Document Type : Research articles


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

2 PhD Student in Health Care Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 PhD in Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional descriptive study conducted on the data collected from a private insurance company. The statistical population included all insured individuals covered by the insurer in 31 provinces throughout the country who have used the services provided in hospitals and other diagnostic centers from March 21, 2019 to September 21, 2019 (1,699,930 insured people), considered as the pre-covid-19 incidence period, and from March 20, 2020 to September 20, 2020 (1,862,657 insured people), as the post-covid-19 incidence period. Data were analyzed using the SPSS and GIS statistical software.
Results: In the 2019 half-year, 10,416,591 medical expense records have been filed in the country, which decreased by 17.1% in the same period in 2020 to 8,633,613 records. The average referral times in the pre-covid-19 period was 7.02, which decreased by 32.9% during the post-covid-19 period, falling to 4.71.
Conclusion: The overall frequency of referrals to receive all services covered by the insurer, including visits, medicine, hospital services (general surgeries), and laboratory services in the post-covid-19 period decreased significantly, compared to a similar period in the previous year. It seems that in many different provinces, non-emergency patients avoided referring to healthcare centers and unnecessary visits to medical centers. Moreover, the number of general surgeries decreased because of the therapists cautiousness and the changing behaviors of the patients, making diagnostic and medical services more real.


  1. WHO. WHO director-general’s opening remarks at the
  2. media briefing on COVID-19 – 11 March. 2020.
  3. Heydari M. COVID-19 in Iran. J Clin Nurs Midwifery. 2020;9(1):572-3.
  4. Babuna P, Yang X, Gyilbag A, Awudi DA, Ngmenbelle D, Bian D. The Impact of COVID-19 on the Insurance industry. Int J Environ Res Public Health. 2020;17(5766):1-14. doi: 10.3390/ijerph17165766. [PubMed: 32784978].
  5. OECD. Insurance sector responses to COVID-19 by governments, supervisors and industry, 2020.
  6. iCarbonX. Our Difference. 2021. en/about.html
  7. Pisoni G. Going digital: case study of an Italian insurance company. Journal of Business Strategy. 2021;42(2):106-15.
  8. Dodrill J. Emergency Order: COVID-19 Insurance
  9. Emergency, Government of West Virginia. 2020.
  10. FC Referencia: Instrucciones relacionadas con el fortalecimiento de la gestion del riesgo operacional ante los eventos derivados de la coyuntura de los mercados financieros y la situacion de emergencia sanitaria declarada por el Gobierno Nacional mediante Resolucion No. 385 de 12 de marzo de 2020, Superintendencia Financiera de Colombia: Circulares Externas. 2020.
  11. MAS. Financial Services Remain Open and Available, Monetary Authority of Singapore, 2020. media-releases/2020/financial-services-remain-open-and-available#:~:text=Singapore%2C%203%20April%202020%E2%80%A6,and%20payment%20services%20are%20unaffected.
  12. Manulife. Special measures in response to COVID-19.
  13. Hozarmoghadam N, Ghanbarzadeh M, Hamzeh A, Ghafoorboroojerdi M. Investigating the Effects of the Coronavirus Outbreak on Life, Health and Travel Insurance. Iran J Health Insur. 2020;3(3):148-61.
  14. Central Insurance Regulations of the Islamic Republic of Iran.
  15. Central Insurance of the Islamic Republic of Iran. Statistical Yearbook of Insurance Market, 2020. Tehran: Central Insurance of the Islamic Republic of Iran, 2021.
  16. Erica Cordova Z. COVID-19 Relief: States Begin Extending Insurance Premium Grace Periods One Digital, 2020.