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Identifying the Factors Affecting the Health Care System in Iran with Using Content analysis

Parivash Heidari Orejlo

1

, DR SHaghayegh Vahdat

2

*, DR Hasan Soltani

3

1 PhD Student in Health Services Management, Department of Health Services Management, Islamic Azad University of Shiraz Branch, Shiraz, [email protected]

2 Assistant Professor, Department of Health Services Management, Faculty of Management, Islamic Azad University, South Tehran Branch, Tehran, Iran. Author )[email protected](

3 Assistant Professor of Management, Islamic Azad University of Shiraz.Shiraz.Iran. [email protected]

*Corresponding author

ABSTRACT

Social welfare is one of the main goals of governments, and the health system is one of its key pillars. This has led the government to improve the access of individuals to health care by financing health systems, such as protecting and regulating the private sector in The health system, the allocation of state subsidies for low-income group health insurance and long-term support for treatment insurance. With the knowledge of the number of different sources of resources in financing the health system of the country, we can provide useful information for planning justice-based health policies and government interventions based on poverty reduction. Health education has been developed to improve the health of the community by providing health services and prevention, but sometimes access to these services, especially in low-income countries, leads to poor households. Understanding how to provide financial resources for the health system to finance the activities of the health sector and identify the patterns of credit concerning the development of the socioeconomic level, capacity and financial infrastructure, the ability to implement, responsibility and political accountability for policies It can be used as a basis for planning justice-oriented health policies. This study examines and identifies health financing models in researches using content analysis. The results showed that factors identified in 22 basic themes and 6 organize themes included Allocation of funds, Health-centered services, Tax system, Disease Fund, Financial partnership, and Profitability.

Keywords

Healthcare, Services, Financing, Tax,

Introduction

Context

Since there are various studies and researches on the health financing system, it is necessary to customize the factors related to the Iran health care system to conduct a systematic study. The content analysis method is used.

Objective

- What are the factors affecting the implementation of Iran's health care system?

Data Sources

For qualitative content analysis, data were extracted from the articles based on the keywords listed in Table (1). The keywords were then searched in the databases that were identified. The criterion for selecting the article was the existence of one of these keywords in the article title. Due to a large number of articles, the priority of analyzing articles with those indexed in the database since 2008 was prioritized. Since some articles are not indexed in popular databases or cannot be freely accessed, Google Scholar has also been searched. The criterion for selecting articles for analysis from 2008 to 2018 was a content-based overview and electronic content. However, 20 articles for analysis were not identified from the beginning. Rather, the article was purposely selected based on its relevance to the topic, content analysis, and then another article was selected and analyzed. Therefore, reaching the theoretical saturation in some categories has led to the selection of the next article.

Keyword Database Number of

Article

Number of

Selection article

1. Healthcare system 1.Proquest 55

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2. Healthcare Financing 3.System Factors Affecting the Health Financing System 4. Success Factors of the Health Financing System

2. Science direct 3.Springer

4. Google Scholar 20

Fig1. Data sources Study Selection

The refinement criteria and the selection of articles were related to the objectives of the research and the applicability of the mentioned factors, which resulted in the identification of the categories and subcategories related to the health system. Articles on the health financing system were analyzed. A table similar to Table (1) was used to analyze the data.

Table1. Coding steps in content analysis

Num Key Sentences Code Basic Themes Organize Themes

1 2 3

Data Extraction

At first, each article text was read once for a general overview. Then, in the context of content analysis, the reading of the text began and continued as a code. In such a way that the unit of record was considered to be a theme rather than a word, sentence, paragraph, or whole text. Codes are for semantic units used to describe or infer information during a content analysis study. After coding the semantic units and reaching the saturation level, they were categorized according to the similarity of the codes, and finally, 22 basic themes and 6 organize themes of qualitative data emerged (Table 2).

Table 2. Basic themes and organize themes of qualitative data emerged

Organize themes Basic themes Reference

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Result

The factors identified in the health financing system are divided into sixth categories: Allocation of funds, Health- centered services, Tax system, Disease Fund, Financial partnership, and Profitability. Research Results Compared to the Results of Calashir et al. (2014), Burton & Mason (2013), Zari et al. (2006) Research on Dimensions Related to the Budgeting System to Provide Systems and Guidelines Implementation of the financing system was not addressed, and the research did not mention how the process of financing the health system was performed. Percker (2014), Orszack (2010) in the context of health-centered services have not addressed how to culturally and how to access social media and national media. Kotzen (2017), Fernandez (2014) does not mention social responsibility services involving the organization of patients who are not financially capable. The results obtained in the present study in the Structural Factors section with Legiton (2011), Gill (2010) research share a view of how to finance tax.

In light of the results, the following suggestions for implementing strategies and policies in health-related organizations are presented:

1) Given the increase in the relative prices of health goods and services in the country and the role of government Allocation of funds

Budget allocation process Savedoff et al (2012). Jowett et al (2016). Farahani et al (2010).

Preparing the payment process Kelly et al (2007). Wagstaff et al (2017)

Preparing budget guidelines Greer et al(2015)

Funding funds Tangcharoensathien (2015)

GBD (2015)

Implementation of the system Savedoff et al (2012). Greer et al (2015)

Health-centered services

Core Thinking Culture United Nations. Transforming (2015). Greer et al(2015)

National Health Media Greer et al (2015). Wagstaff et al (2017)

Health-oriented advertising Tangcharoensathien (2015) GBD (2015)

Tax system

Taxonomy of Culture Kelly et al (2007). Wagstaff et al(2017)

Implementing the tax system Greer et al(2015)

Income Tax Mechanism United Nations. Transforming (2015). Greer et al(2015)

Getting tax Kelly et al (2007). Wagstaff et al (2017)

Pay health subsidies Savedoff et al (2012). Jowett et al(2016). Farahani et al(2010).

