Table 2 Limitations and problems of the HIBP policy process

Limitations and issues that can be investigated

• Lack of clear criteria to include services into the HIBP

• Not considering the epidemiological transitions to increase the effectiveness of included services.

• Scientific evidences were not adequately used

• Health Technology Assessment (HTA) studies were not used

• Bargaining power had an important role in the ISCHI decisions

• The extensive HIBP list regardless of the priorities and costs

• Policies on HIBP and the strategic purchasing were not implemented

• Cultural, social and economic issues were not considered

• Passive performance of health insurance organizations to include new proposed services within the HIBP

• Lack of revision and evaluation systems

• OTC drugs are included in the HIBP

• Unproportioned percentage of the health expenditures are created by a small percentage of patients

• Development and implementation of programs and policies are not permanent

• Inadequate resources