Evaluation of the combination of financing and providing services in social health insurance system in Iran

 Background and Objective: The aim of the present study was
assessment of the status of combination of financing and providing services in
Medical Service Insurance Organization (MSIO) as unique provider. Materials and Methods: Present study was an applied study
that was performed in a descriptive-analytical and statistical manner. The
research population consisted of all Medical Service Insurance Organization’s
(MSIO’s) insured and total services delivered to them. In this study, the time
comparison of correlation coefficient in estimation regression of exponential
function in two times 2005 and 2009 was used. Comparison of changes in
residuals distribution was used for determination of changes in province’s
situation. Finally, the Eviews econometrics software was used for estimation
regression. Results: This study showed that in provinces of country,
the effect of per capital care received by insured on per capital cost pay by
insurance organization significantly reduced from 0.25 in 2005 to 0.14 in 2009
(p < 0.05). Also, with regard to changes in relative situation of provinces in
these periods of time, 8 provinces have worse situation because did not tend to
combination of per capital cost and per capital refers as unique production and
in situation of 16 provinces did not take place noticeable changes. Conclusion: It seems that after about two decades from
policy of developing social health insurance (SHI) in Iran, the financing and
services delivery system through role of social health insurances could not be
able for making it possible to combine financing and services delivery as
unique production for insurers.