Moshiri E^1,2 (MD, MPH, PhD candidate), Takian A^3,4,5 * (MD, PhD, FHEA), Rashidian A^1,6 (MD, PhD), Kabir MJ⁷ (MSC, PhD candidate)

  ¹ Department of Health Management and Economics, School of Public Health,

  Tehran University of Medical Sciences, Tehran, Iran

  ² Deputy for Health Affairs, Semnan University of Medical Sciences, Semnan, Iran

  ³ Division of Health Studies, School of Health Sciences & Social Care, Brunel University London, UK

  ⁴ Department of Practice and Policy, UCL School of Pharmacy, London, UK

  ⁵ National Academy of Medical Sciences, Tehran, Iran

  ⁶ National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran

  ⁷ Department of Health and Social Medicine, Golestan University of Medical Sciences, Gorgan, Iran

  Received: 10 Jul 2012, Accepted: 6 Dec 2012

  Abstract

  Introduction: Analyzing the evidence generated over decades, the World Health Report 2008 recommended the expansion of primary health care (PHC) to achieve better population health, higher equity and lower costs. Over the last two decades, the Iranian model of PHC has resulted in population health indices that match the best in the region. Despite the extensive PHC networks in rural areas, there was an expansion of private outpatient care and hospital-based services. This model has been inadequate to meet the evolving health needs of the population and increasingly difficult to afford. In response, a family physician (FP) program has been implemented since August 2005, funded through universal rural health insurance scheme. In this paper, we aimed to identify facilitators of and barriers to the implementation of the FP in Iran.

  Methods: Data were collected between November 2006 and May 2007 through semi-structured interviews at national (19 interviews), provincial (9 interviews) and local (43 interviews) levels, as well as a purposive document analysis. The framework approach was used for analyzing the interviews. Document analysis followed a narrative contextual framework. We interpreted data using an interpretive framework consisting of multiple streams and network theories.

  Results: The introduction of rural health insurance provided FP advocates with the opportunity to place FP on the policy agenda. They skillfully coupled the two policies and defined FP as the only solution to fulfill the purposes of rural health insurance program. .However, the manner in which policy was formed was the main obstacle to desired implementation of FP.

  Conclusion: The interpretive framework links the concept of outreach to the poor and enhancing equity to rationing health services at a particularly opportune moment in Iran. However, using windows of opportunity to implement a major policy change, if it results in sacrifices in planning and preparedness, may harm the policy and the future success in achieving its objectives.

  Key words: Family physician, universal rural health insurance, implementation, multiple streams, policy networks

 The original paper has been published in Health Policy and Planning (2011, 26(2):163-73). Please cite this revised translation as follows:

  Moshiri E, Takian A, Rashidian A, Kabir MJ. Expediency and Coincidence in Formation of Family Physician and Universal Rural Health Insurance in Iran. Hakim Research Journal 2013 15(4): 288- 299.

  * Corresponding Author: Division of Health Studies, School of Health Sciences & Social Care, Brunel University London, Uxbridge, UB8 3PH, UK. Tel: +44(0)1895268796, E-mail: amir.takian@brunel.ac.uk