Exploring the Challenges in Covering Dental Services through Complementary Insurance in Iran: A Qualitative Study
Table 2
Themes and subthemes extracted from interviews and national documents.
Theme
Subtheme
Insurance commitments and service coverage
(1) Low insurance limit for dental services (2) Lack of clear principles for risk assessment and premium determination (3) Lack of attention to preventive services (4) Low service quality provided by contracted providers (5) Inadequate contracted providers
Reimbursement system
(1) Inappropriate service authentication and reimbursement
Information system
(1) Lack of knowledge about contract details among insured people (2) Lack of an integrated information system between insurance companies
Economic issues
(1) High costs of dental services (2) Major financial contribution of dental services to complementary insurance (3) Actual risk associated with dental service coverage
Population coverage
(1) Lack of dental coverage for small populations (2) Lack of individual and family dental insurance
Regulation and supervision
(1) Dual position of the Central Insurance Organization (CIO) (2) Lack of specific complementary dental insurance (3) Lack of identical and imperative tariffs (4) Poor supervision of contracted providers (5) Fraud in dental insurance
Codes derived from national insurance documents, rules, regulations, and instructions.