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Electron Physician. 2018 Feb 25;10(2):6299-6306. doi: 10.19082/6299. eCollection 2018 Feb.

The challenges of strategic purchasing of healthcare services in Iran Health Insurance Organization: a qualitative study.

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Associate Professor, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
PhD Student, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Iran Health Insurance Organization, Tehran, Iran.
GP, MPH, PhD Student, Department of Health Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Member of the Board of Iran Health Insurance Organization, Tehran, Iran.
GP, MPH, PhD - Deputy Director of Health Insurance, Iran Health Insurance Organization, Tehran, Iran.
RN, PhD, Post-Doc, Assistant Professor, Department of Health Management and Policy, University of Maryland, United States of America.



Strategic purchasing in healthcare services is a key component in improving health system performance, and it has been one of the most important issues in health system reform around the world, especially Europe in the last decade. Iran health system and insurance, although sometimes considered the issue of strategic purchasing goals, has not been made possible to achieve or even to implement, due to the associated problems.


To determine the associated problems of strategic purchasing in the Iran Health Insurance Organization (IHIO).


This study is a qualitative study, and framework analysis which was conducted in Iran in 2014-15. The participants in this study were 34 individuals from decision-makers and executives in the IHIO purchasing process, and university experts who have been chosen purposefully. This study conducted frame analysis, by using MAXQDA 10.


The findings included associated problems of IHIO strategic purchasing in 12 themes and 65 subthemes. The themes included: Laws and regulations for purchasing, Organization of purchasing, Qualified and authorized providers, Right type of services, Right type of contracts, Target groups for purchasing, Resources allocation, financing and pricing system, Purchasing as improving performance and quality, Purchasing as shaping the market and competition, Purchasing as health progress state of people and society, Guided purchasing and stewardship of government, Structure of decision-making process in the health and welfare ministries.


The findings of this study showed associated problems in IHIO strategic purchasing. To achieve strategic purchasing goals in Iran, identification of all issues and factors of the total insurers and health system sets which affect strategic purchasing is essential.


Health insurance; Healthcare services; Qualitative study; Strategic purchasing

Conflict of interest statement

Conflict of Interest: There is no conflict of interest to be declared.

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