Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 22;21(1):724.
doi: 10.1186/s12913-021-06673-0.

The influential factors for achieving universal health coverage in Iran: a multimethod study

Naser Derakhshani  1 , Mohammadreza Maleki  2 , Hamid Pourasghari  1 , Saber Azami-Aghdash  3
Affiliations

The influential factors for achieving universal health coverage in Iran: a multimethod study

Naser Derakhshani et al. BMC Health Serv Res. .

Abstract

Background: The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran.

Methods: This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system's control knobs framework during three expert panel sessions.

Results: Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts' panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the "regulation and supervision" dimension, whilst the "payment system" entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC.

Conclusion: Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries' experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.

Keywords: Control knobs; Health system; Influential factors; Iran; Systematic review; Universal health coverage.

PubMed Disclaimer

Conflict of interest statement

The authors state they have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
The four phases (systematic review, FGD, and semi-structured interview, merging Factors, and Expert Panel) of study and their results
Fig. 2
Fig. 2
Flow diagram of the searches and Inclusion process
Fig. 3
Fig. 3
The percentage of influential factors for achieving universal health coverage in Iran based on health system control knob framework
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Evans DB, Saksena P, Elovainio R, Boerma T. Measuring progress towards universal coverage. Geneva: World Health Organization; 2012.
    1. Organization WH. The world health report 2000: health systems: improving performance: World Health Organization; 2000.
    1. Maeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich MR. Universal health coverage for inclusive and sustainable development: a synthesis of 11 country case studies: World Bank publications; 2014.
    1. Obare V, Brolan CE, Hill PS. Indicators for universal health coverage: can Kenya comply with the proposed post-2015 monitoring recommendations? Int J Equity Health. 2014;13(1):123. doi: 10.1186/s12939-014-0123-1. - DOI - PMC - PubMed
    1. Xu Y, Huang C, Colón-Ramos U: Moving toward universal health coverage (UHC) to achieve inclusive and sustainable health development: three essential strategies drawn from Asian experience: comment on’Improving the World’s health through the Post-2015 development agenda: perspectives from Rwanda’. 2015. - PMC - PubMed

LinkOut - more resources