Table 1 Policy “process” Analysis of HIBP
From: Health insurance benefit package in Iran: a qualitative policy process analysis
Issues | Themes | Sub-themes | |
|---|---|---|---|
Agenda setting | Problem stream | 1. Increasing the number of services that can be provided 2. Soaring health expenditures 3. Unavailability of information about inequality within insured populations 4. Inadequacy of resources 5. 5. Parallel budgets (insurances, hygiene, special programs, etc.) | |
Policies stream | 6. Managing services that can be provided 7. Deficiencies in legislation and decision-making process that are related to the HIBP 8. Lack of clear criteria for including services in the HIBP 9. Not using professional and related staffs (not only those who are experienced) in implementation and support of the HIBP | ||
Politics stream | 10. Prioritizing health, and therefore its related policies, in the twelfth government 11. Increasing health sector budget in the 11th government 12. 13. Notifying OHP and making decision about the HIBP | ||
Policy development | Stewardship of the policy making | 13. Developing the article 29 of the constitution 14. Developing policy’s draft by the MoHME and MoCLSW 15. HCHI as the steward of developing and notifying the HIBP’s strategies 16. Confirming policies by the National Expediency Council 17. Enacting policies by the Parliament 18. Final approval and notifying OHP by the supreme leader’s office 19. The MoHME is the steward of developing the HIBP based on the OHP | |
Method and trend of decision-making | 20. Endorsing the HIBP by the third NDP for the first time 21. Lack of a defined methodology to include/exclude services into/from the HIBP 22. Drafted policies are different from notified policies, up to 70% 23. The ISCHI makes decision about the strategic policies of the HIBP 24. Developing polices according to the available resources 25. A defined contribution approach in developing HIBP-related policies 26. Inadequate attention to people’s preference/demand 27. 28. Using a top-down approach in developing HIBP-related policies in OHP | ||
Policy implementation | Policy implementation timeline | Before 1993 | 28. Article 29 of the constitution, requires the government to cover all necessary services 29. Lack of a clear distinction between service provision in public and private sectors 30. Lack of defined criteria to cover services by health insurance organizations 31. 33. Considering the availability of services when deciding to provide a service |
Between 1993 to 2003 | 32. Developing the UHI Act in 1993 and notifying it in 1994 33. Establishing the HCHI within the MoHME 34. HCHI became responsible about the HIBP 35. Experts debating in joint meetings 36. Commitment to provide all services that can be provided 37. Determining the covered services by the health insurance organizations 38. Political top-down decisions, without expert debates 39. Stakeholders or head of the meeting have greater influence | ||
2004 to 2006 | 40. Transferring the ISCHI from the MoHME to the MoCLSW 41. Insurance-related stakeholders had more influence 42. Services/medicines were included based on the frequency and compensation patterns 43. Including Services/medicines based on the reviewing less expensive services and equipment 44. Top-down political decisions, without expert debates 45. Introducing complementary insurance to cover services that were not covered by the basic insurance | ||
2007 to 2014 | 46. Developing the first comprehensive package 47. Using the most frequent services criterion to develop the HIBP 48. It takes a long time to decide whether to include a service/medicine or not 49. HCHI decides based on the consensus criteria 50. Special packages or separate resources/stewards (e.g. special diseases) 51. In 2010, the MoHME and the MoCLSW started strategic purchasing 52. New mandatory criteria were introduced (i.e. safety studies, effectiveness, cost-effectiveness) to include new medicines to the national formulary 53. In 2012, new RVU Book was developed | ||
Since 2014 | 54. In 2014, the OHP were notified by the Supreme Leader’s office 55. In 2014, the MoHME was mandated to develop the new HIBP 56. The MoCLSW was selected as the steward of financing and implementing the HIBP 57. In 2014, health transformation plan was started 58. The new HIBP was defined in the form of the RVU Book 59. Services that are not included in the HIBP were clearly mentioned in the new RVU Book 60. Defining and providing services that were not previously covered in the HIBP, as a part of the HTP | ||
Process of HIBP implementation | 61. Sending a request to the ISCHI 62. Expert review of the request 63. Deciding about the request 64. If it has low financial burden, notifying its inclusion to the HIBP 65. If it has high financial burden, the cabinet confirmation is required | ||
Evaluation | HIBP Revision | 66. Lack of fundamental and purposive revision(s) 67. Before 2014, there was no significant change occurred in the HIBP 68. Due to changes in the treatment methods, some services/drugs are automatically excluded 69. Mandating the ISCHI to annually revise the HIBP 70. Temporary and non-methodological changes (three times, in 2007, 2012, and 2014) 71. Unorganized revision of the OTC drugs 72. In 2003, some performance-enhancing drugs were excluded | |
Revising the methods and decisions | 73. Process and criteria for including/excluding services are not revised 74. No evaluation has been performed, and laws and regulations are not revised 75. In 2013, service prioritizing program was begun, without clear outcomes | ||
Evaluating the aims of HIBP-related policies | 76. The impact of HIBP-related policies on achieving universal health insurance coverage 77. The impact of HIBP-related policies on developing basic and complementary HIBPs 78. The impact of HIBP-related policies on unifying the HIBP among all health insurance organizations | ||