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了解伊朗初级医疗保健财政资源分配面临的挑战。

Understanding challenges of primary healthcare financial resource allocation in Iran.

作者信息

Mahdiyan Somayeh, Amini-Rarani Mostafa, Rezayatmand Reza, Shaarbafchizadeh Nasrin

机构信息

Health Management & Economics Research Center, Isfahan University of Medical Science, Hezar Jerib Ave, Isfahan, 8174673461, Iran.

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

出版信息

Health Res Policy Syst. 2025 Jun 23;23(1):82. doi: 10.1186/s12961-025-01331-x.


DOI:10.1186/s12961-025-01331-x
PMID:40551159
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12183854/
Abstract

BACKGROUND: Primary healthcare (PHC) is essential for health systems worldwide, and resource allocation is vital for sustainability. However, various challenges hinder the allocation process, negatively affecting health outcomes. Therefore, this study explored the current challenges related to financial resource allocation within the PHC system in Iran. MATERIALS AND METHODS: This study is a qualitative descriptive study conducted on the basis of the guide provided by Villamin et al. Data were collected through semi-structured interviews. Accordingly, 20 interviewees were selected via a purposive and snowball sampling approach. The interviewees were experts in budgeting, primary healthcare, and health policies. This study was conducted in 2024. Data were collected between May 2024 and October 2024. The interviews continued until the saturation point was reached. The interview data were analysed via an inductive thematic analysis approach. MAXQDA version 2020 and Microsoft Excel were used for data extraction. RESULTS: The challenges associated with financial resource allocation were categorized into five main themes, eight subthemes, and 25 codes. Themes (subthemes) included the population base (demographic and geographical), health needs (epidemiological), governance (policymaking and political), implementation (process-related and management) and impact (financial). CONCLUSIONS: The findings provide a comprehensive set of challenges for allocating financial resources to PHC. Addressing these challenges is essential for health system managers, policymakers and political leaders. Additionally, awareness of PHC financial resource allocation challenges and how to address them clearly demands a multifaceted approach. Successful outcomes depend on collaboration amongst managers at the health system's macro, meso, and micro levels. Such cooperation will be instrumental in creating an effective allocation of financial resources that supports the ongoing development and sustainability of PHC initiatives.

摘要

背景:初级卫生保健(PHC)对全球卫生系统至关重要,资源分配对其可持续性至关重要。然而,各种挑战阻碍了分配过程,对健康结果产生了负面影响。因此,本研究探讨了伊朗初级卫生保健系统内与财政资源分配相关的当前挑战。 材料与方法:本研究是一项基于Villamin等人提供的指南进行的定性描述性研究。数据通过半结构化访谈收集。因此,通过目的抽样和滚雪球抽样方法选择了20名受访者。受访者是预算编制、初级卫生保健和卫生政策方面的专家。本研究于2024年进行。数据收集于2024年5月至2024年10月之间。访谈持续进行直至达到饱和点。访谈数据通过归纳主题分析方法进行分析。使用MAXQDA 2020版和Microsoft Excel进行数据提取。 结果:与财政资源分配相关的挑战分为五个主要主题、八个子主题和25个编码。主题(子主题)包括人口基数(人口统计学和地理)、健康需求(流行病学)、治理(政策制定和政治)、实施(过程相关和管理)以及影响(财政)。 结论:研究结果为向初级卫生保健分配财政资源提供了一系列全面的挑战。应对这些挑战对卫生系统管理者、政策制定者和政治领导人至关重要。此外,清楚地认识到初级卫生保健财政资源分配挑战以及如何应对这些挑战需要采取多方面的方法。成功的结果取决于卫生系统宏观、中观和微观层面管理者之间的合作。这种合作将有助于有效地分配财政资源,以支持初级卫生保健举措的持续发展和可持续性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/410d/12183854/c5f5389c15ac/12961_2025_1331_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/410d/12183854/c5f5389c15ac/12961_2025_1331_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/410d/12183854/c5f5389c15ac/12961_2025_1331_Fig1_HTML.jpg

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本文引用的文献

[1]
Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare.

BMJ Glob Health. 2025-1-14

[2]
Measuring Equality in Primary Health Care Budget Allocation in Iran, Using the Gini Coefficient Method.

Med J Islam Repub Iran. 2024-8-7

[3]
Identifying and prioritizing inefficiency causes in Iran's health system.

Cost Eff Resour Alloc. 2024-11-12

[4]
A Worked Example of Qualitative Descriptive Design: A Step-by-Step Guide for Novice and Early Career Researchers.

J Adv Nurs. 2024-10-9

[5]
The application of artificial intelligence in health financing: a scoping review.

Cost Eff Resour Alloc. 2023-11-6

[6]
Iranian primary health care network: challenges and ways forward.

Prim Health Care Res Dev. 2023-1-9

[7]
How health care professionals handle limited resources in primary care - an interview study.

BMC Health Serv Res. 2023-1-3

[8]
Financing primary health care in low- and middle-income countries: A research and policy agenda.

J Health Serv Res Policy. 2023-1

[9]
The Lancet Global Health Commission on financing primary health care: putting people at the centre.

Lancet Glob Health. 2022-5

[10]
A qualitative study of challenges affecting the primary care system performance: Learning from Iran's experience.

Health Sci Rep. 2022-3-14

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