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Collecting financial resources

Insurance premium

• Imbalance between cost and income of insurance organizations

• Income arrears of insurance organizations regarding insurance premiums

• Unstable financial resources

• Challenges of collecting insurance premiums in a centralized and decentralized manner

• Creating a break-even point and balance between costs and expenses

• Creating stable financial resources for the country’s insurance system

• Realization of insurance premiums received

Direct Payment

•Reduction of financial protection following the increase of direct payments

• Severing the financial relationship between the patient and the provider by using the function of supplementary insurances

Subsidy and tax

• Government debts to insurance organizations

• Tax on harmful goods as part of the health sector’s financial resources

Accumulation

Accumulation of financial resources

•The low share of accumulation by insurances in the health financing system

• Creating more accumulation and creating cross-subsidy by consolidating funds

Purchase of service and allocation of financial resources

Service tariff and pricing

• Multi-tariff services

• Unreality of service prices and tariffs in the insurance system

• Unification and actualization of the tariff and price of services through the modification of the tariff process

Strategic purchase

•Defects in the correct execution of the strategic purchasing process

• Strengthening the role of insurance as a broker in the strategic purchase of services

• Separation of the service buyer from the provider

payment system

• Late payment of insurances to medical institutions

• Reforming the payment system

Debts of the insurance organization

• Indebtedness of insurance organizations to contracting party institutions

• Being the same buyer and service provider

• Management of costs to prevent waste of resources by the government

• Development and implementation of clinical guidelines and treatment protocols

Package of services covered by insurance

• Injustice caused by the variation in the service packages of different insurance organizations

• Review and improve the basic service package in the same way for all insurance organizations

Stratification, referral system and family physician

• Failure to comply with the referral system by the insured

• Reforming the system of providing and purchasing services with the system of referral, stratification and family physician

Population covered by insurance

•Overlap of the coverage population due to the lack of a comprehensive and integrated information bank of the insured

•Creating an integrated database system of the population covered by all insurance funds

Insurance contracts

• Insurance deductions based on contracts

• Paying attention to and respecting the rights and interests of the parties in insurance contracts