Table 1 Analysis of the Sixth Five-Year Economic, Social and Cultural Development Plan of the Islamic Republic of Iran for the Health sector: extracted codes, subthemes, and themes
Theme | Subthemes | Code |
|---|---|---|
Organization and delivery | Improving effectiveness and efficiency of healthcare delivery | Outsourcing health services delivery to non-governmental sector. |
Rationing of health services delivery according to user needs and organized in three levels of health services delivery network | ||
Design and implementation of clinical guidelines for improving healthcare delivery. | ||
Family physician and referral system | Family physician program as the basis for referral system | |
Gatekeeping and controlling patient free transition between the health system levels. | ||
Implementing universal and comprehensive healthcare system to get all Iranians under coverage of the referral system. | ||
Stakeholder participation in service delivery | Petroleum Industry Health Organization extends its network of healthcare providers in oil-rich areas and offshore to compensate for the adverse health impacts of harmful operations. | |
Large companies in mine industry should equip and extend its network of healthcare providers in operational areas to compensate the adverse health impacts of harmful operations. | ||
Extending pre-hospital emergency system | Founding independent organization for pre-hospital emergency system. | |
Health workforce | Human resource development to meet health needs | Health needs as a basis for the capacity of health workforce educational institutions and quality and quantity of health workforces. |
Ministry of Health and Medical Education adjusts the capacity of educational institutions based on local health needs and gaps. | ||
Dual practice of specialist physicians and dentists are only allowed in deprived areas. | ||
Human resource development to support health system’s strategies and structures | Human resources for health are educated and trained according to needs of referral system and family physician program. | |
Ministry of Health and Medical Education provides health/medical graduates for provider networks of Social Security Organization. | ||
Information | Electronic health records for Iranian populations | Electronic health records for all Iranians |
Information systems to facilitate or substitute brick-and-mortar health service delivery | Electronic health service delivery | |
Information system for health centers | ||
Information systems for health financing function | Information system for Health insurance services | |
National data warehouse of health insurance enrollees | ||
Strategic purchasing supported by online infrastructures | ||
Access to medicines | Design and implementation of a system for medicine | Design and implementation of generic medicine |
Develop a list of (essential) medicines | ||
Design and implementation of a system for medicine | Design and implementation of national drug system | |
Provision of generic medicine | Provision of generic medicines | |
Financing | Effective payment methods | Drug reimbursement only based on the approved list of generic medicine. |
Strategic purchasing of health services | ||
Purchasing based on clinical guidelines | ||
Pay for performance for outsourced health services. | ||
MoHME to define benefit package | Define benefit package of health services | |
Fair and secured process of pooling | Prepaid arrangements | |
Mandatory enrolment in basic health insurance | ||
To determine contribution based on income level. | ||
Secured process for contribution collection. | ||
State subsidies to pay for the premium of extremely poor. | ||
Revenue generation | 10 % increase in costs of divorce cases and allocation of collected money to reimburse costs of before-marriage genetic examinations. | |
Revenue generation through taxing harmful products. | ||
Governance and leadership | Compliance to fee schedules | Punishment for not adhering to tariff schedules. |
Compliance to prohibiting the dual practice of medical doctors, pharmacists, and dentists | Prohibiting the dual practice of medical doctors, pharmacists, and dentists in public and private sectors simultaneously. | |
Compliance of all providers and insurers to policies made by MoHME | Mandating adherence of providers to decisions of MoHME. | |
All providers and insurers follow MoHME policies. | ||
Health resource stewardship | Centralized management of financial resources | |
MoHME as financial manager of health resources | ||
Acquisition of Iran Health Insurance Organization by MoHME | ||
Social insurance policy integration | Unified insurance policies and procedures | |
Standardize all insurance policies and procedures | ||
Standardize health benefit package | ||
Standardize health insurance premium calculation method | ||
Payer-provider split | Strategic purchasing while reducing the ownerships of health organizations by MoHME. | |
Strategic purchasing while reducing the provision of care by MoHME. | ||
Outsourcing health system functions that have no governance features | ||
Stakeholder participation, responsibility, and management | Making oil and mine industries responsible for their likely harmful operations on health | |
Ministry of Industries, Mines, and Trade determines retail prices of tobacco products for tax purposes | ||
Ministry of Industries, Mines, and Trade provides access to information on the import and production of tobacco products for Iranian National Tax Administration | ||
Ministry of Agriculture provides Iranians with healthy foods | ||
Ministry of Health determines the capacity and number of medical/healthcare undergraduate and postgraduate students of governmental and nongovernment educational institutions. |