Insurance Coverage for Traffic Accident Victims in Iran’s Health System

Abstract

Background: Injuries from traffic accident are the second cause of premature death (after ischemic heart disease) in Iran. In 2004 and 2010, two laws (Articles 92 and 36) were passed by the parliament addressing free health service delivery to victims of traffic accidents (financed by third party insurance premiums). Objectives: The current study explored the challenges and complexities related to problems in the implementation of Articles 92 and 36. Methods: This qualitative study was conducted using the framework analysis method. Thirty-six experts, managers, and policy-makers were selected using snowball sampling. Data was collected through semi-structured interviews in 2016. Data saturation supported the sample size, and Atlas.Ti5.2 software were used. Results: Four main themes were identified in the data analysis namely policy content, policy context, policy processes, and policy makers. Nine sub-themes emerged during the analysis history and the necessity of legislation. Conclusion: Enforcing out-of-coverage financial loads on basic insurance companies and accident victims along with generalization in providing service packages are the most important challenges hampering implementation.