Document Type : Research articles
Authors
- Heshmatollah Asadi 1
- Mehdi Khakian 2
- Hossein Safari Palangi 3
- Fariba Hosseinpour 4
- Pirhossein Kolivand 1
- Khalil Alimohammadzadeh 5
- Maryam Azadi 6
1 Assistant Professor, Department of Health Economics, School of Medicine, Shahed University, Tehran, Iran
2 Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
3 Assistant Professor, Health promotion research center, Iran University of medical sciences, Tehran, Iran & School of Nursing and Midwifery, Qazvin university of medical sciences, Qazvin, Iran
4 Health Economics Policy Research Center, Islamic Azad University of Medical Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran
5 North Tehran Branch, Health Economics Policy Research Center, Islamic Azad University of Medical Sciences, Department of Health Services Management, Islamic Azad University, Tehran, Iran
6 National Center for Health Insurance Research, Tehran, Iran
Abstract
Background: Population has long been known as the most important pillar of governments and societies. However, in recent years, the rate of infertility is increasing rapidly due to various reasons.
Objectives: This study aimed to identify the factors and challenges affecting the implementation of insurance coverage program for infertility services in Iran for the policymakers and implementers of the program. Accordingly, the correct implementation of this program provides the possibility for infertile couples to benefit from the services of this program.
Methods: This qualitative study was conducted in 2022. Purposive sampling was used for selecting a total of 20 Iranian scientific and executive experts of health system with work experience, especially in the field of infertility. The interviews were conducted in a semi-structured manner and analyzed using the content analysis method and MAXQDA 2020 software.
Results: The results showed that the challenges of this program include 6 main themes along with 39 sub-themes. The main themes are challenges of upstream laws and legal requirements; provision of health services; human resources; the service package and its pricing; financial issues, budgets, and methods of service cost reimbursement; and information technology challenges.
Conclusion: Although the service package is defined and announced, the implementation of this plan faces many challenges due to not taking into account the implementation conditions and requirements. By examining the problems of infertility insurance coverage, the present study provides a comprehensive and practical picture of these problems. Accordingly, the factors that can make the program successful in the future consist of inclusion of a part of the services related to infertility treatment in the package of insurance services, the awareness of managers and policy makers about the challenges of implementing this program, providing financial, electronic, and human resources needed by the program, and development and modification of standards of the program.
Keywords
- Taheri M, Pajhan A, Mahmoodi M. Developmental approaches and demographic policies of governments in the Islamic Republic of Iran. Population Mag. 2020;113:247-75.
- Khorramshad MB, Tarrah Zadegan F, Rashed A. Demographic strategies for consolidation the national authority and security of the Islamic Republic of Iran. JNS. 2019;9(32):103-26.
- Maghsudpour MA. Factors affecting fertility decline in Iran from the viewpoint of economics (1986-2011). EJIP. 2015;5(6):83-100.
- Hoseini Mojarad A. Iranian population increase or decrease. Tehran: Supreme Council of the Cultural Revolution: 2015;3.
- Mohebbi SF, Mohammadzadeh KA. Systematic review of the etiology of the infertility on Iranian domestic published articles between 1999 and 2013. TMUJ. 2016;26(1):1-15.
- Wiltshire A, Ghidei L, Brayboy LM. Infertility and assisted reproductive technology outcomes in Afro-Caribbean
- women. J Assist Reprod Genet. 2020;37(7):1553-61. doi: 10.1007/s10815-020-01826-2. [PubMed: 32462416].
- Ledowsky C, Steel A, Schloss J. Methylenetetrahydrofolate Reductase (MTHFR) genetic polymorphisms and the risk of infertility in couples accessing Assisted Reproductive technologies: a systematic review. Adv Integr Med. 2021;8(3):220-9. doi: 10.1016/j.aimed.2021.05.004.
- Aramesh S, Diba E, Hassanzadeh S, Taghavi S. Prevalence of infertility in Boyer-Ahmad city based on SIB system in 2016-2018: a crosssectional study. YUMSJ. 2020;25(4):487-502.
- Akhondi MM, Kamali K, Ranjbar F, Shirzad M, Shafeghati S, Ardakani ZB, et al. Prevalence of primary infertility in Iran in 2010. Iran J Public Health. 2013;42(12):1398-404. [PubMed: 26060641].
- Mohammad K, Ardalan A. An overview of the epidemiology of primary infertility in Iran. J Reprod Infertil. 2009;10(3):213-6. [PubMed: 23926471].
- Darvishi A, Goudarzi R, Habib Zadeh V, Barouni M. Cost-benefit analysis of pharmaceutical treatments of infertility using willingness to pay approach. JSSU. 2018;26(3):245-56.
- Rostami Dovom M, Ramezani Tehrani F, Abedini M, Amirshekari G, Mehrabi Y. Prevalence of primary and secondary infertility among 18-49 years old Iranian women: a population-based study in four selected provinces. Hakim Res J. 2014;16(4):294-301.
