Document Type : Original Article
Authors
Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Abstract
INTRODUCTION: This study was designed and implemented with the purpose of identify and analyze
the stakeholders in Iran’s Health Insurance System (HInS).
MATERIALS AND METHODS: This study was a mixed method study. The study setting was in the
field and consists of all organizations in the HInS. The study steps designed according to the Kammi
Schmeer stakeholder analysis model. The information was collected through semi‑structured and
structured interviews with 16 stakeholder representatives. The data collection tool was checklist
and matrixes that determined the characteristics of the stakeholders. Analysis of data was done by
Maxqda10 and Mactor software.
RESULTS: A total of 34 stakeholders were identified that were involved in nine main activities of
HInS. Major stakeholders have governmental nature. The Government, the Planning and Budget
Organization, the Ministry of Health, the Welfare Ministry, the Higher Health Insurance Council,
and the Medical Council were stakeholders who have high financial, decision‑making, and political
power simultaneously. The Parliament and the Health Commission, the Government, the Planning
and Budget Organization, and the Ministry of Health were stakeholders that had the most influence
on other stakeholders. Most of stakeholders have same position to the objectives of the HInS. The
insurer organizations had opposed position with the objective of integrity of the funds.
CONCLUSIONS: Stakeholders of Iran’s HInS are multiple and involved in various activities that
sometimes they are overlapping and parallel. Regarding the same position of the majority of
stakeholders to the objectives, reforms are possible, provided that influential stakeholders participate
in policies making.
Keywords
system; past experiences, present challenges and future strategies.
Iran J Public Health 2012;41:1‑9.
2. Najar AV, Karimi I, Sadaghiani E. The process of information
system in service packs of complementary health insurance in
selected countries and presenting a model for Iran. Health Inf
Manag 2006;3:51‑62.
3. Mehrdad R. Health system in Iran. JMAJ 2009;52:69‑73.
4. Jahangir M. Provision and Regulations of Social Security and
Welfare. Tehran: Dowran Publication; 2006.
5. Moghadasi H, Hosseini AS, Asadi F, Ismaili M. The problems
of Iran health insurance system and the necessity of reform
approach. Health Manag 2011;14:71‑9.
6. Raeisi AR, Mohammadi E, Noohi M. The points of improvement
and solutions to improve the quantity and quality of Iran’s health
insurance, qualitative study. Health Inf Manag 2013;10:1‑8.
7. Rezaee A, Dabbagh A. Different patterns to optimize health
insurance system. Razi 2008;11:73‑81.
8. Bahadori M, Ravangard R, Alimohammadzadeh K,
Hosseini SM. Plan and road map for health reform in Iran.
BMJ 2015;351:h4407.
9. Akinci F, Mollahaliloğlu S, Gürsöz H, Oğücü F. Assessment of
the Turkish health care system reforms: A stakeholder analysis.
Health Policy 2012;107:21‑30.
10. Haidari AM, Zaidi S, Gul R. Prospects for the sustainability of
delivering the basic package of health services in Afghanistan:
A stakeholder analysis. East Mediterr Health J 2014;20:300‑8.
11. Gilson L, Erasmus E, Borghi J, Macha J, Kamuzora P, Mtei G, et al.
Using stakeholder analysis to support moves towards universal
coverage: Lessons from the SHIELD project. Health Policy Plan
2012;27 Suppl 1:i64‑76.
12. Saghafi F, Abbasi K, Keshtgari E. Sustainable value creation
framework on stakeholder management (case study: Native
operating system of Iran). Modiriat E Farda J 2014;13:20‑42.
13. Abiiro GA, McIntyre D. Universal financial protection through
national health insurance: A stakeholder analysis of the proposedone‑time premium payment policy in Ghana. Health Policy Plan
2013;28:263‑78.
14. Schmeer K. Stakeholder analysis guidelines. Policy Toolkit for
Strengthening Health Sector Reform. WHO int. 2000;2:1‑43.
15. World Health Organization. The World Health Report 2000:
Health Systems: Improving Performance. Geneva: World Health
Organization; 2000.
16. World Health Organization. World Health Report: Health Systems
Financing: The Path to Universal Coverage (Arabic). Geneva:
World Health Organization; 2010.
17. World Health Organization. Research for Universal Health
Coverage. Geneva: World Health Organization; 2013.
18. Zare H. Privatization Strategies of Health Insurance: Principles,
Basis of Health Status of Iran. Iran: Medical Services Insurance
Organization; 2006.
19. Dehnavieh R. Design Model of Basis Health Insurance Package
for Iran. Iran: Iran University of Medical Sciences; 2007.
20. Sedighi S, Hesam S, Maleki M. Influencing factors on the
establishment of basic health insurance in Iran. Healthc Manag
2013;4:7‑19.
21. Tynkkynen LK, Keskimäki I, Lehto J. Purchaser‑provider splits
in health care‑the case of Finland. Health Policy 2013;111:221‑5.
22. Mättö T. Implementation of Quality Cost Management Tool
in Dyadic Purchaser‑Provider Relationship Context. Jyväskylä
Studies in Business and Economics 114; 2012.
23. Gallego R. Introducing purchaser/provider separation in the
Catalan health administration: A budget analysis. Public Adm
2000;78:423‑42.
24. Siverbo S. The purchaser-provider split in principle and practice:
Experiences from Sweden. Financ Account Manage 2004;20:401‑20.
25. Zare H. Available Challenges to do Integrate Health Insurance
in Iran. Iran: Majlis Research Center; 2007.