Leila Doshmangir1, Arash Rashidian2, Mehdi Jafari3, Amirhossein Takian4, Hamid Ravaghi5. 1. Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran, Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. arashidian@tums.ac.ir. 3. Department of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran, Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. 4. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, School of Health and Life Sciences, Brunel University London, Uxbridge, UK. 5. Department of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Abstract
INTRODUCTION: Policy formulation and adoption often happen in a black box. Implementation challenges affect and modify the nature of a policy. We analyzed hospitals' autonomy policy in Iran that was intended to reduce hospitals' financial burden on government and improve their efficiency. METHODS: We followed a retrospective case-study methodology, involving inductive and deductive analyses of parliamentary proceedings, policy documents, gray literature, published papers and interview transcripts. We analyzed data to develop a policy map that included important dates and events leading to the policy process milestones. RESULTS: We identified four time-periods with distinctive features: 'moving toward the policy' (1989 - 1994), disorganized implementation' (1995 - 1997), 'continuing challenges and indecisiveness in hospitals financing' (1998 - 2003), and 'other structural and financial policies in public hospitals' (2004 to date). We found that stakeholders required different and conflicting objectives, which certainly resulted in an unsatisfactory implementation process. The policy led to long-lasting and often negative changes in the hospital sector and the entire Iranian health system. CONCLUSION: Hospital autonomy appeared to be an ill-advised policy to remedy the inefficiency problems in low socioeconomic areas of the country. The assumption that hospital autonomy reforms would necessarily result in a better health system, may be a false assumption as their success relies on many contextual, structural and policy implementation factors.
INTRODUCTION: Policy formulation and adoption often happen in a black box. Implementation challenges affect and modify the nature of a policy. We analyzed hospitals' autonomy policy in Iran that was intended to reduce hospitals' financial burden on government and improve their efficiency. METHODS: We followed a retrospective case-study methodology, involving inductive and deductive analyses of parliamentary proceedings, policy documents, gray literature, published papers and interview transcripts. We analyzed data to develop a policy map that included important dates and events leading to the policy process milestones. RESULTS: We identified four time-periods with distinctive features: 'moving toward the policy' (1989 - 1994), disorganized implementation' (1995 - 1997), 'continuing challenges and indecisiveness in hospitals financing' (1998 - 2003), and 'other structural and financial policies in public hospitals' (2004 to date). We found that stakeholders required different and conflicting objectives, which certainly resulted in an unsatisfactory implementation process. The policy led to long-lasting and often negative changes in the hospital sector and the entire Iranian health system. CONCLUSION: Hospital autonomy appeared to be an ill-advised policy to remedy the inefficiency problems in low socioeconomic areas of the country. The assumption that hospital autonomy reforms would necessarily result in a better health system, may be a false assumption as their success relies on many contextual, structural and policy implementation factors.
Authors: Mohammad Bazyar; Arash Rashidian; Sumit Kane; Mohammad Reza Vaez Mahdavi; Ali Akbari Sari; Leila Doshmangir Journal: Int J Health Policy Manag Date: 2016-02-11
Authors: Seyed Mohammad Esmaeil Fazl Hashemi; Ali Sarabi Asiabar; Aziz Rezapour; Saber Azami-Aghdash; Hassan Hosseini Amnab; Seyed Abbas Mirabedini Journal: Med J Islam Repub Iran Date: 2017-12-14