Factors Influencing Basic and Complementary Health Insurance Purchasing Decisions in Iran: Analysis of Data From a National Survey

Abstract

Expanding the coverage of health‐care insurance is a tool toward achieving universal health coverage and reducing financial barriers to care. Therefore, understanding the factors that affect the expansion of health insurance is important for policymakers. The study aimed at assessing the variables that affected the decisions to purchase health insurance in Iran. We analyzed data gathered from a national survey of health‐care utilization in Iran that covered over 23,000 households. We identified subsets of the data that represented purchasing decisions. Increase in age, education, income, wealth, and the opportunity of working in the governmental sector increased the probability of purchasing BHI and CHI coverage. Past utilization of inpatient and outpatient care increased the probability of purchasing BHI and CHI, respectively. Evidence of adverse selection and wide socioeconomic differences in insurance purchase decisions were observed throughout the study. However, most significant factors were not easily influenced by policy decisions. The findings suggest that it might be very difficult to achieve universal insurance coverage unless nation‐wide nonvoluntary policies are implemented.

Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

“…Our findings suggest that increase in family size, education level, income, past hospitalization and perceived poor health status were consistently correlated with higher WTP for insurance. Increased household income enables the households to purchase more health insurance and increase the demand for health insurance [ 39 ]. A previous study estimated that a 1% increase in national income might lead to a 0.9% increase in health spending after controlling for other factors [ 40 ].…”

Qualitative analysis of Iranian sixth five-year economic, social, and cultural development plan from universal health coverage perspective

“…To this end, vast investment in infrastructure and information technologies are needed to collect data or update available data. There is no penalties for not being enrolled in the basic health insurance schemes [ 15 ]. Other insurance arrangements provide the same benefit as a mandatory enrollment policy.…”

“…Iran has taken steps to tackle the issues of UHC in the past two decades; most requirements set by the 6NPD for the governmental agencies while being aligned with UHC sound right for the current time [ 15 ]. However, accomplishing UHC targets requires investment not only in providing access to health services through improved healthcare financing but also investment in health system strengthening [ 23 ] for improving effective coverage and equity [ 5 ].…”

Eliciting Preferences for Health Insurance in Iran Using Discrete Choice Experiment Analysis

“…This condition might have resulted from the influence of the individuals’ decisions in purchasing the health insurance benefit packages by several factors including the demographic, socioeconomic and past health services utilization. 14…”

“…4 In 2010, around 16% of the urban population did not have any health insurance coverage. 14 In April 2014, the health sector evolution plan of Iran introduced a health insurance scheme to remove the financial barriers of access to healthcare services. This plan provided health insurance coverage for people who have no health insurance coverage by the HIO through the government’s financial support.…”