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Recommendations to improve insurance coverage for physiotherapy services in Iran: a multi criteria decision-making approach

  • Shahabi, Saeed1
  • Skempes, Dimitrios2
  • Behzadifar, Masoud3
  • Tabrizi, Reza4, 4
  • Nazari, Behrooz5
  • Ghanbari, Mahboubeh Khaton5
  • Heydari, Seyed Taghi1
  • Zarei, Leila1
  • Lankarani, Kamran Bagheri1
  • 1 Shiraz University of Medical Sciences, Shiraz, Iran , Shiraz (Iran)
  • 2 Independent Researcher, Zofingen, Switzerland , Zofingen (Switzerland)
  • 3 Lorestan University of Medical Sciences, Khorramabad, Iran , Khorramabad (Iran)
  • 4 Fasa University of Medical Sciences, Fasa, Iran , Fasa (Iran)
  • 5 Iran University of Medical Sciences, Tehran, Iran , Tehran (Iran)
Published Article
Cost Effectiveness and Resource Allocation
BioMed Central
Publication Date
Dec 11, 2021
DOI: 10.1186/s12962-021-00333-0
Springer Nature
  • Research


BackgroundHigh toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and identified gaps in insurance coverage in order to inform future policy reforms and the design of a more comprehensive and universal benefits package for physiotherapy services in Iran.MethodsThis project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time.ResultsWithin the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g., informing policy-makers about physiotherapy services), collection of funds (e.g., placing value-added taxes on luxury goods and services), pooling of funds (e.g., moving allocated resources towards insurance (viz. third-party) mechanism), purchasing (e.g., using strategic purchasing), and benefit package (e.g., considering preventive interventions) as the main components of insurance coverage.ConclusionThe study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.

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