Challenges of the Out-of-Pocket Payment Program in the Health System of Iran: A Qualitative Study

Abstract

Background: The health transformation plan was implemented in Iran with eight service packages in 2014. However, it has faced various problems and barriers since no pilot programs were launched. Objectives: The present study aimed to investigate the challenges of the out of pocket payment in the health system of Iran. Methods: The required data for this applied qualitative study were collected through semi-structured interviews with 30 policymakers and planners of the health system of Iran in 2020. It must be noted that the participants were selected using the purposeful sampling method. The obtained data were entered into MAXQDA software (version 10) and analyzed through the content analysis approach. Results: The data analysis resulted in five themes: 1) weakness in the structure of health expenditure management, 2) weakness in the structure of policy and plan development, 3) low effectiveness and efficiency of the health system, 4) lack of opportunities to identify the challenges facing the Ministry of Health, 5) consequences of the program. They were categorized into 12 concepts and 79 sub-themes, and the challenges were extracted from them. Conclusion: By identification of the opportunities and challenges of the out-of-pocket payment, the results of this study can provide a suitable framework for observation and evaluation of the payment reduction program in the health system of Iran. Moreover, the findings offer good suggestions for policymakers and planners in different stages of the program.