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Governance-structure

Mission and existential philosophy

• Misunderstanding of some managers and policymakers about the function and principles of insurance

• Creating a holistic and health-oriented attitude and coverage of preventive level services in the insurance system

•Prioritizing health as one of the basic priorities of governments

• The need to change the paradigm, mission and paradigm shift in the insurance system

Structure

• Lack of stability in the structure and stewardship of the health insurance system

• The multiplicity of insurance funds

• Traditional and non-flexible structures

• Reviewing the organizational structure of health insurance and creating a stable and independent structure from the ministerial structure

• Consolidation of insurance funds and unification of insurance policies

• Agility of the structure of the insurance system by decentralizing the duties of the governing bodies

Governance-legislation

Regulatory mechanisms such as rules and regulations

• Failure to fully implement insurance guidelines and laws by insurance organizations

• Lack of transparency of the rules of insurance organizations

• Lack of commitment of governance and administration to implement laws

• Establishing the requirement for the full implementation of the law of general insurance of medical services of the country by all insurance organizations

Monitoring and evaluation

• Weak monitoring of the performance of service providers by governing bodies

• Using the insurance system as a cost control tool

Punitive and incentive mechanisms

• Moral hazard and induced demand

• Applying a cap on the receipt of high-use medical services in order to control and correct the consumption pattern

Interdepartmental leadership and coordination

Determining positions

• Conflict of interests due to the multiple roles of the actors

• Collusion and lobbying

• Separation of political games from the country’s insurance system

• Transparency in the duties of actors with multiple roles

Intersectional communication and cooperation

• Lack of coordination, cooperation and constructive interaction between the ecosystem actors of organizations in order to establish effective communication

• Improving relations and cooperation and creating alignment in interests

• Strengthening the Insurance Coordinating Council in order to expand cooperation and alignment

Human resources

• Non-compliance with professional ethics by some service providers

• Appointment of specialist and specialist doctors in management positions

• Empowering presenters regarding the principles of professional ethics

• Empowering doctors regarding management principles and techniques

Policy making

Rational decision making

• The sectional and personal decision-making

• The narrow vision of the Ministry of Health in the stewardship of the health system as an obstacle to macro and intersectoral decisions

• Failure to use scientific and research results and evidence in executive and policy-making actions

• Avoiding hasty decision-making and using decision-making and policy-making based on collective wisdom and scientific evidence

• Establishing a monitoring and data mining system in the insurance system

• Conducting scientific and comparative studies in the field of insurance to produce evidence

Information Resources

•The existence of multiple and separate information systems

• The resistance of service providers against electronicization of the insurance system and

• Weakness in electronics infrastructure

• Lack of transparency in the executive processes of electronicization and systems

• Application of hospital deductions due to users’ unfamiliarity with the relevant systems

• Implementation of the electronic prescribing plan completely

•Unification and integration of information systems

• Improvement of information technology infrastructure

• Creating an online database and collecting information from insurance organizations

• Defining rules in the systems to prevent errors and violations and create transparency

• Forming an electronic health record