مسعود پاک نیت راد

Despite the importance of the issue of empowerment, insurance organizations in Iran do not seek to empower their insureds due to reasons such as the lack of clarity in the meaning and concept, ignorance of the involved and influential factors, and the lack of scientific and functional status. For this reason, the present study was carried out to identify and prioritize the factors affecting the empowerment of the insured of the Iran Health Insurance Organization.

This study was conducted using a mixed method with a sequential design (first the qualitative Delphi method and then the quantitative survey method) and the participation of 15 health insurance and empowerment specialists in the Delphi method and the participation of 414 insured people of the health insurance organization. In accordance with each of the mentioned methods, sampling and validation methods were also used. Exploratory factor analysis technique was used to discover factors and Friedman’s test was used to compare factors.

After determining 60 important variables and identifying 10 main factors influencing the empowerment of the insured, which are: self-reliance, job satisfaction, feeling of alienation, social health, decision-making power, health education, access to services health and treatment, quality of life relationships, power of foresight and improvement of the level of health-oriented attitude, it was found that “improvement of the level of health-oriented attitude” and “power of foresight” had the greatest and least effect on the empowerment of Iran’s health insurance policyholders, respectively.

The insured people of the Iran Health Insurance Organization believe that in order to empower the insured people, the level of attitude of all levels involved in this field should be improved and “health-oriented approach” should be replaced by “treatment-oriented” in the society.

The present study seeks to design an empowerment model for health insurance policyholders to achieve an acceptable level of capability. The reason for choosing this group of insured is their large and considerable population including about 50% of Iranian. The methodological approach is qualitative and of the grounded theory, deep and semi-structured interview data retrieval techniques. For data mining, theoretical coding method was used, which aims to achieve the main and sub-categories to set the theoretical model. The sample number is 15 specialists and experts in the field of health insurance and empowerment who have been purposefully selected. The results show that the central phenomenon is community-based empowerment, which is based on causal conditions, contextual conditions, intervening conditions and strategies. The most important strategies are the right of the insured to access insurance services and opportunities. In discussing the underlying conditions, important components such as: agency, sense of equality and inclusion (integration) and capacity building are emphasized. Findings also show that components such as protecting the rights of the insured, empowering and efficient resources and the quality of insurance services are considered as causal conditions. According to the findings of the present study, the three main categories of education and information, social participation and social support have been proposed as intervening conditions. Complementing the chain paradigm model of the present study is based on the data theory method of the Consequences Foundation, which has examined empowerment in four main sections: social empowerment, cultural empowerment, economic empowerment and psychological empowerment of the insured