Analysis of the Health Sector Evolution Plan from the perspective of equity in healthcare financing: a multiple streams model

• Published date: 07 May 2019
• DOI: https://doi.org/10.1108/IJHRH-07-2018-0044
• Date: 07 May 2019
• Pages: 124-137
• Author: Telma Zahirian Moghadam,Pouran Raeissi,Mehdi Jafari-Sirizi
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work, economy & organizations

Analysis of the Health Sector Evolution Plan

from the perspective of equity in healthcare

financing: a multiple streams model

Telma Zahirian Moghadam, Pouran Raeissi and Mehdi Jafari-Sirizi

Abstract

Purpose –Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in

Iran’s health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose

of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing

(EHCF) using the multiple streams model.

Design/methodology/approach –This qualitative study was conducted by 26 documents review and

analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected

based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist

based on the goals. All audio-taped interviews were transcribed and analyzed thematically.

Data management and analysis were performed using the framework analysis in MAXQDA software.

Findings –The framework analysis identified 12 complementary sub-themes totally. Problem stream

included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low

EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran

World Health Organization’s report in 2000, the Targeted Subsidies Law and emphasis on equalizing

healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes.

Finally, political stream showed four sub-themes including strong support from the Minister of Health for

HSEP, mass media, the pressure of WHO and people’s request to reduce health costs.

Research limitations/implications –The limitations of the present study included paying attention to one

package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of

similar national and international evidence in implementation framework.

Practical implications –The results of this study can be used to analyze other health sector reforms around

the word and can help the formulation and implementation of most practical reforms, especially in field of

health system financing.

Social implications –This study gives a holistic view about health system policy setting that can be used for

understanding policy-making streams to population.

Originality/value –This is the first study that has examined HSEP (the biggest health sector reform in Ira n) from

the perspective of agenda setting. In addition, using the popular and well-known Kingdon’s model to explain HSEP

agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views

by including highly informed people increased the strength of the results of the study. In addition, the short interval

between the interview and reviewing the results on reforms reduced the recall bias of the partic ipants in the study.

Keywords Healthcare, Agenda setting, Equity in healthcare financing, Healthcare reform,

Multiple streams model

Paper type Research paper

1. Introduction

An illness has severalconsequences in poor households,such as absenteeism and temporary or

permanent dropouts, loss of incomeopportunities or even selling theirhouse and its equipment to

restore health (Kavosi et al., 2012; Mirabedini et al.,2017).Theillnessalsocausespovertyof

householdsdue to exposure to direct costs in terms of Out OfPocket (OOP) or indirect healthcare

expendituressuch as loss of income and job (Mirabedini et al., 2017; Mohantyand Kastor, 2017).

Equity in healthcare financing (EHCF) can eliminate the limitationsand barriers of access to health

services for underprivileged and less affluent societies and reduce poverty, as a result.

Received 6 July 2018

Revised 21 July 2018

Accepted 26 July 2018

Telma Zahirian Moghadam is a

PhD Student in Health Policy, at

the Department of Health

Services Management, School

of Health Management and

Information Sciences, Iran

University of Medical Sciences,

Tehran, Iran; and Health

Management and Economics

Research Center, Iran

University of Medical Sciences,

Tehran, Iran.

Pouran Raeissi and Mehdi

Jafari-Sirizi are both based at

the Department of Health

Services Management, School

of Health Management and

Information Sciences, Iran

University of Medical Sciences,

Tehran, Iran.

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VOL. 12 NO. 2 2019, pp. 124-137, © Emerald Publishing Limited, ISSN 2056-4902 DOI 10.1108/IJHRH-07-2018-0044