Document Type : Review articles


1 Professor of Health Policy, Management and Economics, Tehran University of Medical Sciences, Tehran, Iran

2 Ph.D. Student in Health Care Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Ph.D. in Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


Context: Insurance plays a significant role in health systems financing. The existence of multiple risks increases the costs of insurance organizations. The present study aimed to identify cost management strategies in health insurance.
Evidence Acquisition: A scoping review was conducted by focusing on published Persian and English studies in the field of health insurance worldwide by the end of June 2020. Valid keywords were searched in PubMed, Scopus, Web of Science, SID, Magiran, Google, and Google scholar. A list of authoritative sources and journals was also assessed. A total of 51 articles met the inclusion criteria and were analyzed using MAXQDA software.
Results: In total, 97 cost management strategies were identified and classified into 3 groups of providers, insured individuals, and insurance organizations. The most important cost management strategies in the field of insurance internal processes are modifying payment methods and monitoring provided services and prescribed medications to providers, cost sharing, deductible, consumption management, and cultivating the use of services by insured people, strategic purchasing, coverage constraints, internal controls, using risk management and employing specialized personnel. Also, other insurance supervision institutions significantly reduce costs.
Conclusion: Policymakers and managers plan and apply corrective interventions and appropriate changes to reduce the costs of insurance companies by understanding the cost control strategies of health insurance.


