Background: The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades. Methods: We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using 'policy triangle' and 'garbage can' models.Results: Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship. Conclusion: Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.

Background Pricing health services remains to be a contentious issue in Iran. The Universal Health Services Insurance Law of 1994 aimed at introducing structural and legal bases for pricing health services to enhance efficiency and to equate demand and supply, while referring to equity objectives. Until now, the implementation of this law has failed to meet its original objectives. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades. Methods We analyzed data collected through documentary and literature reviews of the official documents developed at the various levels of the Iranian health using inductive and deductive content analysis. 22 face-to-face semi-structured interviews supplemented the analysis. Policy triangle policy analysis model was used to guide data analysis. Results Our comprehensive overview of changes in the medical pricing system provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in prices between public and private sectors make tariffs setting a contentious issue in Iran. Lack of clarity in pricing health care services makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using adequate and technically sound pricing. Technical aspects of pricing health services should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship. Conclusion Evidence-based changes in medical pricing policies can help striking the right balance in the health care services provision process. A sensitive application of policy models can offer significant insights into the nature of medical price policy setting and highlight existing constraints and opportunities.