How Should Health Insurance–Based Pilot Programs Be Managed? A Qualitative Study of Policy Implementation

Background: This study aimed to explore the challenges and areas for improvement across all stages-planning, implementation, and evaluation-of health insurancefunded pilot programs and to provide foundational evidence for refining a comprehensive evaluation framework for their management.Methods: Focus group interviews were conducted with 13 experts from academia, healthcare providers, public interest groups, and beneficiary representatives who had experience with health insurance pilot programs.Data were collected using semistructured interview guides focusing on the operation, evaluation, and transition of pilot programs and were analyzed using conventional content analysis.Results: Participants identified that pilot programs are often initiated through a government-driven process, leading to deviations from their original objectives and their continuation despite limited feasibility of transition to full implementation.They also perceived that unclear evaluation criteria and a lack of transparency in the evaluation process undermined trust in these programs.Furthermore, participants emphasized the need to develop evaluation indicators aligned with the characteristics and objectives of each pilot program, as well as the importance of establishing clear criteria for program termination and transition and creating an independent and objective evaluation environment.Conclusion: This study suggests that, to maintain the role of pilot programs as policy experiments, it is essential to establish systematic management and evaluation criteria across all stages, including program initiation, operation, evaluation, and transition.The findings provide foundational evidence for developing a comprehensive management framework that goes beyond the outcome-focused evaluation of pilot programs.