Table 3. Insurance and financial challenges in the Family Physician Program (FPP) of Iran based on systematic review of the publications.

Theme	Subtheme
Budget and funding	Lack of clear and stable financial resources for the FPP
	Injustice in funding
	Insufficient financial resources
	Delayed budgeting
	Underestimation of the required funds for the plan
	Spending the allocated budget for other purposes
	Weak financial processes
	Lack of a pooled fund
Insurance system	Multiple policies, fragmented health insurance system and lack of coordination among insurance organisations
	Lack of a public insurance scheme
Tariffs	No rational medical tariffs based on the relative value of health services, inflation, educational level and hardship of work
	Lack of a national policy for tariff
	Payment per capita instead of performance-based payment to health teams
Payments	Single payment for levels 2 and 3
	Insufficient infrastructure for a performance-based payment system
	Inadequate criteria for per capita payment
	Individual-centred payments instead of salaries
	Clinical and treatment approaches of managers who pay family physicians
	Lack of a health-oriented vision of insurance organisations
	Delayed reimbursements by health insurances to family physicians
	Unclear methods of payment
	Lack of a backup software for methods of payment
	High insurance deductibles
Financial accountability	Lack of trained and experienced inspectors with the required expertise to evaluate the FPP
	Lack of proper supervision structure in health insurance organisations
	Difficulties in supervision owing to diverse payment methods in the FPP
	Lack of criteria and scientific tools, such as valid and reliable checklists for FPP assessment
	Top-down monitoring approach instead of an educational approach, which can enhance the FPP
Inequity	Unjust payments to members of family physician teams
	Difference in tariffs set for urban and rural physicians
	Lower wages for family physicians than for other medical specialists
	Discrimination between those insured by social security and health insurance organisations and those insured by other organisations to access physicians