determining liability, responsibility and justice; Three basic principles in the health insurance system.
Mohammad Jafar Gham Pena, Senior Vice President:
🔹 In the field of health insurance, the basic question is whether the insurance's responsibility is only to pay for the doctor's visit and services, or is the insurer also responsible for the people's health? If we accept that insurances are responsible for people's health, we must define this responsibility alongside the responsibility for managing financial resources and protecting the rights of the insured. The insurer is responsible for both the financial resources and the results of its performance in the field of health and must give an account of how the resources are spent, the quality of the services and the consequences of its actions.
🔹 Justice in the allocation of insurance resources, when it is said that 80% of the resources are invested in 20% of the people and only 20% of the resources are invested in the other 80%, this model must be carefully examined and see how well it corresponds to the principles of justice and the real health needs of society. Of course, the difference in people's cost can be caused by the difference in the severity of the disease and treatment needs; Therefore, the criteria for making decisions should be the need for people's health and justice, and not just the share of each group of expenses.
In the meantime, we must pay special attention to vulnerable groups, low-income households, heads of households and residents of deprived and remote areas; Groups that may need insurance support more than others, but have less access to health services.