Abstract
INTRODUCTION: Iran is host to one of the world's largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection.
METHODS: This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees.
RESULTS: Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees.
CONCLUSIONS: A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.
| Original language | English |
|---|---|
| Article number | 94 |
| Pages (from-to) | 94 |
| Journal | Health Research Policy and Systems |
| Volume | 21 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 11 Sept 2023 |
Bibliographical note
Funding Information:Although the government of Iran has tried since 2015 by creating the refugee health insurance program to provide the necessary opportunity for the integration of refugee health financing in the national financing system and the combination of national and international funds [], it is necessary to use innovative approaches to strengthen the health financing of refugees. In this regard, creating a regional insurance mechanism for health financing for refugees would significantly escalate financial resources and facilitate service delivery. Such a mechanism can be created by the Organization of Islamic Cooperation (OIC) under the title “Islamic Fund for Refugee Health Financing” and financed by receiving contributions both from member countries and cash donations. The OIC, which is formed with the participation of 57 countries from four continents, can provide significant financial resources to provide health services to refugees in member countries, including Iran [, ]. There are several religious Muslim finance tools, such as zakat (giving a portion of one’s wealth to charity), waqf (assets held for charitable purposes) and sukuk (bonds), which can be considered as one of the fund’s financial sources []. Similar funds have been established in other regions of the world to help countries in crisis, such as the African Risk Capacity (created by the African Union) [] and the Caribbean Catastrophe Risk Insurance Facility (supported by the World Bank and other donors) []. The creation and development of such funds can facilitate resource pooling and provide the necessary capacity for pre-emergency financing, a paradigm shift that is always emphasized by studies in this field []. It is possible to transfer the risk of refugees from host countries to other institutions using such a strategy, so that the burden of financing refugee health services does not fall solely on host countries [].
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
Research Groups and Themes
- HEHP@Bristol
- NIHR ARC West
Keywords
- Humans
- Concept Formation
- Iran
- Policy
- Refugees
- Systems Analysis
