Abstract
BackgroundIranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting.MethodsIt was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014. In order to retrieve the related documents, we searched the official websites related to the Ministry of Health and Medical Education, four main Iranian insurance organizations, the Health Committee of the Parliament Profile, strategic vice president’s site and Supreme Insurance Council. After recognition of documents, their credibility and authenticity were evaluated in terms of their publication or adjustment. For the analysis of documents, the four step-Scott method was used applying MAXQDA version 10.ResultsFindings illustrated that health service purchase challenges in the country can be classified in 6 main themes of policy-making, executive, intersectional, natural, legal and informational challenges with 26 subthemes. Furthermore, 5 themes of Basic Benefit Package, Reimbursement,Decision making, Technology and Contract are considered as the main Challenges in pharmaceutical purchasing area containing 13 relevant subthemes.ConclusionsIt seems that according to documents, Iran has faced many structural and procedural problems with the purchase of the best health interventions. So it is highly recommended to consider consequences derived from the present challenges and try to use these evidences in their policy making process to decrease the existed problems and move to better procurement of health interventions.
Highlights
Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting
Health services purchasing is defined as a process through which the accumulated resources are allocated to healthcare providers by a resource allocation and purchasing (RAP) agency [1]
In other words, summing up obtained data driven from present condition of the purchase of health services demonstrated the fact that what has been done by insurance organizations regarding the identification of the best providers/suppliers of services follows traditional supervision programs without any potentiality for ranking the best suppliers by the insurance organization and no power for the organization to bargain, negotiate and contract with the best selected supplier and at present, it seems from evidences that a comprehensive program for ranking healthcare providers has been missing yet
Summary
Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. Health services purchasing is defined as a process through which the accumulated resources are allocated to healthcare providers by a resource allocation and purchasing (RAP) agency [1]. Purchase is a procurement mechanism of healthcare services whereby accumulated sources are paid to suppliers in order to carry out a set of effective interventions to promote people’s health [2]. Evidences demonstrate that the insurance companies as RAP agencies may purchase healthcare services with two different methods; passive purchase or strategic/active one [3]. Strategic purchasing defines as the constant search for cost-effective, high quality services by an insurance company to procure the best interventions actively. Evidence emphasizes on the vast range of strategic purchase achievements the same as: cost saving, availability, quality
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