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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