Introduction: The present study was conducted with the aim of designing a model for implementing insurance policies in health insurance.
Method: This study is applied in terms of purpose and mixed in terms of method and is based on the inductive-deductive paradigm. In the qualitative part, data were collected through semi-structured interviews with 22 experts and professors in the field of policy-making, using the purposive sampling method and until theoretical saturation was achieved. Qualitative data were analyzed using the content analysis method and MAXQDA 2020 software. In the quantitative part, in order to validate the proposed model, a researcher-made questionnaire was provided to senior and middle managers of the health insurance organization, and the data were analyzed using the structural equation modeling method based on partial least squares and SmartPLS software.
Results: The findings of the qualitative section led to the identification of 19 overarching themes, 45 organizing themes, and 150 basic themes, which were classified into three main dimensions of requirements, strategies, and consequences of implementing insurance policies. The results of the quantitative section also showed that the proposed model had a good fit and that all relationships between the model's constructs were statistically significant.
Conclusion: Based on the research findings, the successful implementation of insurance policies requires the provision of institutional, managerial, legal, financial, technological, and human requirements, the application of appropriate strategies in the areas of planning, management, coordination, capacity development, and process improvement, and ultimately achieving outcomes such as improving service quality, increasing efficiency, financial sustainability, improving governance, increasing stakeholder satisfaction, and developing the health insurance system. Since no comprehensive model has been presented so far for implementing insurance policies in the field of health insurance, the model proposed in this study can be used as a scientific and practical framework for managers, policymakers, and decision-makers of the health insurance system in designing, implementing, monitoring, and evaluating insurance policies, and it can pave the way for the development of theoretical literature and future research in this field.