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. 2025 Nov 3;25(1):3741.
doi: 10.1186/s12889-025-23359-y.

The agenda-setting process for urban family physician program within Iran's health insurance

Amirhossein Fatahpour  1   2 , Hamed Tasdighi  2 , Mostafa Amini-Rarani  3
Affiliations

The agenda-setting process for urban family physician program within Iran's health insurance

Amirhossein Fatahpour et al. BMC Public Health. .

Abstract

Background and objective: Since 2005, health policymakers in Iran have focused on the rural family physician plan to minimize unnecessary specialist referrals and enhance both efficiency and equitable access to services. In September 2021, the urban family physician plan was launched, engaging various organizations, including insurance companies. A trustee was appointed to manage the implementation of the Iranian health insurance program. This study examines how Iran Health Insurance prioritized the urban family physician program on its agenda by applying Kingdon's agenda-setting model.

Materials and methods: This descriptive qualitative study gathered data through semi-structured interviews with 13 stakeholders in Iran's urban family physician program, including planners, policymakers, and implementers. Purposive sampling, followed by snowball sampling, was used until data saturation was reached. Directed content analysis was applied, guided by Kingdon's multiple streams framework.

Results: Three themes emerged: problem, policy, and political streams. The problem stream for Iran's family physician plan included structural challenges (such as incomplete implementation, physician shortages, fragmented health data systems, poor stakeholder coordination), social-cultural barriers (including low public awareness, resistance to change), and economic issues (such as high treatment costs, inadequate insurance coverage). The policy stream proposed solutions such as electronic systems, standardized protocols, new technologies, expanded education, and improved physician working conditions. Strong government and parliamentary backing were identified as critical to addressing these challenges, emphasizing the need for sustained commitment and holistic strategies.

Discussion and conclusion: The WHO, Iranian Parliament, Ministry of Health, and health insurers can serve as policy entrepreneurs to advance the family physician program within Iran's health insurance system. The WHO can leverage global health data to emphasize Iran's healthcare challenges, while the Ministry of Health and insurers can pinpoint issues via national research. The Parliament can facilitate public voices to gather input from citizens and experts.

Keywords: Agenda setting; Family physician; Health insurance; Multiple streams.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Isfahan University of Medical Sciences (Ethics Code: IR.MUI.NUREMA.REC.1401.105). It adhered to the ethical principles outlined in the Declaration of Helsinki, emphasizing the respect for human dignity, participant privacy, and the principle of informed consent. Prior to data collection, researchers provided participants with a comprehensive explanation of the study’s purpose, methodology, and potential implications. Participants were given the opportunity to voluntarily decide on their involvement, ensuring that their consent was informed and obtained without any form of coercion. Throughout the research process, strict confidentiality measures were observed to safeguard participant anonymity. Data were securely collected, stored, and managed to prevent any identification of individual participants. The findings of the study were presented in a transparent and unbiased manner. Additionally, where further analysis was required, participants were consulted to validate the representation of their perspectives and experiences, ensuring accuracy and fairness. Moreover, this study placed a strong emphasis on ethical integrity by prioritizing the rights, dignity, and welfare of its participants, fully aligning with the ethical standards set forth in the Declaration of Helsinki. This approach underscores the commitment of the researchers to uphold the highest ethical standards in qualitative research. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The agenda setting process for urban family physician program within Iran’s health insurance
See this image and copyright information in PMC

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