{"title":"伊朗境内阿富汗难民的全民公共医疗保险：背景分析。","authors":"Sahar Amuzadeh-Araei, Amirhossein Takian, Alireza Jabbari","doi":"10.1186/s12992-025-01143-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health insurance scheme for refugees. Therefore, this study aims to identify the contextual factors influencing the basic universal health insurance program for Afghan refugees in Iran using the PESTEL framework.</p><p><strong>Methods: </strong>This qualitative study was conducted between October 2024 and March 2025. Data were collected through semi-structured interviews with 22 key individuals, including managers and experts from the Health Insurance Organization, the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA), the United Nations High Commissioner for Refugees (UNHCR), refugee researchers, educated Afghan refugees, and healthcare service providers. Participants were selected through purposive sampling. Data analysis was conducted using framework analysis based on the PESTEL framework. MAXQDA 20 software was used to assist with data management and analysis.</p><p><strong>Results: </strong>The contextual determinants of the universal public health insurance policy for Afghan refugees in Iran were 61 factors that were categorized into six main themes and 17 sub-themes. The main themes identified in this study included political (four factors), economic (five factors), legal and regulatory (two factors), sociocultural (four factors), technological (one factor), and environmental factors (one factor).</p><p><strong>Conclusion: </strong>Findings from this study, based on the PESTEL framework, revealed that the refugee health insurance policy in Iran is influenced by a range of political, economic, social, technological, legal, and environmental factors. To improve insurance coverage among refugees, policymakers-particularly senior health system managers-can create an enabling environment for equitable and sustainable access to healthcare services by strengthening information infrastructures, reforming financial and legal mechanisms, and enhancing intersectoral and international collaboration.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"46"},"PeriodicalIF":4.5000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345101/pdf/","citationCount":"0","resultStr":"{\"title\":\"Universal public health insurance for Afghan refugees in Iran: a contextual analysis.\",\"authors\":\"Sahar Amuzadeh-Araei, Amirhossein Takian, Alireza Jabbari\",\"doi\":\"10.1186/s12992-025-01143-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health insurance scheme for refugees. Therefore, this study aims to identify the contextual factors influencing the basic universal health insurance program for Afghan refugees in Iran using the PESTEL framework.</p><p><strong>Methods: </strong>This qualitative study was conducted between October 2024 and March 2025. Data were collected through semi-structured interviews with 22 key individuals, including managers and experts from the Health Insurance Organization, the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA), the United Nations High Commissioner for Refugees (UNHCR), refugee researchers, educated Afghan refugees, and healthcare service providers. Participants were selected through purposive sampling. Data analysis was conducted using framework analysis based on the PESTEL framework. MAXQDA 20 software was used to assist with data management and analysis.</p><p><strong>Results: </strong>The contextual determinants of the universal public health insurance policy for Afghan refugees in Iran were 61 factors that were categorized into six main themes and 17 sub-themes. The main themes identified in this study included political (four factors), economic (five factors), legal and regulatory (two factors), sociocultural (four factors), technological (one factor), and environmental factors (one factor).</p><p><strong>Conclusion: </strong>Findings from this study, based on the PESTEL framework, revealed that the refugee health insurance policy in Iran is influenced by a range of political, economic, social, technological, legal, and environmental factors. To improve insurance coverage among refugees, policymakers-particularly senior health system managers-can create an enabling environment for equitable and sustainable access to healthcare services by strengthening information infrastructures, reforming financial and legal mechanisms, and enhancing intersectoral and international collaboration.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>\",\"PeriodicalId\":12747,\"journal\":{\"name\":\"Globalization and Health\",\"volume\":\"21 1\",\"pages\":\"46\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345101/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Globalization and Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12992-025-01143-2\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Globalization and Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12992-025-01143-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Universal public health insurance for Afghan refugees in Iran: a contextual analysis.
Background: The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health insurance scheme for refugees. Therefore, this study aims to identify the contextual factors influencing the basic universal health insurance program for Afghan refugees in Iran using the PESTEL framework.
Methods: This qualitative study was conducted between October 2024 and March 2025. Data were collected through semi-structured interviews with 22 key individuals, including managers and experts from the Health Insurance Organization, the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA), the United Nations High Commissioner for Refugees (UNHCR), refugee researchers, educated Afghan refugees, and healthcare service providers. Participants were selected through purposive sampling. Data analysis was conducted using framework analysis based on the PESTEL framework. MAXQDA 20 software was used to assist with data management and analysis.
Results: The contextual determinants of the universal public health insurance policy for Afghan refugees in Iran were 61 factors that were categorized into six main themes and 17 sub-themes. The main themes identified in this study included political (four factors), economic (five factors), legal and regulatory (two factors), sociocultural (four factors), technological (one factor), and environmental factors (one factor).
Conclusion: Findings from this study, based on the PESTEL framework, revealed that the refugee health insurance policy in Iran is influenced by a range of political, economic, social, technological, legal, and environmental factors. To improve insurance coverage among refugees, policymakers-particularly senior health system managers-can create an enabling environment for equitable and sustainable access to healthcare services by strengthening information infrastructures, reforming financial and legal mechanisms, and enhancing intersectoral and international collaboration.
期刊介绍：
"Globalization and Health" is a pioneering transdisciplinary journal dedicated to situating public health and well-being within the dynamic forces of global development. The journal is committed to publishing high-quality, original research that explores the impact of globalization processes on global public health. This includes examining how globalization influences health systems and the social, economic, commercial, and political determinants of health.
The journal welcomes contributions from various disciplines, including policy, health systems, political economy, international relations, and community perspectives. While single-country studies are accepted, they must emphasize global/globalization mechanisms and their relevance to global-level policy discourse and decision-making.
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