[Information criteria for basic health insurance package in Iran from health insurance organization's view]

ABSTRACT

Neglecting to define important criteria in developing a basic health insurance package and to notice their real roles will result in defining a package which is politically unacceptable, non-economical, technically inefficient or mixed of them. Therefore development of basic health insurance package should be according to appropriate composition of influential criteria. This study was carried out to determining Information Criteria to define basic health insurance package and their importance. The study was qualitative, descriptive, and cross-sectional, conducted in 2008. At the first stage 20 health insurance experts and involved people were interviewed. At the second stage the notified criteria in these interviews in addition to other criteria, revealed from conceptual study were viewed by experts of Iranian basic health insurance companies [52 people]. The first stage data were analyzed in Atlas-Ti and the second stage data were analyzed in SPSS. The revealed criteria from the first stage were classified as 32 criteria in six groups. Iranian health insurance experts believed that most important factors involved in defining Iranian basic health insurance package were applicability, the view of politic individuals and groups, interventions cost, and patients' membership in vulnerable patient groups. The study participants indicated cost-effectiveness of services, effectiveness of services, quality of evidence, and equity as the main factors by which the basic health insurance package can be defined appropriately. According to results the current influence of some criteria such as the view of politic individuals and groups, and vulnerable patient groups were much more than their appropriate influence in defining Iranian basic health insurance package. Also some criteria like cost- effectiveness, quality of evidence, long-term sustainability, and safety of manipulations were focused less than what was appropriate for defining the package. According to the results of this study it is suggested that for defining basic health insurance package more appropriately, cost-effectiveness studies should be facilitated and the results of such studies should replace such criteria like the influence of different groups in defining basic health insurance package