The impacts of health transformation plan on physiotherapy sector in Iran: a qualitative study using five control knobs.

PURPOSE: To investigate physiotherapists', academics', and relevant decision- and policy-makers' experiences regarding the impacts of the Health Transformation Plan (HTP) on the physiotherapy sector in Iran. MATERIALS AND METHODS: This qualitative study was conducted using in-depth semi-structured interviews. The participants were selected using both purposive and snowball sampling strategies with maximum diversity. The sampling procedure continued until data saturation was achieved. The collected data were analyzed using thematic content analysis in accordance with Braun and Clarke's methodology. RESULTS: The findings showed that the physiotherapy sector has faced several challenges after the implementation of HTP in five control knobs: (1) financing (a decline in the government budget and insufficient health insurance coverage), (2) payment (delayed payments and setting a tight ceiling for reimbursements), (3) behaviors (a decrease in the motivation of physiotherapists, the tendency toward misbehaviors such as absenteeism and providers' unwillingness to cooperate with insurance companies), (4) organization (difficulty in clinical education and ignoring the preventive effects of physiotherapy interventions), and (5) regulation (absence of stakeholders in political processes and inconsistency of upstream documents). CONCLUSION: HTP has posed various challenges on the physiotherapy sector in Iran. Promoting the policymakers' awareness and aligning the health reforms such as HTP with the current upstream documents would diminish the existing challenges.IMPLICATIONS FOR REHABILITATIONMore government budgets and better insurance coverage are needed to strengthen the physiotherapy sector.Timely payment and modification of limitations for reimbursements of physiotherapy services are recommended.It is recommended to adopt strategies to increase the motivation of physiotherapists and reduce the risk of professional misconduct in the physiotherapy sector.Problems in clinical physiotherapy training should be addressed by policy-makers, and the preventive effects of physiotherapy interventions deserve more attention.Enhanced participation of physiotherapy stakeholders in relevant legislative processes is recommended to improve their services.