Empowering the insured under health insurance: a case study in center of Iran

Abstract

Purpose

Currently, the health system is a treatment-oriented system focused on service providers. In this system, the main focus is on the health market, with little attention on insured. One way to get out of existing conditions is to empower the insured in order to involve them actively in maintaining and improving health. The paper aims to discuss these issues.

Design/methodology/approach

This qualitative study was done using the content analysis method. Based on the purposive sampling method and theoretical saturation criterion, 24 individuals including 12 health insurance experts and 12 insured participated in the study in 2018. The semi-structured interview method was used to collect data. Data were analyzed using MAXQDA10 software.

Findings

Having analyzed the interviews, 750 codes were obtained. These codes were categorized into two categories of “insurance experts” and “insured” and ten subcategories of “informing and educating, cost reduction, intersectional activities, expectations from the insured, services package, access to services, inability to pay costs, participation, and expectations from the insurance organization.”

Originality/value

This qualitative study was conducted to assess and determine the effective strategies for empowering the insured under health insurance. The results of this study are helpful to the health insurance organizations and health decision makers to detect the effective ways to develop the quality of insurance services, improve the status of insured, and increase access to health care goods and services.

Citation

Pakdaman, M., Geravandi, S., Hejazi, A., Salehi, M. and Davoodifar, M. (2019), "Empowering the insured under health insurance: a case study in center of Iran", International Journal of Human Rights in Healthcare, Vol. 12 No. 5, pp. 328-338. https://doi.org/10.1108/IJHRH-04-2019-0029