Financing of health services for undocumented immigrants in Iran: common challenges and potential solutions

Abstract

Introduction Iran is host to one of the largest urban refugee populations worldwide, about two million of whom are undocumented immigrants (UIs). UIs are not eligible to enroll in the Iranian health insurance scheme and have to pay out-of-pocket to access most health services. This increases the likelihood that they will delay or defer seeking care, or incur substantial costs if they do seek care, resulting in worse health outcomes. This study aims to improve understanding of the financial barriers that UIs face in utilizing health services and provide policy options to ensure financial protection to enhance progress towards UHC in Iran. Methods This qualitative study was conducted in 2022. A triangulation approach, including interviews with key informants and comparing them with other informative sources to find out the complementary findings, was applied to increase data confirmability. Both purposive and snowball sampling approaches were used to select seventeen participants. The data analysis process was done based on the thematic content analysis approach. Results The findings were explained under two main themes: the financial challenges in accessing health services and the policy solutions to remove these financial barriers, with 12 subthemes. High out-of-pocket payments, high service prices for UIs, fragmented financial support, limited funding capacity, not freeing all PHC services, fear of deportation, and delayed referral are some of the barriers that UIs face in accessing health care. UIs can get insurance coverage by using innovative ways to get money, like peer financing and regional health insurance, and by using tools that make it easier, like monthly premiums without policies that cover the whole family. Conclusion The formation of a health insurance program for UIs in the current Iranian health insurance mechanism can significantly reduce management costs and, at the same time, facilitate risk pooling. Strengthening the governance of health care financing for UIs in the form of network governance may accelerate the inclusion of UIs in the UHC agenda in Iran. Specifically, it is necessary to enhance the role of developed and rich regional and international countries in financing health services for UIs.

Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions

“…The findings of this review show that during Ebola and COVID-19, the response of health systems was not optimal to fill these gaps in LMICs. This was provoked by pre-existing inadequate funding for healthcare services, geographical inaccessibility, and higher disease burden that further impedes access to PHC for the general population [ 77 – 79 ], and creates huge constraints for displaced women and children in accessing MNCH care [ 42 ]. Other key aspects that were highlighted in the included studies, which are also essential for ensuring continuity of MNCH care for our target population, are cultural beliefs related to gender preferences for health workers, which influence healthcare-seeking behaviors among refugee populations in LMICs [ 47 , 55 , 77 , 78 ].…”

Opportunities and challenges for financing women’s, children’s and adolescents’ health in the context of climate change

“…Common financial challenges among refugees in humanitarian settings include high out-of-pocket payments, fragmented financial support and limited funding. 42 Sources of innovative humanitarian health financing for refugees and migrants, such as health insurance schemes, 42 multipurpose cash transfers 43 or remittances, are needed to strengthen adaptive capacity and resilience among households. 44 …”