Assessing progress in the national health financing system towards universal health coverage in Iran: a mixed-method study protocol

Is mobile renewal enough? A qualitative study exploring stakeholders' perspectives on mobile phone-based add-ons for national health insurance uptake in Ghana

BACKGROUND

The Mobile Renewal System (MRS) has increased insurance renewal rates among Ghana's National Health Insurance Scheme (NHIS) subscribers. However, population coverage with active NHIS membership remains insufficient for Universal Health Coverage (UHC) ambitions, especially among informal workers. This qualitative study aimed to explore stakeholders'(technical experts and informal workers) perspectives on the implementation and use of mobile renewal system (MRS) add-on(s) to improve NHIS uptake in Ghana.

METHODS

Technical experts were interviewed in depth based on their experience and ability to provide information on developing and implementing mobile health technology, and 17 focus group discussions were held with informal workers in Accra and Kumasi between March and August 2022. Thematic analysis was used to identify recurring themes and categories.

RESULTS

Participants (13 technical experts and 96 informal workers) suggested several add-ons to improve the use of the MRS. These included reminders to renew, mobile registration of new members, an automatic renewal option, a savings wallet, and a facility locator. These add-ons could potentially encourage more people to use the MRS and further increase insurance uptake. For implementing and utilizing the MRS and these add-ons, reliable technological infrastructure, stakeholder involvement, adequate funding, training, and awareness campaigns were considered crucial. Barriers to using MRS and add-ons may arise from concerns regarding data protection, transparency, and potential taxes on digital transactions resulting in additional costs. In addition, individual factors such as experience with mobile phone transactions and knowledge about insurance influenced participants' willingness to use the MRS and the suggested add-ons.

CONCLUSION

Different mobile phone-based technologies can potentially increase NHIS coverage in Ghana. Implementation should address insurance literacy and build communities' trust in mobile technology.

Challenges and Weaknesses of Leadership and Governance-related Health Policies in Iran: A Systematic Review

BACKGROUND

A better understanding of health system performance requires evaluating achievements and challenges, thereby providing a basis for effective reforms. This systematic review aims to investigate the challenges and weaknesses of leadership and governance-related health policies in Iran.

METHODS

In this qualitative systematic review, we followed the instructions of the Joanna Briggs Institute (JBI). It encompassed qualitative studies assessing challenges and weaknesses of leadership and governance-related health policies. Thematic synthesis was conducted in three stages to identify common themes.

RESULTS

The primary database search yielded 1890 records, of which 152 were fully assessed, resulting in the inclusion of 57 studies in this review. Thematic synthesis produced 157 structured codes and identified 11 main descriptive themes of challenges in leadership and governance-related health policies. These themes included hospital autonomy policy, challenges to the entire health system, governance of medical universities, healthcare payment systems, sustainable universal health insurance coverage, informal payments, insurance systems, induced demand, strategic purchasing of health services, the family physician program, family physician and rural health insurance programs, and primary healthcare human resources.

CONCLUSION

The identified challenges underscore the urgent need for strategic reforms and interventions to overcome the complex issues plaguing the healthcare system. By addressing these challenges, policymakers and top healthcare managers might ensure that the population have access to high-quality care in a more responsive healthcare system.

User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran

Introduction

Removal of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran.

Methods

This is a qualitative study carried out in 2018. The purposive sampling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software.

Results

The most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms.

Conclusion

Implementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization.