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Table 2 Health Care Services Purchasing challenges of Iranian Insurance Companies

From: Qualitative analysis of national documents on health care services and pharmaceuticals` purchasing challenges: evidence from Iran

Themes Sub Themes
Policy making Challenges External and political forces on insurers for contracting with providers
ambiguities in strategic purchase policies
lack of regulations, evaluation instructions and ranking providers of services
Lack of purposefulness of subsidies for purchasing agencies
lower per capita income in those under medical services coverage
High rate of out of pocket because of low coverage of services
great number of households facing catastrophic costs especially in outpatient services
Executive Challenges lack of effective referral system based on family physician in the whole country
different prices for the same service by insurance organizations
heterogeneous distribution of medical experts in different parts of the country
lack of realization of universal health coverage
lack of exclusive use of power of purchase (use of inactive purchase).
Intersectional Challenges Low level of relations between insurance organizations and scientific& expert associations
lack of competition among insurance organizations
lack of clarity in the relationships among producers of health services, providers, policy-makers, supervisor and purchaser of services in the country
the existence of supplementary insurances which buy basic services several times that of the original price
Natural Challenges The existence of high induced demand in outpatient and drug sections
Existence of spiral of death because of adverse selection outbreak
Radar syndrome because of the lack of continuity in offering services level
Cream scheming in some insurance companies
Legal Challenges Lack of an exact and scientific basis in assessing insurance rights and tariffs
The high range of inpatient in patient costs
Persist on implementing the governmental model of family physician and referral system
lack of regulations and instructions of health care delivery
Informational Challenges lack of a comprehensive information bank
lack of sufficient familiarity with successful health systems experiences in strategic purchase of health services