Purpose: This study aims to identify the insurance challenges faced by retired or pensioner older adults covered by the Social Security Organization in accessing healthcare services.
Method: This study employed a qualitative approach using thematic analysis. Data were collected through semi-structured individual and group interviews with 65 retirees and pension beneficiaries aged 60 and over covered by the Social Security Organization. Participants had received healthcare services from the Organization’s medical facilities within the preceding year. Sampling was conducted using a combination of maximum variation sampling and theoretical sampling, and data collection continued until conceptual saturation was reached.
Findings: The insurance challenges of older adults were identified in four organizing themes: inefficiency of the insurance system, limitations of insurance coverage, the appointment scheduling crisis and waiting time, and financial pressures on patients and their families. The key theme governing the findings is the systemic gap between insurance commitments and executive capacity, which manifests at three levels: the coverage gap (lack of effective coverage for dental services, physiotherapy, assistive medical devices, and home nursing care), the access gap (defective appointment scheduling and complex bureaucracy), and the financial gap (heavy out-of-pocket payments and financial pressure on older adults and their families).
Conclusion: Retired older adults face several forms of structural exclusion: treatment exclusion, equipment exclusion, and care exclusion. The lack of long-term care insurance and coverage for home nursing care has placed the entire burden of caring for older adults squarely on families. In the current system, health is not a citizenship right but rather a class privilege. Under these circumstances, instead of acting as a safety net, the insurance system itself becomes a reproducer of inequality and a destroyer of social capital. Reforming this situation requires a fundamental redesign of the insurance system based on expanding coverage for the basic needs of older adulthood, reducing out-of-pocket payments, and redefining health as a universal right.