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A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran

Objective: To understand the Iranian health financing system and provide lessons for policy makers about achieving universal coverage.


Methods: Twenty-five interviewees from seven major health insurance companies were selected for a qualitative study in 2007. Using a semi-structured interview, three
main tasks of the health financing system (revenue collection, risk pooling and purchasing) were investigated. A framework method was applied for the data analysis.


Results: The results of the study show the following seven major obstacles to universal coverage: unknown insured rate; regressive financing and non-transparent financial flow; fragmented and non-compulsory system; non-scientifically designed benefit package; non-health-oriented and expensive payment system; uncontrolled demands; and administrative deficiency. A long-term systematic plan is required to address the above problems.


Keywords: Health insurance, universal coverage, Iran, population coverage, sustainable financing, benefit package 


Authors:  Hossein Ibrahimipour, Mohammad-Reza Maleki, Richard Brown, Mohammadreza Gohari, Iraj Karimi and Reza Dehnavieh