Table 3 Recommendations to improve the insurance coverage for physiotherapy services
IDs | Recommendations | Quotes |
|---|---|---|
(a) Stewardship | ||
1 | Moving towards united stewardship | “A variety of organizations and institutions are currently involved in providing and financing rehabilitation services, including physiotherapy ones in Iran. Well, that is why there are many fragmentations. Moving towards a united stewardship can curb redundancies and waste”. [HPM2] |
2 | Informing policy-makers about physiotherapy services and their effects | “You know that many decision- and policy-makers in our health care system are not fully aware of physiotherapy services. I think efforts should be made to inform these people”. [UP5] |
3 | Involving rehabilitation experts in decision- and policy-making processes | “More involvement of physiotherapists and relevant experts in policy-making processes can lead to the promotion of these services in the health care system”. [RM3] |
4 | Improving HTA process | “Today, in countries such as the United Kingdom, the use of health technology assessment is a prerequisite for considering health interventions in benefit health packages. Therefore, it is necessary to use this approach to cover physiotherapy services by health insurance”. [HPM6] |
5 | Facilitating interdisciplinary collaborations | “One of our serious challenges in the service delivery process is poor collaboration with other health professionals and even rehabilitation professionals, which has left them with insufficient information about our services”. [PT1] |
6 | Conducting regular supervisions and accreditations | “The quality of provided services cannot be guaranteed unless there is comprehensive and proper supervision of physiotherapy centers”. [RM1] |
7 | Strengthening referral systems | “All patients should be now referred to us by a physician. Well … due to our poor referral systems, we cannot expect patients come on time”. [PT7] |
8 | Conducting comprehensive needs assessments | “The importance of rehabilitation services such as physiotherapy becomes evident to policy-makers when the population requesting these services is determined. Therefore, we need to move forward by conducting needs assessments at the national and regional levels”. [RM1] |
9 | Establishing accurate information systems | “Existence of accurate information systems such as electronic files can facilitate awareness of the services provided to patients and their effects. As a result, the insurer can cover the services”. [UP4] |
10 | Prioritizing and rationing | “As there is no clear prioritization process in Iran, many expensive services are included in the basic packages by influential groups, and services such as physiotherapy, which have less influence and power, are being excluded”. [RM3] |
11 | Promoting interactions between scientific associations and insurers | “The Iranian Physiotherapy Association can persuade other financing agencies, such as insurance companies, to cover physiotherapy services”. [PT3] |
(b) Collection of funds | ||
1 | Levying value-added taxes on luxury goods and services | “One of the appropriate ways to finance rehabilitation services such as physiotherapy in Iran is to impose a taxes on luxury goods”. [HPM7] |
2 | Placing taxes on chemical and toxic industries | “You see, chemical and oil industries are one of the causes of chronic diseases and disabilities in Iran due to pollution, so it is possible to provide necessary resources for insurance coverage by imposing special taxes on these industries”. [RM5] |
3 | Imposing taxes on harmful substances such as tobacco, sugar, etc. | “Many disabilities and illnesses, such as stroke, in which people need physiotherapy services, are caused by harmful substances such as smoking. Therefore, taxing these materials can facilitate financing”. [UP2] |
4 | Considering higher insurance contributions for childless families | “Some developed countries charge higher premiums from childless families because they need more rehabilitation in times of disability and old age they need more rehabilitation”. [UP4] |
5 | Obligating complementary health insurance for employed groups | “In my opinion, we should make supplementary insurance mandatory for some working groups. This process will facilitate the coverage of insurance services such as physiotherapy ones”. [HPM6] |
6 | Promoting rehabilitation funding proportion from public budget | “The share of rehabilitation services in the government budget allocated to the health system is very small. Therefore, like many countries, the government’s share of financing these services must be increased”. [RM4] |
7 | Earmarking allocated resources | “Although some government resources are allocated to finance rehabilitation services such as physiotherapy, since they are not marked, they are not well allocated to provide these services”. [HPM6] |