- Torres-de la Roche LA, Devassy R, de Wilde MS, Cezar C, Krentel H, Korell M, et al. A new approach to avoid ovarian failure as well function-impairing adhesion formation in endometrioma infertility surgery. Arch Gynecol Obstet. 2020;301(5):1113-5. doi: 10.1007/s00404-020-05483-9. [PubMed: 32206876].
- Moradi G, Asadi H, Gouya MM, Nabavi M, Norouzinejad A, Karimi M, et al. The communicable diseases surveillance system in Iran: challenges and opportunities. Arch Iran Med. 2019;22(7):361-8. [PubMed: 31679378].
- Damari B, Vosough Moghaddam A, Rostami Gooran N, Kabir MJ. Evaluation of the urban family physician and referral system program in Fars and Mazandran provinces: history, achievements, challenges and solutions. SJSPH. 2016;14(2):17-38.
- Shirjang A, Mahfoozpour S, Masoudi Asl I, Doshmangir L. Challenges and strategies of implementation rural family physician in Iran: a qualitative study. DOH. 2020;11(1):62-73. doi: 10.34172/doh.2020.07.
- Doshmangir L, Rashidian A, Akbari SA. Unresolved issues in medical tariffs: challenges and respective solutions to improve tariff system in Iranian health sectors. J Hosp. 2011;10(4):32-9.
- Shaarbafchi-zadeh N, Azami S, Bastani P. Opportunities and challenges against cross border supply of health services in Iranian health sector: a qualitative approach. RJMS. 2012;19(100).
- Mehrolhassani MH, Jafari Sirizi M, Poorhoseini SS, Yazdi Feyzabadi V. The challenges of implementing family physician and rural insurance policies in Kerman province, Iran: a qualitative study. JHAD. 2012;1(3):193-206.
- Group ECW, Group ECW, Baird D, Barri P, Bhattacharya S, Devroey P, et al. Economic aspects of infertility care: a challenge for researchers and clinicians. Hum Reprod. 2015;30(10):2243-8. doi: 10.1093/humrep/dev163. [PubMed: 26141712].
- Roberts MJ, Hsiao W, Berman P, Reich MR. Getting health reform right: a guide to improving performance and equity. New York; 2008.
- Widge A, Cleland J. The public sector's role in infertility management in India. Health Policy Plan. 2009;24(2):108-15. doi: 10.1093/heapol/czn053. [PubMed: 19181675].
- Mir SA, Khosravi S, Bidkani MM, Khosravi AA. Expanding the health care in deprived areas in Iran: policies and challenges. J Mil Med. 2019;21(4):342-52.
- Yahyavi F, Nasiripour A A, Keikavoosi Arani L. Challenges of implementation of Iranian national hospital accreditation standards (3rd Edition 2016) for Tehran’s Islamic Azad University Hospitals. TMUJ. 2018;28(3):252-7.
- Ravaghi H, Rafiei S, Mohseni M, Heidarpour P, Arab M. Existing challenges in clinical governance establishment evaluation based on national assessors' aspect (a qualitative study). J Hosp. 2016;15(3):9-20.
- Jaafaripooyan E, Pourreza A, Kheirollahi F. Communication challenges between insurance companies and hospitals: an exploratory study in Tehran. SJSPH. 2017;15(3):225-38.
- Morshed-Behbahani B, Lamyian M, Joulaei H, Montazeri A. Analysis and exploration of infertility policies in Iran: a study protocol. Health Res Policy Sys. 2020;18(1):1-7. doi: 10.1186/s12961-019-0505-3.
- Akhavan Behbahani A, Alidoost S, Masoudi Asl I, Rahbari Bonab M. Investigating the performance of Iran’s health insurance organization and providing solutions for improvement: A mixed method study. Iran J Health Insur. 2018;1(3):88-96.
- Soltani A, Khajavi A, Heyrani A, Fakhr-Movahedi A. Challenges of clinical guidelines implementation from the perspective of clinical care providers at Gonabad university of medical sciences: a qualitative study content analysis. JHPM. 2022;11(3):40-53. doi: 10.22034/JHPM.11.3.40.
- Ebadifard Azar F, Rezapour A, Rahbar A, Abbasi Broujeni P. Receivables collection and turnover period in selected hospital of the Qom university of medical sciences from insurance companies (2005-2009). J Hosp. 2012;11(3):53-60.
- Nasiripour AA, Rahmani H, Radfar R, Najafbeigi R. Effective elements on e-health deployment in Iran. Afr J Bus Manage. 2012;6(16):5543-50. doi: 10.5897/AJBM11.2791.
- Naghipour M, Ahmadi M. Investigating E-health strategic planning and review of the challenges and obstacles in Iran. TMUJ. 2017;27(4):237-43.
- Rosenfeld DL, Garcia C-R, Bullock W, Schieffle S, Smith D, Casey M. An infertility data registry. J Fertil Steril. 1978;29(1):112-4. [PubMed: 563807].
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