Network governance theory as basic pattern for promoting financial support system of the poor in Iranian health system.

BACKGROUND: The share of out-of-pocket payments in Iranian families has the greatest burden on the poor and lead to an impoverishment caused by catastrophic health expenditures. In order to improve access of the poor to public resources, it is necessary to create a better governance system and effective policy-making. The purpose of this study is to improve network effectiveness of the Iranian health system and to design a financial protection network for the poor, based on the network governance theory. METHODS: We are using a quantitative method framework in conjunction with a Social network analysis (SNA) strategy. To draw an optimal network, we conducted interviews with experts by focusing on the arrangement and relationship among different institutions. The research sample was purposefully selected. We used UCINET software for data analysis and NetDraw software to draw networks. RESULTS: In this article, an optimal network was proposed with the following characteristics: First, the problem of the density of relationships among several central institutions and the isolation of the other institutions have been solved. Second, in our model, the relationships have been distributed in a balanced manner among all institutions in the network. Third, the number of participants has been reduced and consensus on poor people support policies has been achieved in this optimal network. Forth, executive organizations keep their central positions and upper institutions are not at the central position, so that the power is distributed in favor of more balanced governance. However, in order to increase efficiency and to have coherent decision-making, it is necessary to establish a "core" for this optimal network. The "core" has to include the organizations with the most relationship with others. CONCLUSION: The result revealed that the usefulness of network analysis as a tool for proposing the effectiveness of governance. By strengthening the relationship among the main actors, an organized system of network management can be achieved. The network has to include all actors from different levels, from policy-making to implementation. The network also has to clarify the tasks from identifying the poor to covering costs. From an academic perspective, this study showed the adequacy of network analysis as a tool for policy sciences. Governance in our optimal health financial protection model follows the shared-governance pattern due to its high density, low centralization and low distance. The model of network governance can be the source of changes in the health governance system. It is a necessary structural condition to provide access to universal health coverage.

Which groups of the poor are supported more by the law? Pro-poor health policy network in Iran.

BACKGROUND: Considering the challenges of health services utilization of the poor in Iran, it is necessary to examine the supportive policy documents about the poor in order to identify such challenges. METHODS: This study is a policy documents analysis that has evaluated the legal documents in the health financial support to the poor. The researchers looked in the websites for documents and referred to related organizations. Social network analysis approach and UCINET software were chosen for data analysis. RESULTS: Twenty-seven different disadvantaged groups were identified for financial support in the legal documents. The main focus was on "poor people," "unsupported women and children," and "disabled and elderly poor people." There is a bundle of confusion about the number of supporting institutions for different groups and the amount of support in the network. CONCLUSION: The coverage of the poor in Iran has been impaired by a lack of clear boundary in their support. Because of the interorganizational partnership challenges, much more promising results would have been achieved if there was only one administrative institution for the Iranian poor. Given the inconsistencies seen in the support types and levels for the poor to access health services, it is inevitable to amend the laws.

Power structure among the actors of financial support to the poor to access health services: Social network analysis approach.

The extent of universal health coverage in terms of financial protection is worrisome in Iran. There are challenges in health policies to guarantee financial accessibility to health services, especially for poor people. Various institutions offer support to ensure that the poor have financial access to health services. The aim of this study is to investigate the relationship network among the institutions active in this field. This study is a policy document analysis. It evaluates the country's legal documents in the field of financial support to the poor for healthcare after the Islamic Revolution in Iran. The researchers looked for the documents on the related websites and referred to the related organizations. The social network analysis approach was chosen for the analysis of the documents. Block-modelling and multi-dimensional scaling (MDS) was used to determine the network structures. The UCINET software was employed to analyse the data. Most the main actors of this network are chosen from the government budget. There is no legal communication and cooperation among some of the actors because of their improper position in the network. Seven blocks have been clustered by CONCOR in terms of the actor's degree of similarity. The social distance among the actors of the seven blocks is very short. Power distribution in the field of financial support to the poor has a fragmented structure; however, it is mainly run by a dominant block consisting of The Supreme Council of Welfare and Social Security, Health Insurance Organization, and the Ministry of Health and Medical Education. The financial support for the poor network involves multiple actors. This variety has created a series of confusions in terms of the type, level, and scope of responsibilities among the actors. The weak presence legislative and regulatory institutions and also non-governmental institutions are the main weak points of this network.

Health Priority Setting in Iran: Evaluating Against the Social Values Framework.

BACKGROUND: Health systems, as part of the social system, consider public values. This study was conducted to examine the role of social values in the health priority setting in the Iranian health system. METHODS: In this qualitative case study, three main data sources were used: literature, national documents, and key informants who were purposefully selected from health care organizations and other related institutions. Data was analyzed and interpreted using the Clark-Weale Framework. RESULTS: According to our results, the public indirectly participates in decision-making. The public representatives participate in the meetings of the health priority setting as parliament members, representatives of some unions, members of the city council, and donors. The transparency of the decisions and the accountability of the decision makers are low. Decision makers only respond to complaints of the Audit Court and the Inspection Organization. Individual choice, although respected in hospitals and clinics, is limited in health care networks because of the referral system. Clinical effectiveness is considered in insurance companies and some hospitals. There are no technical abilities to determine the cost-effectiveness of health technologies; however, some international experiences are employed. Equity and solidarity are considered in different levels of the health system. CONCLUSION: Social values are considered in the health priority decisions in limited ways. It seems that the lack of an appropriate value-based framework for priority setting and also the lack of public participation are the major defects of the health system. It is recommended that health policymakers invite different groups of people and stakeholders for active involvement in health priority decisions.