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Table 4 Main characteristics and key findings of hospital organizational reforms in Iran

From: A scoping review of public hospitals autonomy in Iran: from budgetary hospitals to corporate hospitals

Preker Spectrum Autonomization Corporatization
Hospital autonomization policy Independent hospital policy BT hospital policy Hospital corporatization policy
Start date 1994 2017 2005 1993
End date 2005 cont. cont. cont.
Included hospitals 41 35 56 7
Included studies 7 0 10 3
Key findings •The autonomy granted to the hospitals was unbalanced and paradoxical.
•More decision rights should be granted for management of strategic, human, physical, and financial resources.
•The hierarchical bureaucratic structure should be transformed into a modern participatory structure.
•Governance and regulatory mechanisms were ineffective.
•Stakeholders with different and conflicting objectives led to the inefficiency of the policy during the implementation phase.
•Focusing on ideology and ignoring the context of policy led to its failure.
•Parallel reforms should be made in financing and payment methods) such as setting tariffs based on scientific principles and prospective payment systems)
•Disparities in tariffs between public and private sectors reduced the ability of autonomous hospitals to compete in the healthcare market.
•Some hospitals were not the sole residual claimant and some hospitals were subsidized contrary to the principles of autonomization.
•Little attention was given to evidence and there was a dearth of research on the hospital autonomization policy years into its implementation.
•There is no evidence so far •Different dimensions of the policy were not implemented in a balanced manner.
•In theory, with the modern structure of the board of trustees, autonomy was granted to hospitals, but in practice, these hospitals are still controlled by the central government.
•Unsustainable financing and inefficient payment system hindered the successful implementation of the policy.
•Due to financial burden, the policy was not supported by insurance organizations.
•Poor interaction with key stakeholders, especially insurance organizations, resulted in unsustainable financing.
•Evidence on policy evaluation, especially the number of studies, has increased, but other aspects of policy such as the appropriate structure and composition of the board of trustees, regulatory arrangements, performance reporting methods and hospital accountability have received less attention.
•The structure of the board of trustees, including the number of board members and board composition, were inappropriate and board sessions were not held regularly.
•Inefficient governance and regulatory arrangements such as ambiguity in implementation laws s and unclear accountability mechanisms
•Decision rights regarding human resource management were limited.
•The results of quantitative studies do not indicate better performance of board of trustees hospitals than budgetary hospitals
•Scientific evidence on the efficiency and effectiveness of the policy is lacking even in 2020, i.e. 22 years after its implementation (1993).
•The results of quantitative studies are not generalizable due to a small sample size or unreliable methodology.
•Financing, monitoring and evaluation, and changes in payment and human resource management systems are considered the most important factors that affect SSO’s Healthcare Holding
•poor governance mechanisms, weak internal controls, low commitment to corporate governance, and poor regulatory arrangements are among the possible reasons for the failure of this policy, but further research is needed