Physical rehabilitation financing in Iran: a policy analysis using Kingdon’s multiple streams

Abstract

Background Adequate financing is a crucial function, securing that physical rehabilitation services (i.e., physiotherapy, occupational therapy, prosthetics and orthotics) are available with no financial hardship. Like many other countries, despite the adoption of various policies and strategies in recent decades, Iran enjoys no desirable physical rehabilitation financing (PRF). Accordingly, this qualitative study aimed to explore the PRF-related strategies and issues as well as their impacts on relevant policies in Iran. Methods An analysis of PRF-related policies was conducted in Iran using semi-structured interviews and policy documents review. Purposive and snowball sampling techniques were employed to select key informants, including health-policy makers, civil society, rehabilitation-policy makers, university professors, and practitioners. Thematic analysis was used to analyze the collected data. The analysis was framed within Kingdon’s multiple streams. Results The hindering factors for desirable financing were weak insurance coverage, lack of sustainable financial resources, fragmented financing, lack of split between provider and financer, high-cost of physical rehabilitation services, low engagement of relevant experts in policy-making processes, and corrupt activities. In the policy stream, the following factors were highlighted: involvement of sustainable financial resources, the use of external revenue sources, allocated resources’ earmarking, the integration of the current funds to have better pooling, the use of incentive and timely payment mechanisms, the implementation of strategic purchasing principals, and the employment of effective rationing strategies. Moreover, parliament support, changes in administrations, international effects, pressures from interest campaigns and NGOs, and international sanctions were found as factors affecting the politics stream. Conclusion The study findings revealed that a variety of national and international factors affect PRF-related issues in Iran. The recently enacted laws indicate that the PRF policies have already been on the national health political agenda. The study reflected the multifaceted nature of barriers to optimal PRF in Iran.

Integrating rehabilitation services into primary health care: policy options for Iran

“…Based on the literature, inadequate financing is one of the most critical challenges of the rehabilitation sector in Iran [33]. The use of rehabilitation services and a disabled or elderly family member are known to be some of the main determinants when someone is facing catastrophic health expenditure [51,52].…”

“…An important issue addressed in this study is financing the integration of rehabilitation services into PHC, which means increasing government investment in this area and increasing the utilization of such services by the public. The collaboration of donors and NGOs can be very effective in financing rehabilitation services in PHC in countries like Iran, which face limited financial resources [32,33]. In relation to how payments are made to rehabilitation providers, applying the global budget approach to compensate for the services provided by PHC staff is more effective than approaches such as feefor-service, in which the necessary resources to pay the rehabilitation service provider must be provided by the physician.…”

“…However, in addition to the small number of rehabilitation graduates in many countries, especially developing countries [13], many graduates are not interested in serving in deprived and remote areas [7]. This situation is also seen in Iran (64.6 physiotherapists and 22.1 occupational therapists per 1,000,000 population), where the majority of graduates are working in metropolitan areas due to preferable social and economic conditions [33,34]. One of the proposed solutions in the present study was to increase the number of graduates in the rehabilitation professions, although this policy needs time to be implemented.…”

“…Despite the significant successes of Iran's PHC network and the implementation of numerous reforms in recent decades [29], the program still faces challenges, including the lack of effective integration of rehabilitation services [32][33][34]. According to the recent recommendations of WHO on strengthening rehabilitation services in health systems and the increased demand for rehabilitation services in Iran due to aging population, high prevalence of non-communicable diseases, musculoskeletal conditions, traffic collisions, and natural disasters in recent years [7,11,35], we conducted this qualitative study to determine policy solutions that might facilitate the integration of rehabilitation services into Iran's PHC Network.…”

Toward good governance for the prosthetics and orthotics sector in Iran: Evidence from a qualitative study

“…11 In Iran, as in many other countries, evidence suggests that the governance for the P&O sector is underdeveloped causing target groups to face several challenges regarding benefiting from these services. 6,7,12 Aging populations and increased incidence and prevalence of neurological disorders, 13 traffic injuries, 14 and raising trend in natural disasters 15 have all increased the demands for the P&O services in Iran. Improved governance for the P&O sector is therefore an inevitable strategy to respond optimally to such ascending demands.…”