Criteria for Priority-setting in Iran Basic Health Insurance Package: Exploring the Perceptions of Health Insurance Experts

Background : Determining Services of Basic Health Insurance Package has been the big challenge of Insurance Organizations in Iran. These organizations have no choice to identify the proper criteria to formulate the insurance package services, given the limited resources. Objectives: This research is an attempt to tackle this issue by determining the necessary criteria and their importance for defining Basic Healthcare Insurance Package in Iran. Methods and material: This is a qualitative, descriptive and cross sectional study which has been conducted in 2010. This study has been carried out in two steps. In the first step, a sample of 20 professionals was selected. A sample of professionals was selected using purposeful and snowball based methods, who were then individually interviewed. The whole interviews were digitally recorded, and were transcribed and analyzed later to obtain the criteria. In the second step, a questionnaire was sent to experts from the six organizations involved with health insurance. Purposeful and Snowball sampling techniques were used to identify 52 health insurance experts. The SPSS software was used to analyze the collected data. Results: Practicability, stockholders and politicians' perspectives, cost of interventions and belonged to the vulnerable group criteria are playing a major role in the provided package of health care services by health insurance organizations in Iran in the current situation. Cost-effectiveness, effectiveness, quality of evidence and equity of access are the most important criteria in the ideal situation. Conclusion: There is a big difference between the criteria which have been used to set the priority in the current situation with what it should be in the criteria in the ideal situation in Iran. Given the differences in the role of priority setting for the current and ideal situation, it is necessary to apply a policy that can reduce the present gap.