the iranian health insurance system; past experiences, present challenges and future strategies

background: the iranian healthcare system is primarily an insurance based system. this structure has an important influence on the efficiency and equity of the provision of healthcare in iran. this paper reviews the history of the iranian healthcare system and the impact of the iranian health insurance system on healthcare performance based on the results of interviews with key opinion leaders and empirical evidence. methods: this review uses mixed methods: a systematic literature review of electronic databases supplemented by hand searching of books and journals including government publications and other grey literature. the issues identified were explored through a series of semi-structured interviews with key informants from within the iranian healthcare system. the interviews were recorded transcribed, coded, classified, and analysed thematically. empirical evidence was also sought to support or contradict the views expressed in the interviews. results: sixteen interviews with key informants were conducted and presented anonymously. the interviewees raised many issues which were summarised into five main issues: increasing health expenditures, lack of systematic health technology assessment, very limited financial resources, challenging management and regulation, and uncovered population. conclusion: a wide range of issues have affected the efficiency, quality and equity of the services provided by the iranian healthcare system. the initial and most important step toward improving the efficiency, equity and quality of the health insurance system is to focus on evidence-based policy making to generate feasible, reasonable and comprehensive reforms.