Effect of the Health Transformation Plan (HTP) on Implementation Processes, Rules and Regulations of Basic Health Insurance Organizations in Iran

Effect of the Health Transformation Plan (HTP) on Implementation Processes, Rules and Regulations of Basic Health Insurance Organizations in Iran Efat Mohamadi 1, Alireza Oliaeemanesh 1, 2 *, Reza Majd Zade 3, 4, 5, Mohamad Javad Kabir 6, Mojtaba Atri 7, Kamran Asghari 8, Mohammad Reza Mobini Zadeh9, Mosa Tabatabaei 10, Mani Yusefvand 11, Zahra Goudarzi 12 1 Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran 2 National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran 3 Center for Community Based Participatory Research Centre,  Tehran University of Medical Sciences, Tehran, Iran 4 Center for Knowledge Utilization Research Centre,  Tehran University of Medical Sciences, Tehran, Iran 5 Iran’s National Institute of Health Research, Tehran, Iran 6 Department of Health Services Management, Golestan University of Medical Sciences, Gorgan, Iran 7 Dana Insurance Company, Central Insurance, Tehran, Iran 8 Social Security Organization, Tehran, Iran 9 National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran 10 Deputy Treatment, Ministry of Health and Medical Education, Tehran, Iran 11 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 12 Department of Health Management and Economics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Abstract Introduction: From the first year of implementation, the Health Transformation Plan (HTP) has had many effects on the practice of health system actors. The present study was designed to investigate the effect of the HTP on the implementation processes, rules, and regulations of the basic health insurance organizations. Methods: This qualitative study was conducted using semi-structured interviews and document analysis. Data were analyzed using qualitative content analysis with an inductive approach. The interviews were analyzed using MAXQDA version 11 software. The research population consisted of experts and senior managers of the health insurance sector selected using purposive sampling. Results: Four topics and 11 themes were identified, including population coverage, service coverage, cost of services, process of arranging and manipulating documents, the process of paying claims, the impact of HTP packages, the interactions of insurance companies with the Ministry of Health and hospitals, rules and regulations, structures, and workload of insurance agencies. They all constituted 75 subthemes. Conclusions: The experience of implementing the HTP in Iran shows that primary access to healthcare services for all is an achievable goal for any middle-income country although there are always questions about their sustainability and quantity. Major reforms in the financing of plans need changes that require government investment and long-term commitment to overcome challenges. Keywords: Transformation Plan; Reform; Health System; Health Insurance   Please cite this article as follows: Mohamaadi E, Oliaeemanesh AR, Majdzade R , Kabir MJ, Atri M, Asghari K et al. Identification of the Impact of the Health Transformation Plan on processes, standards and regulations of the Basic Health Insurance Organizations in Iran. Hakim Health Sys Res 2019; 21(4): 255- 265. *Corresponding Author: Associate Professor, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9124117610, Email: [email protected]