BACKGROUND Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. METHODS A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. RESULTS This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. CONCLUSIONS Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.

中文翻译：

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在零散的背景下合并医疗保险资金：应考虑什么样的挑战？

背景技术伊朗议会于2010年通过了一项法律，以合并现有的健康保险计划，以促进风险共担。合并可能具有挑战性，因为健康保险计划在各个方面都存在差异。这项定性的前瞻性政策分析旨在揭示伊朗引入的该政策的主要挑战和实施障碍。方法对关键信息提供者进行定性研究并进行文献审查。进行了67次半结构化的面对面访谈，相关利益攸关方的主要信息提供者也进行了访谈。目的和雪球采样技术用于选择受访者。还审查和分析了相关政策文件，以补充访谈。数据分析是通过世界银行现有的卫生筹资框架进行的。结果这项研究表明，在合并健康保险基金时，应考虑以下领域的运营挑战：筹资机制，人口覆盖率，福利待遇，提供者参与度，组织结构，卫生服务提供和运营流程。在给定的背景下，有充分的充分理由来“合并过程的合理性”也很重要。在努力合并医疗保险基金时，尤其是在购买者与提供者分开的国家中，决策者必须确保医疗保险系统与更广泛的医疗保健系统的政策和管理保持一致。结论在卫生系统中实施重大改革时，针对目标人群不同的保险计划分散，预付款结构，福利待遇和发展历史本来就很难，特别是当不同的利益相关者对拟议的改革拥有否决权时。解决本研究中产生的健康保险体系主要领域的差异和运营挑战，可以为伊朗和其他情况类似的国家设计和实施社会健康保险计划的合并过程提供一个平台。