Key indicators for evaluating Iran's health insurance performance

Performance evaluation is a critical aspect of managing organizations, especially in the healthcare sector, where financial and resource management have direct implications on public health. The Iran Health Insurance Organization (IHIO), responsible for covering over half of the Iranian population, faces challenges due to rising healthcare costs and international sanctions. This study focuses on identifying performance evaluation indicators for the IHIO, aiming to provide a systematic framework to assess the organization's efficiency and accountability, aligning with the national health policies of Iran.

This study employed a multi-method approach, including content analysis, scoping review, and expert consensus, and was conducted in four phases: (1) content analysis of policies, (2) scoping review of the literature, (3) pooling and screening of indicators, and (4) development of indicator metadata. The content analysis involved examining legal documents and policies governing IHIO from 1994 to 2024. A scoping review was conducted using keywords related to health insurance evaluation, and 40 relevant studies were selected from international databases. The indicators were screened in three round through expert panels and the Delphi method, focusing on technical competence, feasibility, and coherence. The indicators were prioritized and detailed metadata profiles were created for each.

A total of 544 performance evaluation indicators were initially identified. After the first screening, 339 indicators were excluded, leaving 205 indicators classified into 12 thematic areas. Subsequent screening phases further refined this list to 78 indicators, of which 26 were ultimately prioritized based on their relevance to the IHIO's performance. Among these, the "Percentage of the Population Covered by the Health Insurance Organization" emerged as the highest-priority indicator, demonstrating exceptional technical competence and coherence. These findings underscore the critical role of transparent reporting and strategic resource management in improving performance and promoting equity in Iran's health insurance coverage.

The study successfully identified 26 key performance indicators for evaluating IHIO, highlighting the importance of insurance coverage and financial management. Strengthening collaboration with healthcare providers and improving transparency will enhance public trust and improve the organization's performance and productivity. The findings emphasize the need for strategic collaboration between IHIO and healthcare providers and suggest improving resource allocation and policy implementation for better healthcare outcomes in Iran.