Explaining Resource Allocation in Board of Trustees Hospitals: A Case Study of Afzalipour Medical Center in Kerman, Iran

The main resources of health care are allocated to hospitals. However, resource bottlenecks are a challenge faced by health systems around the world, especially in developing countries such as Iran. Inefficiencies in resource allocation can increase the constraints in double fold. Therefore, the present study was conducted to determine the allocation of financial resources in one of the hospitals of the board of trustees, Afzalipour Medical Center, Kerman, Iran.
Review of documents, two deep interviews and five focus group discussions with eleven experts were used to collect data in the present qualitative study. Participants were members of the board of trustees and representatives of the financial department of the hospital. Data were then analyzed using content analysis method.
Based on the present study, four main themes and ten sub-themes were identified, with main themes including decision-making reference, process, criteria and factors influencing decision-making. In this regard, there was no clear process and criteria for allocating resources at this center, and allocation of resources was done based on a reactive approach, response to critical situations, political currents and financial bottlenecks. Contrary to the potential capacity of the structure of board of trustees, in practice, headship and management played a key role in allocating financial resources.
The process of allocating financial resources in the investigated hospital follows a less rational approach and coincided with the chaos theory and the garbage can model of decision-making in the governmental bureaucratic structure. The governmental bureaucratic structure and the board of trustees structure (decentralization) in contrast to each other have led to a disorder, where the lack of transparency in determining goals, criteria and document performance have also exacerbated this disorder. In this regard, the oil-related budget has stabilized the inappropriate allocation of resources.