Golestan University of Medical Sciences Repository

Expediency and coincidence in re-engineering a health system: An interpretive approach to formation of family medicine in Iran

Takian, A. and Rashidian, A. and Kabir, M.J. (2011) Expediency and coincidence in re-engineering a health system: An interpretive approach to formation of family medicine in Iran. Health Policy and Planning, 26 (2). pp. 163-173. ISSN 02681080 (ISSN)

[img]
Preview
PDF - Published Version
Download (162kB) | Preview

Abstract

Background: Analysing the evidence generated over decades, the World Health Report 2008 recommended the expansion of primary health care (PHC) to achieve better population health, higher equity and lower costs. Over the last two decades, the Iranian model of PHC has resulted in population health indices that match the best in the region. Despite the extensive PHC networks in rural areas, there was an expansion of private outpatient care and hospital-based services. This model has been inadequate to meet the evolving health needs of the population and increasingly difficult to afford. In response, a family medicine (FM) programme has been implemented since August 2005, funded through Behbar, a model of social insurance. In this paper, we aim to identify facilitators of and barriers to implementation of FM in Iran. Methods: Data were collected between November 2006 and May 2007 through semi-structured interviews at national (19 interviews), provincial (9) and local (43) levels, and through a purposive document analysis. The framework approach was used for analysing interviews. Document analysis followed a narrative contextual framework. We interpreted data using an interpretive framework consisting of multiple streams and network theories. Results: The introduction of Behbar provided FM advocates with the opportunity to place FM on the policy agenda. They skilfully coupled the two policies and defined FM as the only solution to fulfill Behbar. However, the manner in which policy was formed was the main obstacle to desired FM implementation. Conclusion: The interpretive framework links the concept of outreach to the poor and enhancing equity to rationing health services at a particularly opportune moment in Iran. However, using windows of opportunity to implement a major policy change, if it results in sacrifices in planning and preparedness, may harm the policy and the future success in achieving its objectives. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2010; all rights reserved.

Item Type: Article
Additional Information: Unmapped bibliographic data: LA - English [Field not mapped to EPrints] J2 - Health Policy Plann. [Field not mapped to EPrints] C2 - 20732859 [Field not mapped to EPrints] AD - Department of Practice and Policy, School of Pharmacy, University of London, Tavistock Square, London, WC1H 9JP, United Kingdom [Field not mapped to EPrints] AD - Department of Health Management and Economics, School of Public Healt, Tehran University of Medical Sciences, Tehran, Iran [Field not mapped to EPrints] AD - Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom [Field not mapped to EPrints] AD - National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran [Field not mapped to EPrints] AD - Department of Health and Social Medicine, Golestan University of Medical Sciences, Gorgan, Iran [Field not mapped to EPrints] DB - Scopus [Field not mapped to EPrints]
Uncontrolled Keywords: Behbar, Family medicine, implementation, multiple streams, policy networks, rural health insurance, article, general practice, health care cost, health care delivery, health care organization, health care planning, health care policy, health insurance, health promotion, health service, human, interview, Iran, organization, organization and management, primary health care, statistics, Efficiency, Organizational, Family Practice, Health Care Rationing, Health Expenditures, Health Planning, Health Policy, Health Promotion, Health Services Accessibility, Health Services Needs and Demand, Humans, Insurance, Health, Interviews as Topic, Iran, Organizational Objectives, Primary Health Care
Subjects: مقالات نمایه شده محققین دانشگاه در سایت ,Web of Science ,Scopus
موارد کلی
Divisions: معاونت تحقیقات و فناوری
Depositing User: GOUMS
Date Deposited: 18 Apr 2015 04:33
Last Modified: 16 May 2015 15:40
URI: http://eprints.goums.ac.ir/id/eprint/2135

Actions (login required)

View Item View Item