Developing Criteria for Complementary Health Insurance (CHI) Benefit Packages for a Medical Service Insurance Organization in Iran: A Qualitative Content Analysis

Document Type : Original Article


1 Department of Health Services Management, School of Health, Baqiyatallah University of Medical Sciences (BUMS), Tehran, Iran

2 Ophthalmologist, Chairman of Iran Health Insurance Organization, Tehran, Iran

3 AJA University of Medical Sciences, Tehran, Iran

4 Department of Health Economics, Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran

5 Department of Management, IRI Police University, Tehran, Iran

6 Health Management Research Center, School of Health, Baqiyatallah University of Medical Sciences (BUMS), Tehran, Iran


Introduction: Development of Complementary Health Insurance (CHI) benefit packages has always been one of the main challenges of Health Insurance Organizations in Iran. Records related to developing a health insurance package in Iran show that there is no specific criterion for developing such packages.  This study aimed at developing criteria for providing CHI benefit packages presented by the Medical Service Insurance Organization in Iran.

Methods: The current research is a qualitative and applied research which has been conducted in 2014. The sample size included 24 authorities in the domain of CHI, and a semi-structured interview was used for collecting data. Data analysis was based on framework method applying Atlas-Ti 5.2 software.

Results: Nineteen main themes and 53 sub-themes and finally 20 criteria were identified for four main dimensions of the benefit package including the insured, commitments of insurance services, financial resources and Medical Service Insurance Organization special priorities.

Conclusion: In this study, various criteria were identified for developing CHI. It seems that applying important criteria such as equity, clinical guidelines, effectiveness, and efficiency of CHI benefit package presented by Medical Service Insurance Organization can decrease the shortcomings of the current system and using standardization can lead to targeting the service benefit package, removing its defects and improving the health of insured people. 


