Adapted fairness benchmarks for the evaluation of Iran health system reform.

Abstract

This study has been designed to localize fairness benchmarks for the evaluation of health system reform with an ethical approach. A descriptive-analytic study was applied in which a questionnaire with selected indicators and based on main fairness benchmarks was validated. Besides, the final indicators were chosen for surveys of 255 health equity experts from 31 provinces of Iran to localize fairness benchmarks using the exploratory factor analysis through the SPSS software. Seven fairness benchmarks were adopted: (1) Efficacy, Efficiency, and Quality of Health Care; (2) Impact of Information Infrastructure on Health Reform; (3) Responsiveness; (4) Equitable Access, and Universal Health Coverage; (5) Equitable Financing; (6) Social Determinant of Health; and (7) Financial Barriers to Equitable Access. The priorities of fairness benchmarking through localization included focusing on the quantity and quality of primary health care, allocating resources based on the need; for equitable efficiency, and paying attention to community-based information infrastructure, and social determinants for fair reform. Moreover, respecting patient rights as a part of democratic accountability was more close to equity. Elimination of financial and nonfinancial barriers for health access and coverage based on vulnerability, through fair financing, was also confirmed.