Analysis of the Health Sector Evolution Plan from the Viewpoint of Out-of-pocket Payment: A Multiple Streams Model

Health Sector Evolution Plan (HSEP) is regarded as one of the most dominantreforms in the health system in Iran. This study aimed to review the agenda setting of Outof-Pocket Payment (OOP) reduction in HSEP plan by using the multiple streams Kingdon’smodel. This is a qualitative study conducted through ten semi-structured interviews.Sampling was purposeful and continued until reaching data saturation based on snowballsampling method. To formulate a theoretical structure and review the potential explanations,we used the framework analysis. A higher proportion of growth in OOP expenditures and catastrophic health costsamong Iranian population in the years 2002-2012 was identified as the Problem stream.Emphasis on establishing an equitable financing system to reduce the problems of gettingaccess to health services based on population health needs led to the Policy stream whichhas been considerably supported by the Islamic Consultative Assembly and Iran Ministry ofHealth and Medical Education. Such supports were made possible by approving the budgetin 2014 and allocating appropriate resources (Political stream). By examining the method of setting the policy of OOP reduction as agenda, wecan make a precise analysis of the basis of this policy, and by emphasizing these three streamsin order to introduce corrective policies, we can improved it, if necessary.