1.   Dehnavieh R, Tabibi SJ, Maleki M, Rashidian A, Noorihekmat S. Information Criteria for Basic Health Insurance Package in  Iran from Health Insurance Organizations View. Health Info Manag. 2010;7(2):109-18. Persian
2.   Williams A. Priority setting in public and private health care: a guide through the ideological jungle. J Health Econ. 1988;7(2):173-83.
3.   Bobadilla JL. Searching for essential health services in low-and middle-income countries: a review of recent studies on health priorities Washington DC: Inter-American Development Bank; 1998. Available from:
4.   Ham C, Coulter A. The Global Challenge of Health Care Rationing. International Experience of Rationing (or priority setting). Philadelphia: Open University Press. 2000: 1-12. Buckingham.
5.   Segal L, Chen Y. Priority Setting Models for Health: The Role for Priority Setting and  A critique of alternative models A Summary. Report to the Population Health Division (Working Paper 119). Centre for Health Program Evaluation (CHPE). 2001. English. Retrieved from
6.   Tourani S, Maleki MR., Hadian M, Amiresmaili MR. Survey on present status of health services priority setting in Iran. Payesh. 2011;10(2):217-30. Persian
7.   Ministry of Labour and Social Affair IRoI. Health care system 2014. Persian. Available from:
8.   Central Bank of Islamic Republic of Iran.  Selected Economic Indicators       2015. Persian. Retrieved from
9.   Davari M, Haycox A, Walley T. The Iranian health insurance system; past experiences, present challenges and future strategies. Iran J Public Health. 2012;41(9):1-9.
10. Zare H. A brief introduction to complementary health insurance. Public Health Insurance Journal. 2001;19(5):20-33. Persian
11. Hassanzadeh A. Proceeding of 27th ‎International Social Security Association General Assembly (ISSA). Tehran: Scientific and Cultural publisher. 2002:144-3. Persian
12. Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 2. Priority setting. Health Res Policy Syst. 2006;4(14).
13. Saltman RB, Figueras J. European healthcare reforms; Analysis of current strategies WHO Regional Publications,European Series. 1997;72. Summary Retrieved from
14. Abel-Smith BFJ, Holland W, Mckee M, Mossialos E. Choices in health policy; an agenda for European union. 1st Edition. Dartmouth Publisher Company: Aldershot, 1997.
15. New B, King Edward's Hospital Fund for London. Rationing talk and action in health care. 1s t Edition. King's Fund and BMJ Publishing: London, 1997.
16. Hauck KSP, Goddard M. The Economics of Priority Setting for Health Care:  A Literature Review  (Health, Nutrition and Population (HNP) Discussion Paper). Washington, DC: World Bank. 2004. Retrieved from
17. Kapiriri L, Norheim OF. Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values. Bull World Health Organ. 2004;82(3):172-9.
18. Wellington, New Zealand: 5th International Conference on Priorities in Health Care; 2004. The role of Health Related Quality Of Life (HRQL) measurement in setting priorities in the Iranian health care system; p. 1-142.
19. Kapiriri L, Norheim OF, Heggenhougen K. Using the burden of disease information for health planning in developing countries: the experience from Uganda. Social Sci Medi. 2003;56(12):2433-41.
20. Kapiriri L, Martin DK. A strategy to improve priority setting in developing countries. Health Care Analysis. 2008;15(3):159-67.
21. Danesh-Dehkordi N. Health universal coverage from law perspective. Health Insurance Organization(Scientific and Cultural Publication). 2004, Tehran: Medical Service Insurance Organization. Persian
22. Sasannejhad AH. Complete set of  rules and regulations of the NHS. Tehran: Medical Service Insurance Organization. 1996. Persian
23. Hossein Z. Health systems in the world. 1st Edition. Health insurance organization: Tehran, 2004. Persian
24. Wong H, Bitran R, Shepard D, Thompson M. Designing a benefits package: cost- effectiveness analysis in health(Prepared for the Flagship Course on Health Sector Reform and Sustainable Financing World Bank Institute). World Bank Institute (WBI). 1999; First principles. English. Retrieved from
25. Lai-Kow Chan, Wu ML. Quality Function Deployment in Services: A literature review. Eur J Oper Res. 2002;143(3):463-97.    
26. Mohebifar R, Tabibi S, Asefzadeh S. Design of Disaster Management Structure Pattern for Iran.   Health Manag J. 2008;11(33):47-56. Persian
27. Schreyögg J, Stargardt T, Velasco-Garrido M, Busse R. Defining the “Health Benefit Basket” in nine European countries. Eur J Health Econ. 2005;6(1):2-10.
28. Lacey A LD. Trent focus for research and development in primary health care:  to qualitative analysis. Unpublished manuscript: Trent Focus, Nottingham. 2001.
29. Pope C ZS, Mays N. Qualitative research in health care: analysing qualitative data. British Medical Journal (BMJ). 2000;320(7227):114-6. Retrieved from
30. Bryman A, & Burgess, R. G. Burgess RG. Analyzing Qualitative Data. Routledge, 1994.
31. Rosen S, Sanne I. Rationing Antiretroviral Therapy for HIV/AIDS in Africa: Choices and consequences. PLoS Med. 2005;2(11):303.
32. Lammintakanen J. Health care prioritization, Evolution of the Concept, Research and policy process faculty of social sciences of the university of Kuopio. Department of health policy and management. 2005. University of Kuopio, Faculty of Social Sciences, Finland, 2005.
33. Greß S, Niebuhr D, Rothgang H, Wasem J. Criteria and procedures for determining benefit packages in health care: A comparative perspective. Health Policy. 2005;73(1):78-91.  
34. Leggat S. Developing a clinical priority setting framework, 1st ed Melbourne : South Australian Department of Health. Adelaide and La Trobe University, school of public health. 2004. English. Retrieved from
35. Makundi E, Kapiriri L, Norheim OF. Combination evidence and values in priority setting: testing the balance sheet method in a low-income country. BMC Health Serv Res. 2007;7(1):152.
36. Tourani S, Maleki MR, Hadian M, Amiresmaili MR. An interview survey on health priority setting practice in Iran. Res J Biol Sci. 2009;4(11):1193-201. Persian
37. Kabir MJ, SoudabehVatankhah BD, Ravaghei H, Jafari N, Heidari A, Behnampour N, et al. Determinant Criteria for Designing Health Benefit Package in Selected Countries. Life Sci J. 2013;10(3):1392-403.
38. Wiseman V MG, Berry G, Tang K. Involving the general public in priority setting: Experiences from Australia. Social Sci Med. 2003;56(5):1001-12.