HEALTH INSURANCE
Year:2022 | Volume:5 | Issue:2|Papers Count:8

Introduction: Awareness of benefiting from health services and its determinants is important for health care planning. In Andersen’, s behavioral model, predisposing and enabling factors and factors related to need explain the use of health services. The purpose of this study is to identify the factors related to the use of inpatient services in Iran based on the mentioned model. Methods: The present study is a secondary analysis study that was conducted based on the data of the national survey of the use of health services in 2008 and 2015. The number of sampled people was 8326 in 2008 and 5684 in 2015. Logit regression was used to examine the factors related to the use of health services. Results: Female patients (OR=1. 48, P<0. 01), older patients (OR=0. 01, P<0. 05), patients whose needs were diagnosed by doctors or medical personnel (OR=1. 98, P<0. 01), patients whose head of household had higher than diploma education (OR=1. 65, P<0. 01), and residents of disadvantaged areas of the country (OR=1. 42, P<0. 05) were more likely to benefit from inpatient services. The chance of benefiting from inpatient services was higher in 2015 than in 2008 (OR=2. 15, P<0. 01). Conclusion: Andersen’, s Behavioral Model of Health Services can be a suitable the theoretical framework to explain the determinants of the use of inpatient health services in Iran. It is suggested that the 3 categories of factors constituting this behavioral model should be continuously considered in policies related to the use of inpatient services.

Introduction: The increase in the cost of medical services and the aging of Iran's population have created problems for the medical insurance industry, which has turned this field into one of the riskiest fields. In this situation, one of the most basic needs of this field is to fit a suitable model to the treatment losses, so that the insurer can check the trend of the treatment costs, have an accurate estimate of the next year's losses, and calculate the corresponding insurance premium. Methods: Based on an empirical fundamental study, the loss data related to group treatment insurance policies issued from the middle of 2017 to the middle of 2019 was collected by Day insurance company and using mixed distributions, dental claims were modeled and the loss of the next year was predicted using the credibility method. Results: Due to the heterogeneity in the data, mixed distribution will be more suitable due to its high flexibility. The insured people were divided into 2 high-risk and low-risk categories according to their characteristics, and a distribution was given to each of these categories. The general distribution of damages is considered as a mixed distribution of these distributions, and the mixed weights of this distribution were estimated using logistic regression. Conclusion: One of the most basic issues in all types of insurances is determining their insurance premiums. In this research, using the theory of credibility, the next year's insurance premium is calculated for each of the insured according to their risk parameter. In fact, credibility theory combines the existing insurance premium with past losses and provides the adjusted premium.

Introduction: Analyzing data related to morality is one of the important tools in health policy for any country. The present study was conducted in order to cluster people who died in 2017 in the area covered by Mashhad University of Medical Sciences. Methods: An analytical and cross-sectional study was conducted on the number of 21, 838 deaths reported in 2017 in the population covered by Mashhad University of Medical Sciences, which were extracted from the death registration system of this university. After cleaning the data and fixing the existing defects, people were clustered with PAM and CLARA algorithms based on 4 variables: age, gender, cause of death and region of residence. The optimal number of clusters and the evaluation of the clustering performance were obtained using the average silhouette criterion. Results: According to the silhouette criterion, the biggest difference between the clusters was observed with the number of five clusters. In all clusters (except the third cluster), which included people over 65 years old (64. 5%), circulatory diseases (43%), neoplasms (17%), diseases of the respiratory system (10%) and Endocrine, nutritional and metabolic diseases (6%) were the most common cause of death. In the third cluster, the most important causes of death were congenital malformations, deformation (44%) and diseases of prenatal origin (19%) for children under 1 year of age (74%). Conclusion: Age distribution of the causes of death is one of the most important cases. The existence of congenital malformations, deformation, and diseases of prenatal origin for children under 1 year of age, as well as the cause of death due to the presence of cancer at the age of less than 14 years, according to the upcoming policies regarding the youth of the population, should be considered by health care providers. The high percentage of death due to neurological diseases is one of the cases that can be studied carefully to plan a health road map.

