Factors Affecting Implementation of the Policy of Reducing Public Share of Health Spending in Iran: a Qualitative Study

From beginning of the Fourth Development Plan in Iran, the policy of reducing public share of health spending was formally adopted by targeting the reduction of out of pocket payments to less than thirty percent. The policy was also considered in the Fifth Development Plan. However, during implementation of the program (2005 to 2013), out of pocket payments not only did not decrease but increased so far. This study aimed to investigate the reasons for failure of this policy.
In this qualitative study, 39 key informants were interviewed using purposive sampling method. Data were also gathered from related documents. Data were analyzed using the Walt and Gilson triangle model analysis.
The data were classified within four categories: 1) actors (including conflicts of interest and power installation; 2) content (including internal logic and cohesion objectives); 3) context (including political feasibility, environmental impact, resource and structure); and 4) process (including monitoring and evaluation, stakeholder involvement and stewardship and leadership).
The behavior of the main political actors, were influenced by individual and group factors such as conflicts of interest and power of discourse. This policy failed within the context of the government's lack of political commitment, economic shocks, and lack of social support from interaction of regulatory bodies.