Identifying the Components of Complementary Insurance Service Packages in Iran

Abstract

The provision of medical services to patients has become so widespread that it is not economically viable to provide all of these services in the form of health insurance. Global experience shows that in many countries, supplementary health insurance is utilized to cover these services. In this study, the components of Iran supplementary insurance service package are identified. The scientific model of this research is based on a qualitative interview with experts and managers of the insurance organization and experts in the health system in 2020 and the sampling method is both targeted and snowball. Finally, referring to the experts, 16 qualitative interviews were conducted, and by using the grounded theory technique the components of service packages were identified. The necessity of each of the components of the extracted model for complementary insurance service packages was investigated in Iran. The research was analyzed by the coding method in three stages: open, axial, and selective. The results showed that the total number of nodes was 131 non-repetition codes based on the conceptual similarities of the composition and 131 nodes (common codes) were extracted based on the researchers' intuition and understanding of the subject and according to their commonalities in six main components and seven sub-components were classified in the form of tree nodes. In addition, the main and secondary components constitute the following: the main component, health services coverage, including sub-components (general population coverage, manpower, and health system structure) financial resources (supply indicators financial-economic resources) organizational structure (structural indicators) willingness to pay (insured satisfaction) management principles (management index) and  supervisory policies (supervision and control).