Table 2 The main themes and sub-themes of legal and policy requirements of basic health insurance package from 1994 to 2017

Third party insurer requirements

Financing insurance package

Increasing the health share from GDP

Providing sustainable financial resources

Management of resources

Financing the healthcare insurance

Adaptation of measurements for reimbursement

Allocation of 10% of car insurance premiums for accident injuries

Organizational structure

Integrating all medical funds to the Medical Services Insurance

Establishing a High Council of Health Insurance

Defining the country’s medical treatment system

Making comprehensive healthcare system based on referral system

Tariffing the service package

Using actual prices and approved per capita rate for health care

Setting yearly tariff of services by High Council of Health Insurance

Developing healthcare services and tariffs based on evidences

Integration of policies and precedents

Organizing integrated health insurance services based on IT and EHR

Establishment of Iranian insurance database and elimination of overlap

Providing principles for contracting, behaving and monitoring insurers

The same instructions to examine medical claims

Entering new services to approve practical guidelines by MOH

Purchasing the benefit packages

Strategic purchasing of health services from all sectors by HIO

Purchasing comprehensive basic and supplementary health services

Requiring evaluation of health technologies for health interventions

Performance of quality-based payment

Development of clinical guidelines

Definition framework contracts for basic health services

Contracting providers complying with Article 17 universal insurance law

Health care provider requirements

Determining the necessities

Determination of comprehensive healthcare services package by MOH

Defining uniform basic health insurance services for the population

Determining of the covered basic health insurance package in three levels

Updating uniform approach of the list of basic insurance commitments

Provision of services

Reinforcement of competitive market to provide medical insurance

Defining providing mechanism to the insured health sector evolution plan

Providing insurance services based on rules/regulations of High Council

Avoiding contract with providers aren’t interested in UHC cooperation

Supplying the entire requirements covered by the basic insurance package

Rules relating to implementation

Creating the necessary measures for establishment of health insurance

Notifying mechanisms for universal and compulsory health insurance

Cooperating between all basic insurance organizations Ministry of Health

Covered services

Full coverage of basic health needs for members of the Community

Reviewing the basic insurance package with health orient approach

Paying attention to health promotion and prevention activities

Allocating appropriate facilities for women

Insurance coverage for infertility treatment

Citizen/population requirements

Expanded coverage of population

Basic health insurance is universal and mandatory

Implementing the plan of mandatory insurance of wage earners

Providing free basic health insurance to all Iranian uninsured

Coverage of all foreigners residing in the country

Coverage of headed households

Coverage of residents of villages/cities with less than 20,000 people

Free urban inpatient scheme to underserved poor populations

Targeted advocacy to empower supported individuals and institutions

Establishment of basic social security and health insurance

Insurance premium

Premium per capita healthcare coverage for insured people

Paying the share of employees premiums by executive organizations

Using world experience as insurance calculations framework

Defining basic medical insurance of villagers and nomads