Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Geriatric Health, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
Arch Iran Med. 2024 Sep 1;27(9):508-521. doi: 10.34172/aim.28907.
A better understanding of health system performance requires evaluating achievements and challenges, thereby providing a basis for effective reforms. This systematic review aims to investigate the challenges and weaknesses of leadership and governance-related health policies in Iran.
In this qualitative systematic review, we followed the instructions of the Joanna Briggs Institute (JBI). It encompassed qualitative studies assessing challenges and weaknesses of leadership and governance-related health policies. Thematic synthesis was conducted in three stages to identify common themes.
The primary database search yielded 1890 records, of which 152 were fully assessed, resulting in the inclusion of 57 studies in this review. Thematic synthesis produced 157 structured codes and identified 11 main descriptive themes of challenges in leadership and governance-related health policies. These themes included hospital autonomy policy, challenges to the entire health system, governance of medical universities, healthcare payment systems, sustainable universal health insurance coverage, informal payments, insurance systems, induced demand, strategic purchasing of health services, the family physician program, family physician and rural health insurance programs, and primary healthcare human resources.
The identified challenges underscore the urgent need for strategic reforms and interventions to overcome the complex issues plaguing the healthcare system. By addressing these challenges, policymakers and top healthcare managers might ensure that the population have access to high-quality care in a more responsive healthcare system.
为了更好地了解卫生系统绩效，需要评估成就和挑战，从而为有效改革提供基础。本系统评价旨在调查伊朗与领导力和治理相关的卫生政策的挑战和弱点。
在这项定性系统评价中，我们遵循了乔安娜·布里格斯研究所（JBI）的指导原则。它包括评估领导力和治理相关卫生政策的挑战和弱点的定性研究。主题综合分三个阶段进行，以确定共同主题。
主要数据库检索产生了 1890 条记录，其中 152 条被全面评估，最终纳入了 57 项研究。主题综合产生了 157 个结构化代码，并确定了领导力和治理相关卫生政策挑战的 11 个主要描述性主题。这些主题包括医院自主权政策、整个卫生系统面临的挑战、医科大学治理、医疗保健支付系统、可持续的全民健康保险覆盖范围、非正规支付、保险制度、诱导需求、卫生服务的战略采购、家庭医生计划、家庭医生和农村健康保险计划以及初级卫生保健人力资源。
确定的挑战凸显了迫切需要进行战略改革和干预，以克服困扰医疗保健系统的复杂问题。通过解决这些挑战，政策制定者和高层医疗保健管理人员可以确保民众在更具响应性的医疗保健系统中获得高质量的医疗服务。
