Policy-making for Rationing in the Healthcare System: A review to provide suggestions for Iran

Rationing is considered as a solution to control the costs and increase the efficiency in using the limited resources of the healthcare system. Therefore, this study was conducted to review the studies carried out on rationing in different countries and to provide suggestion for Iran's healthcare system. This systematic review was carried out to find the papers published in this regard. To hit this target, we searched the English databases (web of knowledge, PubMed, Scopus, Ovid and Science Direct) using the keywords of "rationing, stewardship, policy making, healthcare, health care, coverage, and services". We selected the related studies and assessed their quality. Authors reached consensus regarding the included studies in order to avoid making errors. We searched the keywords and found 2880 relevant papers. The inclusion criteria were applied and 29 eligible papers were selected finally. A conceptual framework was suggested for rationing at three levels of financing (out of pocket payment, age-based risk assessment, service package, payment to providers), rendering services (evidence-based medicine, duration and the waiting list of services, and medicinal pharmacopoeia), and providing resources (distribution of leveling services, workforce competence, assessment of health technology and pharmaceuticals). Considering the increased health care costs and restrictions of resources for increasing demands, rationing is inevitable. With regard to the proposed conceptual model, the solutions to clarify the rationing policy in the healthcare system of Iran include: creation of information dashboard, implementation of clinical guidelines, homogenization of service packages provided by insurance funds, health technology assessment, and assessment of social preferences.