Table 2. Policy Options .

Policy Option	Keeping the existing structural fragmentations of SHI schemes but implementing a comprehensive "policy integration" strategy	Consolidation of the existing health insurance funds and creating a single national health insurance scheme	Reducing fragmentation by merging minor well-resourced funds together and creating 2-3 large insurance funds under the umbrella of the existing organizations
Advantages	• Less resistance from existing health insurance schemes • Previous experience in some areas in Iran • Supporting harmonization and coordination in non-controversial areas and avoiding touching contentious areas like financial autonomy • Accepting the autonomy of health insurance organizations and not touching their physical structures • Acceptable for health insurance organizations • Removing the differences in working activities and executive policies among health insurance schemes	• Improving risk pooling and cross-subsidization among population • Improving equity in access to healthcare services among population • Opening a new policy window for further improvements in health insurance system and can contribute to better achievement of other relevant reforms in health system • International experiences from other countries about consolidation to learn from • Strengthening strategic purchasing	• Reducing fragmentation in risk pools to great extend (but not complete) • Less political resistance from small better-off insurance organizations because of being governmental • Improving risk pooling among small better-off schemes • Operating as a pilot plan to learn from it to create a single scheme in the future if necessary • Strengthening strategic purchasing
Disadvantages	• Would not improve the redistribution of risk and cross-subsidization between health insurance funds • High potentiality for fragmentation of policies again over the time	• A tough political decision with political resistance because of structural and financial integration • Facing a lot of operational challenges in different aspects of health insurance such as benefit package, financial mechanisms, organizational structure, operational processes, and engagement with providers • Requiring a comprehensive plan for implementation which is difficult in developing countries	• Not improving risk pooling and equity in the whole health insurance system