Introduction: Hemodialysis is the most common renal replacement therapy for end-stage renal disease and is associated with high costs. Implementing an appropriate payment system represents a key strategy for enhancing the efficiency and quality of dialysis services. This study aimed to identify the essential infrastructure required for transitioning toward value-based payments for dialysis services in Iran.
Methods: This qualitative study was conducted in 2021 using in-depth, semi-structured interviews with key experts and stakeholders across different levels of the healthcare system. Data were analyzed through conventional content analysis using MAXQDA software version 2020.
Results: Data saturation was achieved after 30 interviews. Analysis revealed four main categories of infrastructure requirements: governance and oversight infrastructure, encompassing regulatory frameworks, effective monitoring, and evaluation mechanisms; resource and empowerment infrastructure, involving sustainable financing, addressing human resource shortages, and comprehensive training; information and technology infrastructure, data integration, development of monitoring systems, and multi-stakeholder collaboration; and finally, executive and support strategies, focusing on pilot implementation and addressing social determinants of health such as nutrition.
Conclusion: The transition to a value-based payment system in Iran’s dialysis sector requires simultaneous and well-planned strengthening of these four infrastructure domains, with particular emphasis on equity and support for vulnerable patients as critical success factors.