Financing subsidies Wagstaff et al (2017) Disease Fund Patient Protection Fund Tangcharoensathien (2015)

Health care mechanism GBD (2015)

Financial partnership

Financial participation through the stock exchange

Kelly et al (2007). Wagstaff et al (2017)

Government financial participation Savedoff et al (2012). Jowett et al (2016). Farahani et al(2010).

Foreign investment in the health sector Tangcharoensathien(2015) GBD (2015)

Profitability

Pay attention to earning profit Kelly et al (2007). Wagstaff et al (2017)

Providing Sustainable Revenues Tangcharoensathien (2015) GBD (2015)

Cost control Kelly et al (2007). Wagstaff et al (2017)

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spending in the health sector in the development process, more attention should be paid to increasing the share of public credit (health share from per capita production). It should be noted that, as seen from the results of the study, this increase is also due to the role of government and oversight in the formulation of essential commodities in the

countries under study.

2) Financing through Taxes and Duties, because the tax system can provide some insights into how to manage the economic situation, management risks and purchasing power of the community, which have many advantages and disadvantages. However, the implementation of this system may also present common challenges in the effective management of public service delivery and problems due to poor or unstable accountability. Ways that can be obtained in addition to income tax, value-added tax, profit tax, indirect tax, direct tax, etc., can increase the taxation of health risk sources and allocate it to the health system. Be it.

3) Determination of per capita and tariff of medical services according to the cost of services 4) Cohesive relationship between the private sector and the public sector in the provision of health services and the development of specific oversight rules on how the private sector operates, given the constraints on government

resources and market failure in the field of health.

5) Designing and operating a comprehensive information system to ensure the accuracy and ease of information flow and prevent insurance overlap.

6) Organizing charitable status in terms of inputs and expenditures, given the size of support institutions and the existence of charities in the country, and in some areas donating donations directly through the central government channel to the group. The target groups are allocated or provided to non-governmental organizations. In short, there is no regular list of foreign and charitable donations in this area in terms of income and expenditure, which are well- organized. The finances and expenses of these associations are essential.

Conflict of Interests:

There is not any Conflict of Interests.

References

[1] Savedoff WD, Ferranti D de, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. Lancet 2012; 380: 924–32.

[2] Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health

coverage—effects of alternative tax structures on public health systems: cross-national modeling in 89 low- income and middle-income countries. Lancet 2015; 386: 274–80.

[3] Savedoff W, Ferranti F, Smith A. Transitions in health financing and policies for universal health coverage.

http://www.r4d.org/ wp-content/uploads/THF-Summary-Transitions-in-HealthFinancing-and-Policies-for- Universal-Health-Coverage.pdf (accessed Feb 14, 2018).

[4] Jowett M, Petro Brunal M, Flores G, Cylus J. Spending targets for health: no magic number. Geneva, World Health Organisation, 2016. http://www.who.int/health_financing/documents/no-magicnumber/en/ (accessed Feb 14, 2018)

[5] Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 2017; 389: 2005–30.

[6] Institute for Health Metrics and Evaluation. Financing global health. http://www.healthdata.org/data- visualization/financingglobal-health (accessed Dec 19, 2017).

[7] GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390: 231–66.

[8] World Bank. World Bank country and lending groups—world bank data help desk.

https://datahelpdesk.worldbank.org/ knowledgebase/articles/906519-world-bank-country-and-lending groups (accessed Dec 17, 2017).

[9] Farahani M, Subramanian SV, Canning D. Effects of state-level public spending on health on the mortality probability in India. Health Econ 2010; 19: 1361–76.

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[10] Jensen, K ‘Introduction: The Qualitative Turn’, in K. Jensen and N. Jankowski (eds), A Handbook of Qualitative Methodologies for Mass Communications Research,1991. pp. 1–12. London: Routledge [11] Kelle, U., Prein, G. and Bird, K. Computer-Aided Qualitative Analysis: Theory, Methods and

Practice.1995. London: Sage.

[12] Wagstaff A, Flores G, Hsu J, et al. Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Glob Health 2017; 6: e169–79.

[13] Wagstaff A, Flores G, Smitz M-F, Hsu J, Chepynoga K, Eozenou P. Progress on impoverishing health spending in 122 countries: a retrospective observational study. Lancet Glob Health 2018; 6: e180–92.

[14] Reich MR, Harris J, Ikegami N, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet 2016; 387: 811–16.

[15] GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1345–422.

[16] Wagstaff A, Flores G, Hsu J, et al. Progress on catastrophic health spending in 133countries: a retrospective observational study. Lancet Glob Health2017; 6: e169–79.

[17] United Nations. Transforming our world: the 2030 agenda for sustainable development. New York: United Nations, 2015.

[18] Greer S, Wismar M, Figueras J. Strengthening HealthSystemGovernance: Better Policies, Stronger Performance 2015; 2015, 272 p

[19] Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J, Jongudomsuk P, Sirilak S. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing. Health Policy and Planning 2015;30(9):1152–61.

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