Table 2 Themes and sub-themes emerged from interview transcripts

Basic health insurance instruments

User fee reduction mechanisms [25]

“If I covered by the Relief Committee and spend on my health services up to a certain ceiling, it’s all the responsibility of the Committee or the health insurance organization to pay for the remaining. For example, if I filled the stop-loss ceiling by August, the insurance organization has to pay for it whenever I get sick. It’s not my share anymore. The stop-loss, for example, can be 15% of your annual income. We do not have such a thing, and that’s why OOP is constantly increasing.” P23

User fee exemption [17]

“This is the principle. It is a mistake to receive money from the poor. If you have a referral system, there is no reason to pay because the system guides the patients. Because diseases are unpredictable, they are similar to accidents that can push the rich to poverty. Therefore, if there is an effective referral system, it should not be direct payment at all.” P2

Free health services to the poor outside of the health insurance system

MOHME’s direct reimbursement to hospitals [23]

“The MOHME can do this, and the poor can stay in hospitals for months, weeks, and days without any financial problem. For basic services, we should not receive user fee from the poor, and they should be covered using public resources.” P25

Social assistance organization’s reimbursement to the hospitals [16]

“Mechanisms like this, for example, if poor patients went to a hospital and paid a user fee, they can come to us in the IKRC, we will reimburse the user fee to him/her. Pay the money, come and get it from us. If they could not pay, the Social Work Department in the hospital records the expenditures in the miscellaneous claims account. No need to receive money from the poor. “P23

Charities and NGO’s reimbursement to the hospitals [13]

“Our assessments and the documents provided by the patient show that the person has incurred expenses. His illness is determined for us based on the prescription he receives or his medical certificate. As a medical charity, we cover as many patients as we can each year.” P23