Background
The status of dental health services in Iran
Methods
Setting and sampling
Data collection
Data analysis
Results
Characteristics | Frequency | |
---|---|---|
Gender | Female | 53 |
Male | 21 | |
Both (simultaneous interview with household head and spouse) | 10 | |
Marital status | Married | 75 |
Single | 6 | |
Divorced | 2 | |
Widowed | 1 | |
Education | Less than high school degree | 17 |
High school degree (Diploma) | 38 | |
Bachelor’s degree and higher | 39 | |
Occupation | Housewife | 51 |
Private sector employee | 10 | |
Self-employed | 16 | |
Governmental employee | 11 | |
Others | 6 | |
Basic health insurance status | No insurance | 6 |
social security insurance (Obligatory) | 47 | |
Optional social security insurance (Voluntary) | 22 | |
Iranian Health Insurance | 4 | |
Institutional health insurance funds | 9 | |
Others | 6 | |
Complementary health insurance status | No | 57 |
Yes | 36 | |
Not asked | 1 | |
Distance of residence place from location of receiving dental health services | Receiving services at neighborhood area | 45 |
Receiving services at centers not very far from home | 24 | |
Receiving services near the workplace | 3 | |
Others | 22 | |
Total | 94 |
Theme | Sub-theme | Codes |
---|---|---|
Pecuniary attributes | Insurance premium | Fixed |
Free of charge | ||
Varied to type of services | ||
Varied to salary | ||
Coinsurance | Between 40 and 70% | |
Up to 75% | ||
Selective | ||
Insurance coverage granted | Insurance flooring | |
Insurance ceiling | ||
Other coverage granted | ||
Discounting option | To vulnerable groups | |
To low risk individuals | ||
To low-income insured | ||
Reimbursement of expenses | Compensating providers | |
Compensating patients | ||
Non-pecuniary attributes | Notification status | Enrollment |
Contract renewal | ||
Centers in contract | ||
Ethical issues | The insurer | |
The insured | ||
Providers | ||
Benefits package | Right to choose dentist | |
Right to choose dental services | ||
Inclusion of necessary dental services | ||
Contract providers | Public provider | |
Private provider | ||
Public/private providers | ||
Centers in neighborhood | ||
As enough centers | ||
Quality of dental centers | Dentist’s work quality | |
Less crowded centers | ||
Shorter waiting time | ||
Administrative process | Affair process | |
Reimbursement process | ||
Dental insurance scheme | A united package | |
An Independent package |
Pecuniary attributes
Sub-theme 1. Insurance premium
Nevertheless, some interviewees preferred dental insurance to be free of charge. With regard to, they believed that dental services should be provided basic insurance. And they demanded the provision of essential dental services through basic insurance without extra premium.“I am ready to pay the premium of around 2 million IRR per month for four people... I could not pay something around 10 million IRR.” (District 19 - doctor’s office - interview 7 - married)
On the other hand, some people were willing to pay more and have better dental insurance coverage with better services:“I think we're paying enough. We pay a monthly premium, but we may not receive any services in return for 2-3 years; so, that is enough.” (District 11, health care center, interview 4, married)
Many interviewees from deprived background believed that fixed-rate payment was not appropriate for low-income jobs. Whereas, others were concerned that salary-based dental insurance might trouble freelance, informal, and self-employment workers, whose jobs are often without a steady income:“We are now paying 4 million IRR per month for four people as the insurance premium. I would be willing to pay up to 5 million IRR per month, but have all dental services covered.” (District 2 - health services center - interview 7 - married)
“My husband is self-employed. Complementary health insurance would be very expensive for him. They have to be insured as a group... which is still too expensive.” (District 2 - health services center - interview 9 - married)
Sub-theme 2. Coinsurance
Some participants suggested a revised tariff and co-payment mechanism for the most demanding and specialized dental health services.“I think the insurance should offer more, for instance 70%; otherwise, it is pointless” (District 2, clinic, interview 6, married)
Some interviewees preferred to pay extra premium if they would be able to receive dental services from insurance contract providers:“It would be better if we might pay above 50% for more basic procedures and the insurance might pay more for specialized procedures.” (District 2, clinic, interview 1, married)
“Well, I think it was at least 50%. If someone wants to use private centers, they could pay higher percentage.” (District 2, clinic, interview 3, married)
“Insurance companies should have contracts with certain providers; other providers should also accept the insurance at a higher cost. Then, we could choose whether to visit the center parties to the contract or other centers.” (District 11 - dentist's office - interviewer 8 - married)
Sub-theme 3. Insurance coverage granted
Some other interviewees preferred insurance reimbursement for costs above the insurance flooring. Due to their dental diseases and the possibility of heavy costs of treatment, they preferred to pay up to a certain amount of cost, first, and have the rest paid by the insurance.“It is better that insurance companies pay at first because someone who goes for complementary insurance may have financial problems and cannot afford dental services.” (District 19, clinic, interview 7, married)
“I think it’d be great if I could pay up to 10 million IRR and have the compensation for the rest. Most people need the dental care services at least once a year. You'd have to pay 30 million IRR to treat three teeth.” (District 11 - health center - interviewer 3 - married)
A group of interviewees were concerned about the existing insurance reimbursement policy, which leaves big room for OOP due to the high cost of some dental health services and noted its negative consequences. They accused the insurance coverage limits as dysfunctional and inappropriate because dental health costs vary:“I prefer to pay up to a maximum limit; if the costs exceed the limit, the insurance should pay.” (District 11, clinic, interview 8, married)
