Strategic purchase of cardiovascular health services by DIMATEL method

Strategic purchasing is a key element and strategy for realizing universal health coverage. This study aimed to determine the factors influencing the strategic purchasing of health services for cardiovascular diseases.

In this mixed-methods (qualitative-quantitative) applied study, data were collected through semi-structured interviews and a matrix of pairwise comparisons. The study population consisted of managers and policy makers of basic insurance organizations, Ministry of Health, hospital managers, and university faculty members who were selected by the purposive sampling method.The data were analyzed via thematic analysis in MAXQDA and prioritized in MATLAB via the DEMATEL technique.

Stewardship and policy-making, financial, insurance-related, structural, behavioral, and social determinants of health were identified as influential factors. Patient-, provider-, and contract-related were identified as the influenced factors. The stewardship and policy-making element (1.32, 2.73) was the most influential factor, while the patient-related element (-1.30, 1.30) was the most influenced factor in strategic purchasing of cardiovascular health services.

Strategic purchasing of health services requires the widespread participation of all the stakeholders and players of the healthcare system. Having effective stewardship of the healthcare system, institutionalizing an evidence-based decision-making system, empowering and increasing citizens’ participation in health-related decision-making and policies, and providing stable financing are the most important factors influencing the implementation of the health service strategic purchasing.