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Identification and Prioritization of the Effective Factors on Evidence-Based Decision Making in the Health Policy of Iran
Ali Ayoubain, Amir Ashkan Nasiripour, Seyed Jamaledin Tabibi, Mohammadkarim Bahadori,
Volume 2, Issue 2 (9-2019)
Abstract
Introduction: Evidence-based decision making plays an important role in the health system. Decision-making is based on observable results and real information, and it will naturally be easier to achieve the desired output. Therefore, this study aimed to identify and prioritize evidence-based decision making in health policy.
Methods: This is a descriptive-analytic study that was carried out in 2019. The population of the study consisted of all experts in the health system of Iran. Twenty people were selected through targeted sampling. The data gathering tool is a pairwise comparison questionnaire. Data were analyzed using Expert Choice Version 11 software.
Results: According to the findings of this study, external factors, data factors and evidence-based models with the highest weight of 0.649 have the highest weight. In addition, in internal factors, the IT factor with the weight of 0.415 have the highest weight. In general, data and evidence-based models and IT and IT have the highest weight and communication and trust respectively of 0.015 and 0.013, respectively, among the lower limitations of the number of factors derived from evidence-based decision-making methods in the field of health management.
Conclusions: The results of this study showed that a total of 10 structures in evidence-based decision making in the health system of Iran. Therefore the managers and policy makers can identify the best evidence and make the best decisions in an evidence-based decision-making process.

Designing a Strategic Purchasing Model for Health Services of the Social Security Organization
Hamid Mohammadi, Shahram Tofighi, Mostafa Rajabi, Hamidreza Izadbakhsh, Bahar Hafezi,
Volume 4, Issue 3 (12-2021)
Abstract
Introduction: Strategic purchasing in health services has been one of the basic components in improving performance and one of the most important issues in order to improve the health system in the world. Although the Ministry of Health and insurance organizations in Iran sometimes address the issue of strategic purchasing goals, it is not possible to achieve or even implement it due to existing problems. For this purpose, this study was conducted to identify the most important factors affecting the launch of strategic procurement of health services and its implementation in the treatment department of the Social Security Organization and to provide an applicable model.
Methods: This is a qualitative study that was conducted in 2020 to identify the factors affecting the implementation of strategic procurement of health services in the Social Security Organization and provide a local model in two stages. In the first step, semi-structured interviews were used to extract important factors in the field of strategic purchasing. In the second step, the Delphi method was used to determine the approval or non-approval of the factors influencing the strategic purchase in the Social Security Organization.
Results: In this study, 6 subjects and 40 sub-subjects were extracted. The main topics of the research include: target groups, social structure, insurance structure, management and coordination of departments, knowledge and information systems and service providers. The two main issues of interest to experts were the target groups and the structure of insurance. The highest score of consensus among experts on the following topics included health needs assessment and prioritization of target groups, equitable allocation of resources, income level of covered individuals, and strategic purchasing discourse.
Conclusion: According to the model, most attention is paid to the role of target groups and insurance structure as a leader in purchasing health services and a suitable distributor of services. It is important that the Social Security Administration is able to communicate with providers and select the best providers and receive price information through competition in the most appropriate mechanism. Also, with this model, it can strategically purchase the best and most effective services for its insured individuals. The practical model presented in this article can help the development of health systems to overcome the existing obstacles in the implementation of strategic purchasing progress. This model meets the need for knowledge necessary for strategic purchasing of health services.

Performance Evaluation Indicators of Iran Health Insurance Organization Based on Macro Policies
Efat Mohamadi, Ahad Bakhtiari, Mohammad Mehdi Nasehi, Mohammad Effatpanah, Mehdi Rezaei, Zahra Shahali, Amirhossein Takian, Alireza Olyaeemanesh,
Volume 7, Issue 1 (6-2024)
Abstract
Introduction: The performance evaluation of the Iranian Health Insurance Organization (IHIO), considering the responsibilities, objectives, and duties outlined in the higher-level documents and laws, is an important issue that has received less attention. Given the importance of systematic monitoring and evaluation to facilitate planning based on overarching domestic policies, it is necessary to adopt a suitable approach to monitor programs and policies and to respond to higher-level authorities to fulfill assigned tasks. The present study aims to identify performance indicators for IHIO based on the analysis of relevant higher-level documents and laws.
Methods: This study was conducted qualitatively and based on content analysis of documents, policies, and executive activities related to monitoring the performance of IHIO, from the year the Universal Health Insurance Law of the country was passed (1373) until 1402, in the year 1402 (Solar Hijri calendar, equivalent to 2023/2024 Gregorian calendar). The Scott method was used to examine the validity of the documents, and qualitative content analysis and the deductive approach were employed to analyze the data.
Results: Nine policies related to monitoring the performance of the IHIO were identified, with 11 themes and total of 188-indicators identified as follows: Population indicators (8 indicators), National Health Accounts (NHA) (13-indicators), Covered population (25-indicators), Covered health services (19-indicators), Covered costs/financial participation status (11-indicators), Organization’s financial resources (26-indicators), Contracted centers (11-indicators), Cost trends, cost burden, and visit burden (23-indicators), Monitoring indicators (11-indicators), Operational efficiency of the organization (30-indicators), Access to services and health outcomes (11-indicators).
Conclusion: In order to conduct a thorough and comprehensive evaluation of the Iranian Health Insurance Organization's performance, which aims to enhance transparency and public trust in the organization, it is imperative to take into account a diverse range of indicators that encompass all operational and performance aspects of a health insurance entity. Additionally, national macro indicators, including population metrics and national health accounts, play a crucial role in this process. Failing to consider these indicators may lead to challenges and biases when assessing the organization's performance.

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