Key indicators for evaluating Iran's health insurance performance

Area of Science:

• Health Policy and Management
• Healthcare Financing
• Public Health Administration

Background:

• Organizational performance evaluation is crucial in healthcare, impacting public health.
• Iran Health Insurance Organization (IHIO) faces challenges from rising costs and sanctions.
• This study aims to develop performance indicators for IHIO to enhance efficiency and accountability.

Purpose of the Study:

• To identify and prioritize key performance indicators (KPIs) for the Iran Health Insurance Organization (IHIO).
• To establish a systematic framework for assessing IHIO's efficiency, accountability, and alignment with national health policies.

Main Methods:

• A multi-method approach combining content analysis, scoping review, and expert consensus (Delphi method).
• Analysis of IHIO policies (1994-2024) and a scoping review of 40 international studies on health insurance evaluation.
• Three screening rounds and expert panels refined indicators based on technical competence, feasibility, and coherence.

Main Results:

• Initially 544 indicators were identified, refined to 205, then 78, and finally prioritized to 26 KPIs.
• The highest-priority indicator is 'Percentage of the Population Covered by the Health Insurance Organization'.
• Results highlight the importance of transparent reporting and strategic resource management for health insurance performance.

Conclusions:

• 26 key performance indicators were identified for evaluating IHIO, emphasizing insurance coverage and financial management.
• Enhanced collaboration with healthcare providers and improved transparency are vital for organizational performance.
• Strategic resource allocation and policy implementation are recommended for better healthcare outcomes in Iran.