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Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran

BACKGROUND: In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called “hospital autonomy” policy involved giving...

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Autores principales: Doshmangir, Leila, Rashidian, Arash, Jafari, Mehdi, Ravaghi, Hamid, Takian, Amirhossein
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841059/
https://www.ncbi.nlm.nih.gov/pubmed/27102262
http://dx.doi.org/10.1186/s12913-016-1405-7
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author Doshmangir, Leila
Rashidian, Arash
Jafari, Mehdi
Ravaghi, Hamid
Takian, Amirhossein
author_facet Doshmangir, Leila
Rashidian, Arash
Jafari, Mehdi
Ravaghi, Hamid
Takian, Amirhossein
author_sort Doshmangir, Leila
collection PubMed
description BACKGROUND: In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called “hospital autonomy” policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals’ performance, hoping to reduce government’s costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. METHODS: We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. RESULTS: We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals’ organization, feasibility of policy implementation, actors and stakeholders’ support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. CONCLUSIONS: Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result.
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spelling pubmed-48410592016-04-23 Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran Doshmangir, Leila Rashidian, Arash Jafari, Mehdi Ravaghi, Hamid Takian, Amirhossein BMC Health Serv Res Research Article BACKGROUND: In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called “hospital autonomy” policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals’ performance, hoping to reduce government’s costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. METHODS: We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. RESULTS: We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals’ organization, feasibility of policy implementation, actors and stakeholders’ support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. CONCLUSIONS: Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result. BioMed Central 2016-04-21 /pmc/articles/PMC4841059/ /pubmed/27102262 http://dx.doi.org/10.1186/s12913-016-1405-7 Text en © Doshmangir et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Doshmangir, Leila
Rashidian, Arash
Jafari, Mehdi
Ravaghi, Hamid
Takian, Amirhossein
Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran
title Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran
title_full Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran
title_fullStr Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran
title_full_unstemmed Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran
title_short Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran
title_sort fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in iran
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841059/
https://www.ncbi.nlm.nih.gov/pubmed/27102262
http://dx.doi.org/10.1186/s12913-016-1405-7
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