8 | Considering a separate premium for rehabilitation services (including physiotherapy) | “Rehabilitation services are expensive and that is why many insurance companies are reluctant to cover them. One solution would be to set a separate premium for these services”. [UP3] |
(c) Pooling of funds | ||
1 | Moving allocated resources towards insurance (i.e., third party) mechanisms | “Incorporating funds into the insurance process can reduce financial pressures on high-risk groups by sharing risks”. [HPM1] |
2 | Integrating insurance funds | “Existence of multiple insurance funds in the Iranian health system is one of the major financing challenges. Merging and integration of these funds can be thus a potential solution”. [UP6] |
3 | Cross-subsiding across different regions and groups at national level | “Given the differences between regions as well as different demographic groups, cross subsidies at the national level can be an appropriate policy solution to reduce injustice”. [HPM7] |
4 | Using individual medical saving accounts | “One of the interesting solutions in health financing system is individual medical saving accounts in Singapore. This approach can be also used to finance physiotherapy services, as it increases the responsibility of individuals and also divides the risks over time”. [HPM7] |
5 | Consolidating small insurance funds | “There are several insurance funds in Iran that are very small. For this reason, they are not productive enough. So, consolidating these funds can be a good approach”. [HPM2] |
(d) Purchasing | ||
1 | Separating providers and purchasers | “Interestingly, the Ministry of Health and Medical Education is both the main financer and provider of health services in Iran. However, the separation between the financier and the provider is one of the principles of favorable financing”. [HPM1] |
2 | Exploiting strategic purchasing | “Coverage of physiotherapy services by health insurers requires the use of strategic purchasing principles”. [HPM6] |
3 | Considering quality indicators in purchasing process | “I think it is better to buy services based on quality indicators and clinical effects in order to reduce the purchases of poor quality services”. [UP2] |
4 | Utilizing performance- or outcome-based payment systems | “One of the recent approaches in many developed countries to improve motivation and quality of services is to link payment mechanisms to performance and health outcomes”. [PT5] |
5 | Limiting induced demands by payment and punishing mechanisms | “I myself have seen several times that service providers deliver services to patients that are not really needed. Well… there must be effective punitive mechanisms”. [UP1] |
6 | Using rehabilitation experts in purchasing process | “The presence of physiotherapists in the purchasing process, given their familiarity with the services, can prevent many abuses and misbehaviors”. [PT7] |
7 | Correcting tariffs based on economic situation | “Nowadays, service tariffs are not really compatible with inflation and rising costs”. [RM3] |
8 | Reducing co-payment rates | “Although some physiotherapy services are covered by health insurers, co-payment by recipients is still high”. [UP2] |
9 | Practicing capitation mechanisms to control expenditures | “Per capita payment is one of the effective approaches to control costs, especially in primary health care. This mechanism can be also used for physiotherapy services in primary health care”. [HPM7] |
(e) Benefit package | ||
1 | Considering cost-effectiveness interventions | “Many physiotherapy services are cost-effective. At least the same services can be covered by insurance”. [UP2] |
2 | Using preventive interventions | “Interestingly, many physiotherapy services have preventative effects that can thwart majority of severe disabilities”. [UP3] |
3 | Practicing needed interventions in golden time treatments after diseases | “If physiotherapy interventions are provided early for some patients, such as stroke cases, especially in the first three to six months after their occurrence, they can prevent many long-term complications such as reduced range of motions of the joints”. [PT1] |
4 | Reflecting on inpatient interventions | “Physiotherapy services required by hospitalized patients can be covered by health insurance to avoid heavy costs. For example, cardiac rehabilitation services can speed up a patient’s recovery and discharge”. [UP5] |
5 | Covering physiotherapy services required for children up to the age of 6 years | “It is true that health insurance institutions face limited resources, but like many developed countries, physiotherapy services needed by children up to the age of 5 or 6 years can be at least covered in Iran”. [HPM5] |
6 | Covering of physiotherapy services up to the age of 18 years | “Since many musculoskeletal disorders can be corrected by the time a person reaches puberty, covering physiotherapy services until the age of 18 years can improve public health and avoid heavy costs in the future”. [PT7] |