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伊朗卫生系统中基于税收的可持续财政资源创建策略:一项定性研究

Strategies for Creating Tax-Based Sustainable Financial Resources in Iran's Health System: a Qualitative Study.

作者信息

Taheri Ghasem, Gorji Hasan Abolghasem, Behzadifar Masoud, Rezapour Aziz, Martini Mariano, Sirizi Mehdi Jafari

机构信息

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.

出版信息

J Prev Med Hyg. 2024 Oct 31;65(3):E442-E448. doi: 10.15167/2421-4248/jpmh2024.65.3.3379. eCollection 2024 Sep.

Abstract

BACKGROUND

Ensuring uninterrupted and free access to health services highlights the critical need for sustainable health financing. Given that tax revenues are essential for achieving universal health coverage, this study, conducted in 2024, aims to identify strategies for generating sustainable financial resources through taxation.

METHODS

This qualitative study gathered data through in-depth, semi-structured interviews with 10 experts. Participant selection continued until data saturation was achieved, using purposeful and snowball sampling to ensure maximum diversity. Thematic analysis was employed for data analysis, using Atlas.ti software (version 8).

FINDINGS

The study identified strategies for generating tax-based sustainable financial resources across five main topics: transportation, services, production, individuals, and 11 subtopics. These subtopics include traffic control schemes, highway and road tolls, taxes on urban and intercity transportation systems, fines for traffic violations and vehicle inspection deficiencies, equipment and device imports, corporate sales and revenue, health-damaging products, environmental pollutants, industrial production and petroleum products, businesses and occupations, and long-term exit or migration taxes for health professionals.

CONCLUSIONS

Implementing tax policies on the identified items requires strong political support, fostering a shared understanding among stakeholders at various levels of policy-making and implementation, and aligning executive program designs with existing infrastructure. Enhancing regulatory systems and increasing transparency in resource allocation are also essential to improving the implementation of health-related tax policies. Further research should carefully examine the economic and social side effects of these taxes on different sectors of society.

摘要

背景

确保卫生服务的不间断免费提供凸显了可持续卫生筹资的迫切需求。鉴于税收对于实现全民健康覆盖至关重要,这项于2024年开展的研究旨在确定通过税收产生可持续财政资源的策略。

方法

这项定性研究通过对10名专家进行深入的半结构化访谈收集数据。采用目的抽样和滚雪球抽样以确保最大程度的多样性,持续选择参与者直至达到数据饱和。使用Atlas.ti软件(版本8)对数据分析采用主题分析法。

结果

该研究确定了五个主要主题下基于税收的可持续财政资源生成策略:交通、服务、生产、个人,以及11个子主题。这些子主题包括交通管制方案、公路和道路通行费、城市和城际交通系统税、交通违规罚款和车辆检查不足罚款、设备和装置进口、企业销售和收入、有害健康产品、环境污染物、工业生产和石油产品、企业和职业,以及卫生专业人员的长期离职或移民税。

结论

对确定的项目实施税收政策需要强有力的政治支持,在各级决策和实施的利益相关者之间促进共同理解,并使执行方案设计与现有基础设施保持一致。加强监管系统和提高资源分配透明度对于改善与卫生相关的税收政策的实施也至关重要。进一步的研究应仔细审查这些税收对社会不同部门的经济和社会副作用。

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本文引用的文献

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Political economy of Thailand's tax-financed universal coverage scheme.泰国税收融资全民覆盖计划的政治经济学。
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