Table 3 The effective factors in the failure of CHE reduction policies in the category of context
Theme | Sub-theme | Category | Subcategory |
|---|---|---|---|
Context | Political | political atmosphere in Iran | Factionalism in health policy making |
The government's opposition to the fourth development plan | |||
Political decisions-making | Lack of political will to implement programs | ||
Lack of public demand | |||
Lack of priority for health in the governance perspectives | |||
Lack of support from political authorities | |||
The superiority of the political component over the technical component of the decision | |||
Situational | Economic factors | Inefficient economic system | |
Economic impulses caused by sanctions | |||
Economic problems caused by the spread of covid-19 | |||
Economic instability | |||
The decrease in gross domestic product per capita (GDP) | |||
The effect of targeted subsidies | |||
The high cost and large copayment for some medical services | |||
The high administrative costs of the departments | |||
Improper payment system | |||
The high inflation in the health sector | |||
Resource shortage problem | Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure [46] (%) | ||
Planning without resource allocation | |||
Insufficient financial resources of the health sector | |||
Resource management | High priority for allocating resources to treatment | ||
Poor resource management | |||
Weakness of compliance with the referral system | |||
Structural | Service delivery structure | Inefficiency of the health insurance system | |
Fragmentations in Iran’s health insurance system | |||
The inefficiency of the public sector in providing quality services | |||
Low financial protection against healthcare expenditures for the insured persons | |||
High coinsurance rates | |||
A notable rate of insurance coverage duplication | |||
Government entrepreneurship in the health sector | |||
Decision making structure | Concentration of policy-making, monitoring and implementation in one institution | ||
Improper organization of health care system components | |||
Incompetence of implementing organizations | |||
Weakness of the health system structure | |||
lack of reliable data and statistics | |||
Lack of transparency of responsibilities | |||
Cultural | Cultural factors | The culture of specialization care in Iran | |
The culture of consumerism in health care in Iran | |||
The public demand for utilizing advanced technologies | |||
The paternalism and medicalization | |||
Changing people's lifestyles | |||
The lack of media in promoting CHE reduction policies | |||
Social factors | Consumer moral hazard | ||
Lack of real health literacy | |||
Lack of public demand | |||
Ignoring policy by the media | |||
Social determinants of health | |||
Supplier induced demand |