhburdhā-yi Mudīriyyat dar Niẓām-i Salāmat |
| spelling | doaj.art-c3dceb9133434a75aed5a01e767647532022-12-22T04:32:00ZfasShahid Sadoughi University of Medical SciencesRāhburdhā-yi Mudīriyyat dar Niẓām-i Salāmat2476-68792538-15632022-06-017197107Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts PerspectivesAzam Delavarinejad0Elahe Hooshmand1Javad Moghri2Ali Vafaeenjar3 MSc in Health Services Management, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran Associate Professor, Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Iran Assistant Professor, Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Iran Professor, Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Iran 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.http://mshsj.ssu.ac.ir/article-1-512-en.htmlkeywords: health insurance ceilinghealth insurancehospital |
| spellingShingle | Azam Delavarinejad Elahe Hooshmand Javad Moghri Ali Vafaeenjar Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives Rāhburdhā-yi Mudīriyyat dar Niẓām-i Salāmat keywords: health insurance ceiling health insurance hospital |
| title | Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives |
| title_full | Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives |
| title_fullStr | Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives |
| title_full_unstemmed | Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives |
| title_short | Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives |
| title_sort | elaborating the challenges of health insurance extent of coverage and proposing solutions from experts perspectives |
| topic | keywords: health insurance ceiling health insurance hospital |
| url | http://mshsj.ssu.ac.ir/article-1-512-en.html |
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