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Table 1 Categorization of extracted factors based on an expert panel on Health system Control knob in Iran

From: The influential factors for achieving universal health coverage in Iran: a multimethod study

Financing Payment system Organization Regulation and Supervision Behavior Others
▪ Financial risk protection
▪ Constraints and Structural barriers in Financial
▪ Methods of health system financing (specific tax to health, Sell resources, …)
▪ Sustainability of financing
▪ Health expenditure as % of GDP
▪ Out of pocket
▪ Method of Collecting
▪ Method of pooling money
▪ Strategic purchasing
▪ Health insurance system
▪ International assistance (donation, Charity)
▪ Benefit package
▪ Economic vulnerability in health
▪ International sanctions
▪ Costs Control
▪ Health service tariffs
▪ Per capita income
▪ The economic growth rate
▪ Inflation rate
▪ Exemption or Subsidies for prepayments
▪ Contribution-based on payment capacity
▪ Prepayment mechanisms
▪ Payment systems
▪ Information and interaction of insurance deductions for health
▪ Informal payments
▪ Deductible
▪ Health system Leadership
▪ Management in the health system (Resource management, human resources, Change management, …)
▪ Health infrastructure (technology, information system, …)
▪ The capacity of formulation and implementation of health policies
▪ Structural and functional reforms
▪ Distribution of health provider
▪ Decentralization in decision-making
▪ Non-governmental organizations (Civil society organizations: Private sector, NGOs and charities) participant
▪ Integration or Fragmented degree of the health system
▪ Equity in the distribution of health system resources
▪ Equity in access to health services
▪ Use of Appropriate technology in the health system
▪ The necessity for grading health service centers and giving the insured sufficient notice of this grading
▪ Bureaucratic obstacles
▪ Systematic perspective
▪ Inter and intra-sectoral collaboration
▪ teamwork
▪ Competency and Stability Management
▪ Policies and programs belonging to persons
▪ Effective Services Coverage
▪ Priority health services
▪ Overlaps in healthcare provision
▪ Involving all relevant stakeholders in the policy-making process
▪ Health system efficiency
▪ Government commitment
▪ Have Legal commitment
▪ Problems of law
▪ Political commitment and not having politically look
▪ Good governance
▪ Hasty policy implementation by politicians
▪ Conflict of interest
▪ Quality of health care services
▪ Supporting revision projects and national health indicators development.
▪ Focus on, villagers, nomads, less populated cities poor, disadvantaged and marginalized groups
▪ Family Physician Program
▪ Referral system
▪ Strengthen the central government’s Ministry of Health
▪ Control demands
▪ Regular transparency of revenues, expenditures, and activities
▪ Implement the rules of the World Health Organization
▪ Administrative and employment regulation
▪ Regulate the market of medical equipment
▪ Reviewing job classification schemes according to the needs of the health system.
▪ Electronic Health Record (EHR)
▪ Overlap in population coverage
▪ The dual practice of physician and another health workforce
▪ Competitive space between the providers.
▪ Policy dynamism
▪ Use of clinical guidelines and standards
▪ Performance of Supreme Council of Insurance
▪ oversight parliament
▪ Supervision by the ministry and the university
▪ The presence of specialists in public hospitals
▪ Plan to support the retention of physicians in underserved areas
▪ Assessment and accreditation of the health system performance
▪ Evidence-based policymaking
▪ Health promotion and education
▪ Culture-building
▪ Empowering community
▪ Perceived behavioral control
▪ Issues of urbanization
▪ Absence of obligation for health providers to contract with insurance organizations
▪ Negligence of social factors
▪ Social acceptability of health service
▪ public participation in health promotions programs
▪ Creating an incentive mechanism for behavior change
▪ The pattern of health service utilization
▪ Poverty
▪ Reviewing other countries experiences
▪ The unemployment rate in the country
▪ Active primary health care
▪ International relationship
▪ Health status of health indicators
▪ Prevention and control plans of non-communicable and communicable diseases
▪ Demographic and epidemiologic transitions
▪ Provide community-based services
▪ Health system service preferences (prevention-oriented or treatment-oriented)
▪ Disease Pattern
▪ Knowledge translation