مطالعه تطبیقی ساختار و محتوای بیمه درمان مکمل در چند کشورهای منتخب و ارائه الگویی برای ایران

Introduction: the boundaries of providing health services for patients is so much expanded that it is not, at least an economical cost-effective activity in the framework of the health insurances. In many countries the complementary health insurances have been used to provide these services. The aim of this study is to comparison between complementary health assurance structure and content in selected countries and presenting a paradigm for Iran. Methods: The present study is an applied descriptive study, has been done comparatively between 1383-1384(2003-2004). Parameters such as management and organizations, population coverage , the criteria to choose the insurance fees, services and their reimbursement payments methods, limitations and the obligations of the services supervision and evaluations in countries such as USA, Germany, Slovakia, Britain, Belgium, France , Finland, Philippine, Netherlands, and Iran has been chosen based on the Gordon Model. The chosen methods are based on Delphi techniques and by using the statistical tests were analyzed. Results: Our study results showed that the main reason of choosing the complementary insurance is the insufficient coverage of the public health insurance (89%). The High Council for Health selected as responsible authority for approving complementary health insurances(78%), also because of decentralized organizational structure of the delivery systems for the complementary health insurance ,and meanwhile centralized policy making and planning the complementary health insurances fees fixed based on actual services prices, given the competitive principle(78%). conclusion:Using insurances in terms of governmental and private complementary health insurance and creating the competition among them, could have an important role on improvement the health insurance quality, raising the level of customers' satisfactions, and finally improve the public health.