Volume 8, Issue 1 (Jan-Mar 2019)                   2019, 8(1): 18-28 | Back to browse issues page

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Pakdaman M, Shafiei M, Geravandi S, Hejazi A, Abdi F. The Interaction between Insurance Organizations and Health System: The Insurance Mechanism based on Game Theory. Journal of Community Health Research 2019; 8 (1) :18-28
URL: http://jhr.ssu.ac.ir/article-1-509-en.html
1- Health Policy and Management Research Center, Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
2- Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
3- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
4- Department of Community Medicine , Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
5- Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd , Iran , farhadtl@hotmail.com
Abstract:   (4324 Views)
Introduction: In order to achieve the highest level of effective interaction between the insurance organizations and the health system, efforts should be made to identify existing communication challenges for policymakers and decision makers. The present study was conducted to identify interactive behaviors aimed at designing an insurance mechanism based on game theory to cover the existing gaps.
Methods: This study consisted of two phases of qualitative and quantitative. In the qualitative phase, data were collected and classified by a semi-structured interview with a number of insurance professionals in insurance organizations and the health system. In the quantitative phase of the study, interactive behaviors between the two organizations were studied. Finally, with the help of Gambit software, the insurance mechanism was designed.
Results: In the qualitative phase, the data were collected in three main categories: behavioral and communicative, structural and financial and deductibles and 11 sub-categories. In the quantitative phase, 35 optimal interactive behavioral strategies were delineated.
Conclusion: The best behavioral strategy for interaction between insurance organizations and health system, to fill gaps in insurance system and to improve the interaction between the two organizations, was introduced in the form of 35 strategies to provide an insurance mechanism.
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Review: Research | Subject: Public Health
Received: 2019/03/9 | Accepted: 2019/03/9 | Published: 2019/03/9

1. Semnani S, keshtkarr A. Assessing of equality on health care cost in Gorgan population laboratory study. Journal of Gorgan University of Medical Sciences. 2003; 5(2): 53-59. [Persian]
2. Ahmadi A, Taheri E. Factors affecting health expenditures of households in Iran: application of Ordered Probit model. Journal of Health Administration (JHA). 2017; 20(67): 89-97.
3. Maleki M, Ebrahimipour H, Karimi I, et al. Challenges of sustainable public insurance in Iran. Payesh. 2010; 9(2): 173-187.
4. Nasiriad N, Rashidian A, Joodaki H, et al. Assessing issues and problems in relatioship between basic insurance organizations and university hospitals: a qualitative research. Journal of Hospital. 2010; 9(1): 5-18.
5. Dehnaviyah R, Haji Zadeh M, Najafi B. A survey on the causes and rate of insurance deduction bills with Iranian medical services insurance organization on inpatients' bills in Hasheminejhad and Firoozgar hospitals. Special Scientific Journal of Health Services Universal Insurance. 2004; 25(7): 70-74.
6. Tavakoli N, Saghaeian-nejad S, Rezayatmand MR, et al. Documentation of medical records and insurance deductions imposed by health services Insurance. Health Information Management. 2006; 3(2): 53-61. [Persian]
7. Karimi S, Vesal S, Saieedfar S, et al. Evaluation of insurance deductions and suggested strategies on hospital bills Seyed alshohada. Health Information Management. 2011; 7: 590-604.
8. IRNA. Health insurance, the response to the need to take action sooner. Available at: URL: http://www.irna.ir/fa/NewsPrint.aspx?ID=81127820. Accessed March 13, 2019.
9. Insurance Institute. Quantitative and qualitative analysis of the coefficient of influence of the insurance industry of the country. Available at: URL: http://www.irc.ac.ir/news/upload/pen.pdf. Accessed March 13, 2019.
10. Ibrahimipour H, Maleki MR, Brown R, et al. A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran. Health Policy and Planning. 2011; 26(6): 485-495. [DOI:10.1093/heapol/czq084] [PMID]
11. Davari M, Haycox A, Walley T. Health care financing in iran; is privatization a good solution?. Iranian Journal of Public Health. 2012; 41(7):14-23. [PMID] [PMCID]
12. Bahrami MA, Vatankhah S, Tabibi SJ, et al. Designing a health system performance assessment model for Iran. Health Information Management. 2011; 8(3): 285-305.
13. Khedmatgozar M. Comparative analysis Right to terminate as one of the legal remedy violations of contractual obligations. Case Research Journal. 2008; 1(47): 183-204. [Persian]
14. Tabatabaei SS, Kalhor R. The prevalence and causes of insurance deductions in records bills. Homa-ye-Salamat Journal. 2006; 3(5): 21-23.
15. Tavakoli G, Mahdavi S, Shokrolah Zadeh M. The study of MSIO & SSO insurance companies deductions in Keraman Shafa Hospital in 2001. Imam Hossein University Press; 2002. [Persian] [PMCID]
16. Dehnavie R. Study of MSIO insurance companies deductions in Hasheminejad & Firuzgar Hospital in 2002. Special Issue of The Scientific Journal of Medical Services Insurance. 2004.
17. Abdolhak M. Health information of a strategic resource. USA: W.B Saunders Company; 2001. 18. Kesselheim AS, Brennan TA. Overbilling vs. downcoding-the battle between physicians and insurers. New England Journal of Medicine. 2005; 352(9): 855-857.
18. Hatam N, Askarian M, Pourmohammadi K. The implication of quality improvement module in using medical records and its effect on hospital income. Health Information Management. 2008; 5(2): 111-119. [Persian]
19. Saif Rabie MA, Sedighi I, Mazdeh M, et al. Evaluation of information registration in hospitals records of Hamadan university of medical sciences. Scientific Journal of Hamadan University of Medical Sciences. 2009; 16(2): 45-49. [Persian]
20. Purdom DT, Griffith RS, Weaver DL. A positive, systematic approach to improve inpatient medical record completion in a family practice residency program. Family Medicine. 1996; 28(6): 411-414. [PMID]

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