Qualitative Analysis of National Documents on the Role and Duties of Supplementary Medical Insurance in Health System: Evidence from Iran

Ebrahim  Hasanzadeh; Hasan  Aboulghasem Gorji; Aziz  Rezapour; Mani  Yousef Vand

doi:10.18502/htaa.v9i2.18718

Ebrahim Hasanzadeh Department of Health and Medical Services Management, Faculty of Medical Information and Management, Iran University of Medical Sciences, Tehran, Iran.
Hasan Aboulghasem Gorji Department of Health and Medical Services Management, Faculty of Medical Information and Management, Iran University of Medical Sciences, Tehran, Iran.
Aziz Rezapour Department of Health Economics, Faculty of Medical Information and Management, Iran University of Medical Sciences, Tehran, Iran.
Mani Yousef Vand Department of Health Policy, Health Insurance Planning and Policy Office, Ministry of Health, Treatment and Medical Education, Tehran, Iran.

DOI: https://doi.org/10.18502/htaa.v9i2.18718

Keywords: Medical Insurance; Supplementary Insurance; Commercial Health Insurance; Document Analysis

Abstract

Context: Supplementary medical insurance plays a key role in enhancing access to healthcare services and improving the overall quality of life for individuals. In healthcare system of Iran, these insurance companies face various legal and operational challenges that impact their effectiveness in providing adequate coverage and service delivery.

Objectives: The present study aimed to systematically investigate the roles, responsibilities, and legal framework governing supplementary medical insurance companies in Iran. The goal was to analyze how these companies operate within the health system and their interactions with service providers, as well as to identify the key policies and regulations that influence their operations.

Data Sources: A comprehensive review of all relevant documents related to supplementary insurance companies in Iran was conducted. These documents, published in Persian, included policies, laws, and guidelines governing the sector. No time limitations were applied, and the documents were sourced from governmental and regulatory bodies.

Study Selection: The study included 10 documents based on inclusion and exclusion criteria. These documents were selected for their relevance to the legal and regulatory framework of supplementary insurance in Iran, particularly those outlining the duties and responsibilities of insurance companies.

Data Extraction: Content analysis techniques were employed to extract and categorize the data from the selected documents. The analysis focused on identifying the main themes related to the operational duties of supplementary insurance companies in the Iranian health system.

Results: The study identified eight central themes regarding the legal requirements and responsibilities of supplementary insurance companies: (1) Interactions with service providers, (2) document handling processes, (3) electronic procedures, (4) contracts with healthcare providers, (5) service packages and coverage, (6) insurance premiums, (7) financial resources, and (8) monitoring and evaluation. The results revealed that the supplementary insurance landscape in Iran is highly fragmented, with a diverse range of policies and regulations. This diversity suggests a need for a more unified framework to streamline operations and ensure efficient service delivery.

Conclusions: The findings underscore the necessity of establishing a standardized, unified structure for supplementary insurance companies in Iran. Streamlining regulations and practices would not only reduce confusion but also enhance the effectiveness of supplementary insurance in improving healthcare access and quality. Further reforms in the regulatory framework are recommended to support the long-term sustainability and efficiency of supplementary insurance within healthcare system in Iran.