Objective(s): Contribute to a better understanding of the Iranian health financing system and draw some useful clues for policy makers are the aim of the study. Methods: We interviewed a purposeful sample of 25 participants from 7 main actors in Iranian health Insurance system in late 2007. We asked about three main tasks of health financing system: revenue collection, Risk Pooling and Purchasing and used a model suggested by Guy Carrin to design the study and the framework method for the analysis.Results: Unknown insured rate, Regressive financing and, non transparent financial flow, Fragmented system and non compulsory insurance, Nonscientific designed BP, non health oriented and expensive payment system, uncontrolled demands and defect in administrative efficiency are seven themes which explain the defects of current universal coverage in Iran.Conclusion: A long term systematic approach plan is required in any reform in Iran’s health financing system. The plan should aim to respond the above problems systematically.

Objective(s): Health insurance literacy (HIL) is the knowledge, ability, and confidence of people to find and evaluate information about insurance plans, choose the best plan and how to use it. This study was conducted to examine the level of HIL among the insured person of the Iran Health Insurance Organization in Tehran. Methods: This cross-sectional study was conducted in 2023 with the participation of 309 insured person. The data were collected using a 27-item questionnaire that included three dimensions of access, insurance terms, and performance skills. The validity and reliability of the questionnaire were confirmed. Data analysis was performed in SPSS.24 using T-test and One-way ANOVA. Results: The mean score for access was 8.5±1.91, insurance terms 10.21±2.46 and performance skill was 22.94±3.23. The overall mean HIL score was 41.64±6.22. The HIL status of 60% of the insured person was intermediate and 40% was low. The mean score of HIL was higher among people living in the northern region, those covered by the special diseases fund, those with a monthly less income, and those without supplementary insurance. The HIL level was also higher among people whose source of insurance information was friends and acquaintances (P<0.05). Conclusion: The majority of people had relatively low levels of HIL. Knowing the level of HIL and the factors that influence it can guide policy makers in developing educational interventions to remove barriers and improve HIL. Educational interventions through public media such as television, short videos on the websites and applications of insurance organizations and social media, and the provision of insurance information on waiting room monitors in medical centers are suggested to improve HIL.

Background: In May 2014, the Iranian government announced it would cover all uninsured Iranians. Despite free-of-charge insurance, the studies found that the coverage still needed to be completed (93%). This study aimed to understand why certain population groups remain without insurance despite the accessibility of free-of-charge coverage. This issue is not unique to Iran,it is prevalent in many other countries where, despite free coverage, not all individuals avail themselves of it, thereby exposing themselves to risks. Methods: In a matched case-control study, 89 non-insured patients were compared with 178 hospital-based controls with health insurance (2: 1). The samples were recruited at one of the leading public hospitals in the country (Imam Khomeini Hospital Complex in Tehran) in 2019. Two insured controls were selected and matched for age (± five years) and sex for each person without insurance. A conditional logistic regression was performed to assess the magnitude of effects and the goodness of fit test used to examine the model. Results: Unemployment (Odds Ratio (OR)=8. 33, 95% Confidence interval (CI): 1. 05-50. 0), being single (OR=3. 69, CI: 1. 18-11. 55), low economic status (OR=1. 85, CI: 1. 02-3. 33) and attitude towards performance of health insurance (OR=0. 86, CI: 0. 75-0. 99) were affected not having health insurance. Conclusion: Approaches that cover the entire population may struggle to ensure no one is left without needed services. There is a need for greater focus on vulnerable groups to achieve universal health coverage conscientiously. Moreover, improved services and education can positively shape public perceptions of insurance efficacy, affecting their enrollment choices. Health sector reform

Background & objectives: According to the recommendation of the World Health Organization, health insurance is an effective tool to achieve the global goal of universal health care coverage. The present study was conducted to design and determine a valid and reliable questionnaire to measure universal health insurance coverage in Iran. Methods: This descriptive-applied study was conducted in 2022. Based on the data obtained from the review and comparative study, an initial questionnaire was prepared based on the balanced scorecard model. Content validity was measured using a panel of 15 experts and content validity ratio (CVR) and content validity index (CVI) for each question. The testretest method was used in a sample of 30 people to determine the reliability. Data were analyzed using Excel and SPSS 20 software. Results: Validity assessment was done in two stages. The final questionnaire was approved with a total content validity index score of 0. 85 and a content validity ratio of 0. 67. The results of Spearman's correlation coefficients for the four dimensions of the questionnaire showed the acceptable reliability of the questionnaire components. Conclusion: Considering that the designed questionnaire was approved in terms of validity and reliability, it can be a suitable tool for determining the requirements for achieving universal health insurance coverage in Iran.

Dear Editor, Universal health coverage (UHC) is considered a powerful mechanism for achieving better health, promoting human development, and enabling equitable access to health services for all. In this regard, the whole idea of UHC rests on provision of a full range of essential health services and financial risk protection for all the citizens of a country. Therefore, UHC is advocated as a mechanism to ensure health equity, that is, to ensure equal access to healthcare services for all the individuals. The United Nations' Sustainable Development Goals (SDGs) to be achieved by 2030 also advocates achieving UHC as an important milestone accomplished under larger health goal.