ArticleGlobalization and health2025
Universal public health insurance for Afghan refugees in Iran: a contextual analysis.
Article in Globalization and health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Socioeconomic and Migration-Related Determinants of Newborn Metabolic Screening Uptake: A Case-Control Study in Urban Iran.Journal of immigrant and minority health · 2026Article
- Developing a framework for primary health care resilience in pandemic conditions for Iran.Journal of health, population, and nutrition · 2026Article
- Analysis of inequality in cardiovascular mortality in Isfahan County: a retrospective registry-based study of social and demographic determinants.BMC public health · 2026Article
- Financial challenges in Iran's healthcare system arising from migrant populations: evidence from two hospitals in Yazd Province.BMC health services research · 2026Article
- Forty Years of Primary Health Care (PHC) in Iran: Achievements, Lessons and Future Directions.Medical journal of the Islamic Republic of Iran · 2026Article
- Innovative pathways for sustainable health financing for migrants and refugees in Iran: a stakeholder and social network analysis approach.BMJ public health · 2026Article
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Abstract
backgroundThe 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.
methodsThis 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.
resultsThe 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).
conclusionFindings 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.
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