Universal public health insurance for Afghan refugees in Iran: a contextual analysis
Abstract Background The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health ins...
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| Language: | English |
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BMC
2025-08-01
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| Series: | Globalization and Health |
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| Online Access: | https://doi.org/10.1186/s12992-025-01143-2 |
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| author | Sahar Amuzadeh-Araei Amirhossein Takian Alireza Jabbari |
| author_facet | Sahar Amuzadeh-Araei Amirhossein Takian Alireza Jabbari |
| author_sort | Sahar Amuzadeh-Araei |
| collection | DOAJ |
| description | Abstract Background The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health insurance scheme for refugees. Therefore, this study aims to identify the contextual factors influencing the basic universal health insurance program for Afghan refugees in Iran using the PESTEL framework. Methods This qualitative study was conducted between October 2024 and March 2025. Data were collected through semi-structured interviews with 22 key individuals, including managers and experts from the Health Insurance Organization, the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA), the United Nations High Commissioner for Refugees (UNHCR), refugee researchers, educated Afghan refugees, and healthcare service providers. Participants were selected through purposive sampling. Data analysis was conducted using framework analysis based on the PESTEL framework. MAXQDA 20 software was used to assist with data management and analysis. Results The contextual determinants of the universal public health insurance policy for Afghan refugees in Iran were 61 factors that were categorized into six main themes and 17 sub-themes. The main themes identified in this study included political (four factors), economic (five factors), legal and regulatory (two factors), sociocultural (four factors), technological (one factor), and environmental factors (one factor). Conclusion Findings from this study, based on the PESTEL framework, revealed that the refugee health insurance policy in Iran is influenced by a range of political, economic, social, technological, legal, and environmental factors. To improve insurance coverage among refugees, policymakers—particularly senior health system managers—can create an enabling environment for equitable and sustainable access to healthcare services by strengthening information infrastructures, reforming financial and legal mechanisms, and enhancing intersectoral and international collaboration. Clinical trial number Not applicable. |
| format | Article |
| id | doaj-art-1103a3bd7fcc4d5cbc5f6e80dd606554 |
| institution | Kabale University |
| issn | 1744-8603 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Globalization and Health |
| spelling | doaj-art-1103a3bd7fcc4d5cbc5f6e80dd6065542025-08-20T04:02:50ZengBMCGlobalization and Health1744-86032025-08-0121111410.1186/s12992-025-01143-2Universal public health insurance for Afghan refugees in Iran: a contextual analysisSahar Amuzadeh-Araei0Amirhossein Takian1Alireza Jabbari2Department of Health Services Management, School of Management & Medical Information Sciences, Isfahan University of Medical SciencesDepartment of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS)Health Management & Economics Research Center, Isfahan University of Medical SciencesAbstract Background The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health insurance scheme for refugees. Therefore, this study aims to identify the contextual factors influencing the basic universal health insurance program for Afghan refugees in Iran using the PESTEL framework. Methods This qualitative study was conducted between October 2024 and March 2025. Data were collected through semi-structured interviews with 22 key individuals, including managers and experts from the Health Insurance Organization, the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA), the United Nations High Commissioner for Refugees (UNHCR), refugee researchers, educated Afghan refugees, and healthcare service providers. Participants were selected through purposive sampling. Data analysis was conducted using framework analysis based on the PESTEL framework. MAXQDA 20 software was used to assist with data management and analysis. Results The contextual determinants of the universal public health insurance policy for Afghan refugees in Iran were 61 factors that were categorized into six main themes and 17 sub-themes. The main themes identified in this study included political (four factors), economic (five factors), legal and regulatory (two factors), sociocultural (four factors), technological (one factor), and environmental factors (one factor). Conclusion Findings from this study, based on the PESTEL framework, revealed that the refugee health insurance policy in Iran is influenced by a range of political, economic, social, technological, legal, and environmental factors. To improve insurance coverage among refugees, policymakers—particularly senior health system managers—can create an enabling environment for equitable and sustainable access to healthcare services by strengthening information infrastructures, reforming financial and legal mechanisms, and enhancing intersectoral and international collaboration. Clinical trial number Not applicable.https://doi.org/10.1186/s12992-025-01143-2RefugeesUniversal public health insuranceHealth insuranceHealth policyIran |
| spellingShingle | Sahar Amuzadeh-Araei Amirhossein Takian Alireza Jabbari Universal public health insurance for Afghan refugees in Iran: a contextual analysis Globalization and Health Refugees Universal public health insurance Health insurance Health policy Iran |
| title | Universal public health insurance for Afghan refugees in Iran: a contextual analysis |
| title_full | Universal public health insurance for Afghan refugees in Iran: a contextual analysis |
| title_fullStr | Universal public health insurance for Afghan refugees in Iran: a contextual analysis |
| title_full_unstemmed | Universal public health insurance for Afghan refugees in Iran: a contextual analysis |
| title_short | Universal public health insurance for Afghan refugees in Iran: a contextual analysis |
| title_sort | universal public health insurance for afghan refugees in iran a contextual analysis |
| topic | Refugees Universal public health insurance Health insurance Health policy Iran |
| url | https://doi.org/10.1186/s12992-025-01143-2 |
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