Table 2.
Strategic purchasing problems in IHIO, 2015
| Theme | Subtheme | |
|---|---|---|
| 1 | Laws and regulations referred to strategic purchasing | - Article 29 of the Constitution of the Islamic Republic of Iran- The law of public health insurance (1994)- 5th and 6th Five-Year National Development Plan and Health Insurance - Instructions on the law of physicians and allied health professions services in 1996 approved by the Islamic Parliament - Lack of law, regulation and instruction or rule based on IHIO functions for strategic purchasing |
| 2 | Organization of the strategic purchasing function | - Lack of provider and purchaser split (PPS) in several functions of the welfare and health ministries- Lack of written mission in the IHIO, for strategic purchasing- Lack of standard structure, and functions for IHIO related to strategic purchasing- Lack of reasonable structure, process and outcome for strategic purchasing in public and private sectors- Lack of strategic planning for strategic purchasing- Lack of vertical and horizontal cooperation for strategic purchasing- Lack of private and public-sector cooperation for strategic purchasing |
| 3 | Qualified and authorized providers | - Lack of suitable methods and control processes, e.g. evaluation, validation, and accreditation for providers’ services- Lack of standard structure, process, and outcome in services providing- Lack of training, retraining, and training applications for services providers- Variability in quantity and quality of provided services due to not being based on proper and approved clinical protocols and guidelines- Lack of needs assessment and priority setting for services providers |
| 4 | Right type of services | - Lack of appropriate and approved clinical protocols, guidelines, procedures, and policies for services that will be purchased, it leads to a reduction in service quality levels and then rising costs- Ignoring indicators of quality, efficiency, effectiveness, and safety for services - Failure to use appropriate and approved standard of the structure, process, and outcome in providing services- Lack of consisting 3 dimensions of coverage (group, services and cost) for vulnerable groups- Lack of accessibility, affordability, availability, and comprehensiveness of services |
| 5 | Right type of contracts | - Not paying attention to the structure of market components and dominations in the contracts- Lack of suitable incentive in the purchase- Lack of appropriate mechanisms in payments and purchases |
| 6 | Target groups for purchasing | - Lack of identification of vulnerable groups for purchasing- Overlapping in groups coverage by related health insurance organizations- Absent sustainable universal health coverage in related health insurance organizations |
| 7 | Resources allocation, financing, and pricing system | - Lack of enough financial resources to strategic purchasing accordance with volume and variations of UHC in IHIO- Lack of sufficient transparency in financial resources- Lack of tariff and pricing system to determine the price of services- Lack of appropriate and sustainable financing system and risk assessment- Lack of attention to efficiency and effectiveness in financing |
| 8 | Purchasing, as improving performance and quality | - Improve the health status level of the community and especially the primary health care- Increasing commitment and accountability- Improve equity and accessibility to services- Improve technical and allocative efficiency, and economy in the scale- Improve the level of quality, performance and effectiveness indicators of services- Empowering citizenship |
| 9 | Purchasing, as shaping the market and competition | - The number and volume of the purchasers- The degree of patient choice of purchaser- The degree of patient care which directly developed policy of purchaser- The degree of choices involved in purchasing contracts that patients agree with- The degree of control of clinical services, used by the patients, which is included in the purchasing contracts- Content of services which may be variables- The terms and conditions placed in contracts by purchaser and refer to how to compete with providers- Lack of competition between healthcare providers as a consequent of provider and purchaser split (PPS) |
| 10 | Purchasing as health progress state of people and society | - Assessment of needs, demands and responsibilities- Specify the cycle: Need assessment, Determining of the care, Purchasing the care, Monitoring the outcome- Determining the details of the health state problems of society- Determining the prevalence and incidence for each disease- Determining the available and needed services for the community- Determining the effectiveness and/or the cost-effectiveness for services delivered to the community in health state related subjects- Designing appropriate health care models for the community- Determining the goals, objectives, and outcome in the health status of the community |
| 11 | Guided purchasing and stewardship of government | - Directing the purchase by organizing- Directing the purchase by financing- Directing the purchase through the appropriate payment system- Guiding the purchase through the proper laws and regulations- Guiding the purchase through shaping customer behavior- Stewardship as accountability and responsiveness- Stewardship and the level of government participation (public, semi-public and private) |
| 12 | Structure of decision-making process in the health and welfare ministries | - Economic barriers- Political obstacles- Social and cultural barriers |