Soltan-Tajian Abdollah, Jabbari Alireza, Shaarbafchizadeh Nasrin, Bastani Peivand
Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Med J Islam Repub Iran. 2024 Jul 23;38:84. doi: 10.47176/mjiri.38.84. eCollection 2024.
In recent decades, healthcare purchasing has been continuously searching for new approaches to improve performance. The pressure of expensive services resulting from more advanced health technology has increased the necessity of these changes. Strategic purchasing of health services, as a recommended approach, remains unknown in diagnostic imaging services. This study explores the potential determinants of strategic purchasing in the context of diagnostic imaging services.
This was a qualitative study conducted through framework analysis (applying five stages of familiarization, identifying a thematic framework, indexing, mapping, and interpretation) in 2023 based on the World Health Organization for strategic purchasing. This framework includes 5 questions: what to buy? From whom to buy? For whom to buy? what mechanism to buy? At what price to buy? A dimension of what structure to buy? Data were gathered through semi-structured interviews with key informants in which data saturation was reached in 18 interviews. After transcribing each interview, data were analyzed using MAXQDA software.
A total of 32 factors were identified to be influencing the strategic purchasing of diagnostic imaging services. Development of an evidence-based service package using a prospective combined payment system, consideration of the burden of disease and health needs, implementation of a referral system and family physician program integrated with the electronic health record, and most importantly, political belief and technical capacity are the most important identified factors.
The implementation of a strategic purchasing policy requires a systemic approach to the factors affecting it. A number of specific and sometimes interconnected activities must be carried out in different areas of strategic purchasing. Governance of purchasing is the foundation of strategic purchasing. It is suggested that this item should be investigated more in countries like Iran.
近几十年来，医疗保健采购一直在不断寻求提高绩效的新方法。更先进的健康技术导致的昂贵服务压力增加了这些变革的必要性。作为一种推荐方法，健康服务的战略采购在诊断成像服务中仍然不为人知。本研究探讨了诊断成像服务背景下战略采购的潜在决定因素。
这是一项定性研究，于2023年基于世界卫生组织的战略采购通过框架分析（应用熟悉、确定主题框架、索引、映射和解释五个阶段）进行。该框架包括五个问题：买什么？从谁那里买？为谁买？用什么机制买？以什么价格买？购买什么结构的维度？通过与关键信息提供者进行半结构化访谈收集数据，在18次访谈中达到了数据饱和。每次访谈转录后，使用MAXQDA软件进行数据分析。
共确定了32个影响诊断成像服务战略采购的因素。使用前瞻性联合支付系统制定基于证据的服务包、考虑疾病负担和健康需求、实施与电子健康记录集成的转诊系统和家庭医生计划，最重要的是，政治信念和技术能力是确定的最重要因素。
战略采购政策的实施需要对影响它的因素采取系统方法。必须在战略采购的不同领域开展一些具体且有时相互关联的活动。采购治理是战略采购的基础。建议在伊朗等国家对这一项目进行更多研究。