Introduction: The Social Security Organization, as the largest social insurance organization in the country, plays an important and decisive role in ensuring the health and dynamism of the society, and one of its most important goals is to provide various insurance and medical services to the covered people. But achieving this goal is possible when the sources and costs and the factors affecting them, which are the prerequisites for providing services and their costs, are accurately and transparently known and analyzed. Method: In this research, by modeling the resources and expenses of the social security organization with the system dynamics method, it has been investigated the effects of the corona disease, as well as forecasting the conditions of this organization in the coming years and providing suggestions to solve its problems. Results: According to the findings of this research, increasing the insurance premium received from 30 to 35%, as well as increasing the retirement age by 5 years, can increase the resources of this organization and prevent its bankruptcy. Conclusion: The adoption of the policies proposed in this research, despite their sometimes very high impact, alone cannot provide a useful approach to prevent the bankruptcy of the Social Security Fund. In order to ensure the improvement of the conditions of the fund, it is suggested that in addition to the proposed policies in the field of changing the social security system, as well as adopting more efficient long-term and mid-term policies, some changes should be made in order to choose a suitable approach to overcome the current situation.

Introduction: The present study seeks to design a health insurance empowerment model so that the insured can achieve an acceptable level of capabilities. The reason for choosing this group of insured persons is their large and considerable population in the country, which now include about 50% of Iran’, s population. Methods: The methodological approach of this research is qualitative and based of the grounded theory, deep and semi-structured interview data retrieval techniques. For data mining, the theoretical coding method was used, which aims to achieve the main and secondary categories in line with the theoretical model setting. The sample number is 15 health insurance experts who were selected purposefully. Results: The results show that the central phenomenon is community-oriented empowerment, which is based on causal conditions, contextual conditions, intervening conditions and strategies. The most important strategies are the right of the insured to access insurance services and opportunities. In the discussion of background conditions, important elements such as agency, sense of equality and inclusion (integration) and capacity building are emphasized. Also, the findings show that components such as maintaining the rights of the insured, enabling resources and the efficiency and quality of insurance services are considered as causal conditions. Conclusion: According to the findings of the present study, three main categories of education and information, social participation and social support have been proposed as intervening conditions. Completing the chain of the paradigm model of the present study is based on the data theory method of the Consequences Foundation, which analyzed the empowerment in four main sections of social empowerment, cultural empowerment, economic empowerment and psychological empowerment of the insured.

Introduction: Health, as an inherent value for humans, plays an important role in improving the happiness of society and the prosperity of individuals, and is often considered as a key component of human capital that leads to greater economic growth. The concept of social capital shows how the social structure of a group can act as a valuable resource for its people to achieve their goals at a lower cost. Considering health as an asset means the decentralization of policies from risk factors to a more comprehensive perspective based on social factors, including social capital, and the upcoming research was conducted on this basis. Methods: This research was descriptive and correlational. Data analysis was performed through canonical correlation and multiple regression using secondary data collected by Legatum Institute in 2021 and data related to Iran in the period from 2007 to 2020, with the 24th edition of SPSS software. Results: According to the significance of Pillais and Wilkes tests at a significance level of 5%, the correlation coefficient of social capital and health was determined to be 0. 89. According to the structural coefficients, elements of longevity, physical health, mental health, care systems, preventive interventions, and high-risk behavioral factors had the greatest impact on the canonical variable of health, respectively. Based on the standard coefficients, it was found that interpersonal trust has the greatest impact on health, and institutional trust, social networks, civil and social participation, and personal and family relationships as elements of social capital, were placed in the next priorities of impact on health. Conclusion: Social capital plays an important role in understanding the determinants of health, and it is inevitable to pay special attention to it by policymakers in order to eliminate health inequalities. This is the basis in Iran’, s health policy process, which is still facing many challenges, in addition to paying attention to hardware and treatment-oriented strategies, social capital can and should be given special importance as one of the most important determinants of health.

Introduction: Basic and supplementary insurances play an important role in achieving universal health coverage. In developing countries, supplementary medical insurances have many structural and organizational problems and inadequacies. The present study was conducted with the aim of investigating the factors affecting the service packages of supplementary medical insurance. Methods: The current research is of a qualitative type with a framework analysis method that was carried out in 2021. 11 experts of the insurance organization and experts in the health system were selected as the research samples by the purposeful sampling method. MAXQDA software was used for data analysis. Results: The dimensions of the complementary insurance model of treatment in Iran based on the analysis of the opinions of experts in Iran included five main dimensions: «laws and regulations, service coverage, strengthening and creating a competitive market, developing standards for the use of services and treatment guidelines,developing supplementary insurances. Conclusion: Based on the findings, the effort to formulate a comprehensive package of complementary treatment services in the country in order to increase people›, s access should be taken into consideration by the policy makers and the financial capacity to manage and finance universal health coverage should be increased. It is expected that with the scientific development of supplementary medical insurance, a great contribution will be made to universal health coverage in the country.