“I prefer proportional rate for insurance premium. With parameters such as varied cost of materials and sanctions, it is impossible to have a maximum; so, it is better to be in percentage.” (District 2, clinic, interview 1, married)
Sub-theme 4. Discounting option
“It should be free for children up to the age of seven and for adults above the age of 70. The government should support these people or those with certain diseases.” (District 2, clinic, interview 13, married)
However, few participants were happy to pay their insurance premium without discount and accused the discounting policy fraudulent and immoral:“I think they should give a discount at the beginning of each year, like the car insurance, or consider an incentive for those who pay on time or those who do not use it.” (District 11, clinic, interview 8, married)
“… unfortunately, everyone wants to use discounts, if possible, whether they are eligible or not.” (District 19, clinic, interview 7, married)
Sub-theme 5. Reimbursement of expenses
“Patient pays a part of the costs; then, the health center could take the rest from the insurance, in the same way as pharmacies. You pay your share and it takes the rest from the insurance.” (District 17, health care center, interview 1, married)
“It should be repaid at the same time. The money loses its value. 4,000 IRR paid this year will worth less than 1000 IRR the next year.” (District 11, clinic, interview 1, married)
Non- pecuniary attributes
Sub-theme 6. Notification status
They also felt they needed more guidance and information on registration and contract renewal. Some interviewees preferred to be notified about the expiry date of their contract via a text message. Also, some suggested they opt for automatic renewable in the insurance contract form.“It must be integrated. I cannot call everywhere to ask if they accept this particular insurance or do they provide these services?” (District 2, health care center, interview 9, married)
“I wish it’d be automatically renewed. Or a text message could notify us, like the car insurance notifications before the expiry date to see whether we would like to renew the contract. It’d be better this way.” (District 19 - doctor’s office - interview 9 - married)
Sub-theme 7. Ethical issues
Besides, some requested that the insured records become accessible in appropriate ways to avoid the violation of the rights of other insured persons:“Insurances must abide by their warranties, so that the insured does not cancel the contract due to the non-fulfillment of warranties.” (District 2, health care center, interview 6, married)
In addition, some interviewees were concerned about the possibility of immoral behaviors of some healthcare providers, e.g., fee splitting and induced demand.“I shouldn’t be able to [illegally] receive insurance reimbursement, while I receive no dental services for a year.” (District 11, clinic, interview 6, married)
“Unfortunately, there are some immoral behaviors among providers. Something must be done about it. For example, the doctor says: ‘it's 12,000 million IRR, but I’d write 15,000, so that you can get money from the insuring company’.” (District 17 - health center - interviewer 14 - married)
Sub-theme 8. Benefits package
A number of interviewees cited the inclusion of necessary dental services, mainly the provision of prevention, education, and screening services in benefit package as an appropriate method to reduce future further expenses. In particular, they emphasized the necessity to make periodic visits compulsory:“If there is a system that lets me choose my doctor, well, that would be much better than going to a center determined by the insurance.” (District 2, clinic, interview 1, single)
Some participants believed they were entitled to choose the type of insurance and preferred that this insurance be part of their basic insurance. They wished they had the right to choose to join the insurance and use its benefits.“I think it must be compulsory. A person who has a contract whose expenses are supposed to be met by insurance must be visited at least once a year or once every 6 months.” (District 11, health care center, interview 1, married)
“I think an insurance program with a right to choose options is better. A type of insurance with a series of basic services, such as tooth extraction, root canal therapy, dental crown, scaling and the rest, should be selected by the insured. If you want to have these, you should pay more.” (District 19, clinic, interview 9, married)
Sub-theme 9. Contract providers
“Now, we are going to our local health center for fasting blood sugar and lipid tests. We have a medical record there. They should do dental screening at least once every 6 months or once per year, which could provide counseling and, then, do the referral if needed.” (District 17, health care center, interview 11, married)
Access to centers in neighborhood and access to as enough centers were the other codes:“I prefer to pay more to get dental services in the private clinic. It should be what I want.” (District 19, clinic, interview 3, married)
“Well, it’s better if it’s close by. It’s difficult to make an appointment if it’s far away. Some hospitals ... also provide dental care services, but we can't often use the services because they are far away.” (District 2 - health services center - interviewee 8 - married)
Sub-theme 10. Quality of dental centers
“I prefer to choose a dentist with high-quality practice and tooth filling. I do not visit a dentist who has poor quality of work.” (District 2 - dentist's office - interviewee 12 - married)
“My time is important for me; the less the crowd, the better the care and attention would be.” (District 2, health care center, interview 1, married)
Sub-theme 11. Administrative process
“... I'd rather send a photo via my phone ... We have to come a long way and that is very difficult ... It would be much better if we had electronic services.” (District 11, health care center, interview 4, married)
“It would be better if insurance can give us a card to provide services in these centers for financial transaction.” (District 19, clinic, interview 10, married)
Sub-theme 12. Dental insurance scheme
“I prefer a separate insurance scheme, just for dental services…. I think it would be much easier if I had a separate card.” (District 19, clinic, interview 11, married)
“I prefer the health insurance notebook. It avoids task duplication.” (District 19, clinic, interview 9, married)