Systematic Analysis the Barriers to the Integration of Health Insurance in Iran Using the Dematel Approach

Background and Aim: Achieving public health coverage is a prerequisite for the sustainable development of countries, and this is highly dependent on patient financing in the form of health insurance. Therefore, improving the efficiency of health insurance through the consolidation of insurance funds is very important. The aim of this study was to structuring the barriers to the integration of health insurance in Iran using the Dematel approach. Methods: The Mixed study was done in three stages qualitative, Delphi technique and systematic analysis of barriers to health insurance integration in Iran on experts and specialists in health insurance (12 samples in the interview and 68 samples in the quantitative phase). The data collection tool in the "Qualitative Stage" was the interview guide, in the "Delphi Stage" was a questionnaire in the Likert, and in the "Systematic Analysis Stage" was a pairwise comparison questionnaire. Qualitative phase analysis was performed by conceptual framework method, Delphi stage using SPSS software and simple sample type test and weighting of factors using FUZZY DEMATEL technique and MATLAB software. Results: Out of 36 identified barriers to health insurance integration in Iran, 28 barriers have been accepted in the Delphi phase. Among the factors accepted in the Delphi phase, the highest average was related to "political behavior and resistance to accepting the integration of insurance" and the lowest average was related to "family physician and referral system". The results of systematic relation analysis showed that "obstructing the structure of the health system" with coordinates (1.30 and 1.30) as the most effective barrier and "preventing cultural-economic infrastructure" with coordinates (1.11 and -1.11) were identified as the most effected barrier. Conclusion: According to the results regarding the impact of financing and structural barriers, it is suggested that while performing accurate statistical and financial data calculations, the share of each insured group to accumulate funds be determined. Health and insurance policymakers need to anticipate sustainable financing. Also, to lay the foundation for the basic infrastructure of this system, in accordance with the conditions of the Ministry of Health and Social Insurance.