Factors Affecting Implementation of the Policy of Reducing Public Share of Health Spending in Iran: a Qualitative Study

Pourreza A¹ (PhD), Sharifi M^1,2* (PhD), Mahmoudi M³ (PhD), Vedadhir A⁴ (PhD), Fayaz-Bakhsh A^5,6 (MD, MSc, PhD)

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

Tehran University of Medical Sciences, Tehran, Iran

² Health Economics Research Center, Petroleum Industry Health Organization, Tehran, Iran

³ Department of Epidemiology and Biostatistics, School of Public Health,

Tehran University of Medical Sciences, Tehran, Iran

⁴ Department of Anthropology, Faculty of Social Sciences, Tehran University, Tehran, Iran

⁵ Health Information Management Research Center, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran

⁶ Department of Health Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Original Article

Received: 14 Apr 2015, Accepted: 25 Jun 2015

Abstract

Introduction: From beginning of the Fourth Development Plan in Iran, the policy of reducing public share of health spending was formally adopted by targeting the reduction of out of pocket payments to less than thirty percent. The policy was also considered in the Fifth Development Plan. However, during implementation of the program (2005 to 2013), out of pocket payments not only did not decrease but increased so far. This study aimed to investigate the reasons for failure of this policy.

Methods: In this qualitative study, 39 key informants were interviewed using purposive sampling method. Data were also gathered from related documents. Data were analyzed using the Walt and Gilson triangle model analysis.

Results: The data were classified within four categories: 1) actors (including conflicts of interest and power installation; 2) content (including internal logic and cohesion objectives); 3) context (including political feasibility, environmental impact, resource and structure); and 4) process (including monitoring and evaluation, stakeholder involvement and stewardship and leadership).

Conclusion: The behavior of the main political actors, were influenced by individual and group factors such as conflicts of interest and power of discourse. This policy failed within the context of the government's lack of political commitment, economic shocks, and lack of social support from interaction of regulatory bodies.

Keywords: policy, implementation, public share of health spending, Iran

Please cite this article as follows:

Pourreza A, Sharifi M, Mahmoudi M, Vedadhir A, Fayaz-bakhsh A. Factors Affecting Implementation of the Policy of Reducing Public Share of Health Spending in Iran: a Qualitative Study. Hakim Health Sys Res 2015; 18(2): 171- 181.