  1. Ke X, Saksena P, Holly A. The determinants of health expenditure: a country-level panel data analysis. Geneva: WHO. 2011;26:1-28.
  2. Mosadeghrad AM. Essentials of healthcare organization and management. Tehran: Dibagran Tehran; 2015.
  3. Kolasa K, Kowalczyk M. Does cost-sharing do more harm or more good? a systematic literature review. BMC Public Health. 2016;16(1):1-14. doi: 10.1186/s12889-016-3624-6. [PubMed: 27633253].
  4. Fazaeli AA. A financial contribution of Iranian Urban Households in the Health System (2004-2016): With an emphasis on the health transformation plan. J Educ Community Health. 2017;4(1):43-50. doi:10.21859/jech.4.1.43.
  5. World Health Organization. (‎2010)‎. World health statistics 2010. World Health Organization. iris/handle/10665/44292
  6. Sekhri N, Savedoff W. Private health insurance: implications for developing countries. Bull World Health Organ. 2005;83(2):127-34. [PubMed: 15744405].
  7. Anderson M, Dobkin C, Gross T. The effect of health insurance coverage on the use of medical services. Am Econ J Econ Policy. 2012;4(1):1-27. doi: 10.1257/pol.4.1.1.
  8. Buchmueller TC, Grumbach K, Kronick R, Kahn JG. Book review: The effect of health insurance on medical care utilization and implications for insurance expansion: A review of the literature. Med Care Res Rev. 2005;62(1):3-30. doi: 10.1177/1077558704271718. [PubMed: 15643027].
  9. Card D, Dobkin C, Maestas N. The impact of nearly universal insurance coverage on health care utilization: evidence from Medicare. Am Econ Rev. 2008;98(5):2242-58. doi: 10.1257/aer.98.5.2242. [PubMed: 19079738].
  10. Mahdavi Gh, Daghighi Asli A, Niyakan L, Ansari AR, Abbasi E, Haghighi Kafash M, et al. Comprehensive handbook of insurance education: principles and basics. Tehran: Central Insurance of the Islamic Republic of Iran, Insurance Research Center (IRC). 2016. [Book in Persian].
  11. Zweifel P, Manning WG. Moral hazard and consumer incentives in health care. In Handbook of Health Economics; 2000.
  12. Popescu GH. Economic aspects influencing the rising costs of health care in the United States. Am J Clin Med Res. 2014;1(1):47-52.
  13. Lorenzoni L, Belloni A, Sassi F. Health-care expenditure
  14. and health policy in the USA versus other high-spending
  15. OECD countries. Lancet. 2014;384(9937):83-92. doi: 10.1016/S0140-6736(14)60571-7. [PubMed: 24993914].
  16. Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 2014;384(9937):45-52. doi: 10.1016/S0140-6736(14)60648-6. [PubMed: 24996589].
  17. Bodenheimer T, Fernandez A. High, and rising health care costs. Part 4: can costs be controlled while preserving quality? Ann Intern Med. 2005;143(1):26-31. doi: 10.7326/0003-4819-143-1-200507050-00007. [PubMed: 15998752].
  18. Delnoij D, Van Merode G, Paulus A, Groenewegen P. Does general practitioner gatekeeping curb healthcare expenditure? J Health Serv Res Policy. 2000;5(1):22-6.
  19. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32. doi: 10.1177/135581960000500107.
  20. Mosadeghrad AM, Rahimi-Tabar P Health system governance in Iran: A comparative study. Razi RJMS. 2019;26(9):10-28.
  21. Mazloumi N, Haghighi Kafash M, Khashei V, Nateghi AA. The model of strategic management risks in the Iranian
  22. insurance industry. J Bus Strategy. 2018;25(12):42-125. doi: 10.22070/CS.2019.15.12.125.
  23. Riyahifar M. Designing a health insurance risk management model for Iran. Iranian Journal of Insurance Research. 2006;55: 84-119.
  24. Ghasemi M, Banisi P, Yadegari F. Presenting a model in the field of risk management training in the insurance industry. Iran J Educ Sociol. 2017;1(5):37-50.
  25. Dehghani A, Shahryar B. A proposed pattern of enterprise risk management in insurance companies. IJIR. 2017;7(1):1-22. doi: 10.22056/jir.2018.46035.1689.
  26. Campbell PC, Korie PC, Nnaji FC. Risk management assessment of health maintenance organizations participating in the National Health Insurance Scheme. Niger Med J. 2014;
  27. (5):399-405. doi: 10.4103/0300-1652.140380. [PubMed: 25298605].
  28. Kamali Khaneghah R. The effect of integrating risk management on corporate strategies and governance (a case study in Pasargad insurance company). Shabak. 2019; 5:10 (49): 167-76.
  29. Barati M, Azami F, Nagdi B, Foladi M, Hajimaghsoudi M, Asadi SA. Moral hazards in providing health services: a review of studies. Evid Based Health Policy Manag Econ. 2018;2(1):61-9.
  30. Johnson ME, Nagarur N. Multi-stage methodology to detect health insurance claim fraud. Health Care Manag
  31. Sci. 2016;19(3):249-60. doi: 10.1007/s10729-015-9317-3. [PubMed: 25600704].
  32. Keyvanara M, Karimi S, Khorasani E, jafarian JM. Opinions of health system experts about main causes of induced demand: a qualitative study. Hakim Res J. 2014;16(4):317-28.
  33. Keyvanara M, Karimi S, Khorasani E, Jafarian Jazi M. Are Health Institutions Involved in Health Care Induced Demand? (A Qualitative Study). J Payavard Salamat. 2014;8(4):280-293.
  34. Cronin CJ. Insurance‐induced Moral Hazard: a dynamic model of within‐year medical care decision making under uncertainty. Int Econ Rev. 2019;60(1):187-218. doi: 10.1111/iere.12349.
  35. Mosadeghrad AM, Esfahani P. Unnecessary length of stay of patients in Iranian hospitals: a systematic review and meta-analysis. Jundishapur Sci Med J. 2018;17(5):529-44.
  36. Greenberg W. Insurance, competition and cost containment. Soc Sci Med. 1982;16(7):805-10. doi: 10.1016/0277-9536(82)90233-7. [PubMed: 7201677].
  37. Riaziat A, Rahmani K, Farshid A, Rezayatmand R. The most costly pharmaceutical services of the health insurance organization and cost control solutions. Iran J Health Insur. 2019;2(2):63-9.
  38. Pan X, Dib HH, Zhu M, Zhang Y, Fan Y. Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study. Health Econ. 2009;18(10):1146-62. doi: 10.1002/hec.1421. [PubMed: 18972328].
  39. Frumkin RN. Health insurance trends in cost control and coverage. Monthly Lab Rev. 1986;109:3.
  40. Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A. Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev. 1987;77(3):251-77. [PubMed: 10284091].
  41. Weinstein MC, Siegel JE, Garber AM, Lipscomb J, Luce BR, Manning Jr WG, et al. Productivity costs, time costs and health‐related quality of life: a response to the Erasmus Group. Health Econ. 1997;6(5):505-10. doi: 10.1002/(sici)1099-1050(199709)6:5<505::aid-hec294>;2-i. [PubMed: 9353651].
  42. Abtahi AR, Rashnavadi Y, Ghadimi R. Designing a supplemental health insurance plan and analyzing the related risk factors faced by insurance companies. IJIR. 2019;33(4):21-42. doi: 10.22056/jir.2019.86014
  43. WHO. The world health report 2000: health systems: improving performance. World Health Organization; 2000.
  44. Collins SR, Nuzum R, Rustgi SD, Mika S, Schoen C, Davis K. How health care reform can lower the costs of insurance administration. Issue Brief (Commonw Fund). 2009;61:1-19. [PubMed: 19618542].
  45. OECD (Organization for Economic Co-operation and Development). Insurance Solvency Supervision: OECD Country Profiles, OECD Publishing, Paris. 2002. doi: 10.1787/9789264196230-en