Abstract
PURPOSE: According to the importance of strategic purchasing as a prerequisite for overall access and universal health coverage, this study was conducted to explore requirements and incentives for implementation of pharmaceutical strategic purchasing in the Iranian health system.METHODS: This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis. Data analysis was started right after transcribing each interview applying MAXQDA10. Data was saturated after 32 semi-structured interviews with experts. These key informants were selected purposefully and through snowball sampling.RESULTS: The findings are categorized under three main themes: “Payment Mechanisms to Service Providers”, “Insurance Reimbursement Mechanisms” and “Rules and Regulations”, and eight related subthemes.CONCLUSIONS: According to the importance of incentive interventions in pharmaceutical strategic purchasing, it is necessary to pay close attention to pharmaceutical price, realistic and fair premiums and appropriate contracts with suppliers, along with estimation a reasonable profit margin for pharmaceutical suppliers and the appropriate reimbursement mechanisms as the most significant incentives for increasing access to pharmaceuticals and implementing strategic purchasing.
Highlights
The extents of supply and demand in Iran’s current health system and shortcomings in the referral system have made patients determine their own demand for health goods and services (Mehralian & Bastani, 2015)
The findings are categorized under three main themes: “Payment Mechanisms to Service Providers”, “Insurance Reimbursement Mechanisms” and “Rules and Regulations”, and eight related subthemes
The mentioned insurance organizations must develop a model for strategic purchasing, since Iran's 20-year prospective national vision emphasized the people’s access to effective, healthy, and high-quality pharmaceuticals at a reasonable price (Bastani, Dinarvand, Samad Beik, & Pourmohammadi, 2016)
Summary
The extents of supply and demand in Iran’s current health system and shortcomings in the referral system have made patients determine their own demand for health goods and services (Mehralian & Bastani, 2015). Iranian Health insurance system suffers inefficiency in many aspects like: high Out of Pocket Expenditures (OOP), Fee For Service (FFS) payment to hospitals and physicians as well as low financial protection against health services for the insured and considerable coinsurance rates (Bazyar et al, 2016) To increase their efficiency and promote equity, these organizations need to adopt strategic purchasing of health services, which has been mentioned in Iran’s Fifth Five Year Development Plan (Choobtarashan, 2011). The mentioned insurance organizations must develop a model for strategic purchasing, since Iran's 20-year prospective national vision emphasized the people’s access to effective, healthy, and high-quality pharmaceuticals at a reasonable price (Bastani, Dinarvand, Samad Beik, & Pourmohammadi, 2016)
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