Introduction: Health care has always been considered as one of the basic needs of human communities. Health insurance is the best choice for establishing social justice in health care settings. Preliminary studies on insurance systems in Iran show that these systems suffer from serious problems. This study was an attempt to identify system problems and review the necessity for adopting a reform in health insurance systems of Iran.

Methods: In this descriptive and exploratory study a questionnaire was used to collect data by reviewing reliable sources and referring to health insurance organizations and Medical Universities. The population included 24 university subject specialist informants and managers of health insurance organizations. The data were analyzed by SPSS software. The validity and reliability of the questionnaire were measured by content validity and test-retest method(r=0.84).

Results: The main challenges of health insurance systems were related to the process of integration of health insurance systems. These problems can be classified as dimensions of policy making, rules and regulations, organizational structures and funding.

Conclusion: Reforming health care and insurance systems stems from both health decision making and strategies. It seems that the creation of a coordinated information infrastructure is the main challenge for the integration and ultimately the reform of health insurance systems in Iran.