Jabbari Alireza, Zakeri Ali, Saghafi Fatemeh, Hadian Marziye
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Assistant Professor of Foresight, Department of Industrial Engineering and Futures Studies, Faculty of Engineering, University of Isfahan, Isfahan, Iran.
J Educ Health Promot. 2023 May 31;12:149. doi: 10.4103/jehp.jehp_507_22. eCollection 2023.
Adequate health financing system should have key criteria and characteristics such as risk distribution over time, risk accumulation, sustainable resource provision, and resource allocation based on meeting essential needs. Weakness of the tariff system, lack of attention to strategic purchasing, inefficient allocation of manpower, and a weak payment system are among the problems within the Iranian financing system. Given the weaknesses of the current health financing system, it seems necessary to identify challenges and provide effective solutions to address them.
This qualitative study was conducted to explore the views of a group of 32 major policymakers and planners in the various departments and levels of the Ministry of Health, Universities of Medical Sciences, Medical System Organization, and Health Insurance Organization in Iran ( = 32), selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process.
Based on the results of data analysis, a total of 5 categories and 28 subcategories were obtained. In this study, five main categories were obtained through the content analysis method, including (1) stewardship; (2) providing services; (3) production of resources; (4) collecting resources; and (5) purchasing and allocation of resources.
It is suggested that those in charge of the health system, following the reform of the organization of the health system, move toward the improvement and widespread implementation of the referral system and that clinical guidelines be carefully compiled. Also, appropriate motivational and legal tools should be used to implement them. However, insurance companies need to make cost, population, and service coverage more effective.
完善的卫生筹资系统应具备关键标准和特征，如风险随时间分布、风险积累、可持续资源供应以及基于满足基本需求的资源分配。伊朗筹资系统存在诸多问题，包括收费系统薄弱、对战略采购缺乏关注、人力分配效率低下以及支付系统薄弱等。鉴于当前卫生筹资系统的弱点，似乎有必要识别挑战并提供有效的解决方案来应对这些问题。
本定性研究旨在探讨伊朗卫生部、医学科学大学、医疗系统组织和健康保险组织各部门及各级别的32名主要政策制定者和规划者（n = 32）的观点，采用目的抽样法选取。通过深入和半结构化访谈收集数据，并使用格兰海姆和伦德曼的传统内容分析法进行分析。使用MAXQDA 16软件的试用版来管理编码过程。
基于数据分析结果，共获得5个类别和28个子类别。在本研究中，通过内容分析法获得了五个主要类别，包括（1）管理；（2）提供服务；（3）资源生产；（4）资源筹集；（5）资源采购与分配。
建议卫生系统负责人在卫生系统组织改革后，朝着改进和广泛实施转诊系统的方向发展，并应仔细编写临床指南。此外，应使用适当的激励和法律工具来实施这些指南。然而，保险公司需要提高成本、人口和服务覆盖的有效性。
