Power structure among the actors of financial support to the poor to access health services: Social network analysis approach

Etemadi, Manal; Gorji, Hasan Abolghasem; Kangarani, Hannaneh Mohammadi; Ashtarian, Kioomars

doi:10.1016/j.socscimed.2017.10.026

Cited by 15 publications

(10 citation statements)

References 14 publications

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“…Financial aid policy making is characterized by multiplicity of governmental and nongovernmental actors. As a result, there is no clear distinction between the responsibilities of organizations as well as the degree of engagement for different actors …”

Section: Discussionmentioning

confidence: 99%

“…As a result, there is no clear distinction between the responsibilities of organizations as well as the degree of engagement for different actors. 28 There are unbalances and irregularities in lawmaking and regulations with regard to the poor people. A number of categories of the poor have been ignored in the laws and regulations, and some have been mentioned marginally.…”

Section: Discussionmentioning

confidence: 99%

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Which groups of the poor are supported more by the law? Pro‐poor health policy network in Iran

Etemadi

Ashtarian

Gorji

et al. 2019

Health Planning & Management

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Summary Background Considering the challenges of health services utilization of the poor in Iran, it is necessary to examine the supportive policy documents about the poor in order to identify such challenges. Methods This study is a policy documents analysis that has evaluated the legal documents in the health financial support to the poor. The researchers looked in the websites for documents and referred to related organizations. Social network analysis approach and UCINET software were chosen for data analysis. Results Twenty‐seven different disadvantaged groups were identified for financial support in the legal documents. The main focus was on “poor people,” “unsupported women and children,” and “disabled and elderly poor people.” There is a bundle of confusion about the number of supporting institutions for different groups and the amount of support in the network. Conclusion The coverage of the poor in Iran has been impaired by a lack of clear boundary in their support. Because of the interorganizational partnership challenges, much more promising results would have been achieved if there was only one administrative institution for the Iranian poor. Given the inconsistencies seen in the support types and levels for the poor to access health services, it is inevitable to amend the laws.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Which groups of the poor are supported more by the law? Pro‐poor health policy network in Iran

Etemadi

Ashtarian

Gorji

et al. 2019

Health Planning & Management

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“…A holistic program for providing palliative care services does not yet exist in Iran, and existing services are inaccessible to many patients (Fallahi et al, 2017). As well as, the lack of an optimal insurance system for end of life care and as well as rate of universal health coverage from the aspect of financial support is troublesome in Iran (Etemadi et al, 2017) meaning that most Iranian patients face challenges and must personally finance their care. A comprehensive understanding of the Iranian palliative care system requires considering the socio-cultural context (Etemadi et al ., 2017).…”

Section: Experiences Of End-of-life Care Of Older Adults With Cancer mentioning

confidence: 99%

“…As well as, the lack of an optimal insurance system for end of life care and as well as rate of universal health coverage from the aspect of financial support is troublesome in Iran (Etemadi et al, 2017) meaning that most Iranian patients face challenges and must personally finance their care. A comprehensive understanding of the Iranian palliative care system requires considering the socio-cultural context (Etemadi et al ., 2017). Furthermore,besides the health care team, family support is essential in Iranian society and the familyis expected to be heavily involved in different areas of caring for the patientsuch as; handling the paperwork related to the health care or insurance, providing some grooming and hygiene services etc.…”

Section: Experiences Of End-of-life Care Of Older Adults With Cancer mentioning

confidence: 99%

Experiences of End-of-Life Care of Older Adults with Cancer From the Perspective of Stakeholdersin Iran: A Content Analysis Study

Ghezelsefli

Ahmadi

Mohammadi

et al. 2021

Asian Pac J Cancer Prev

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Cancer is the second cause of death worldwide. The World Health Organization reported that 9.6 million people died of cancer in 2018 (World Health Organization Cancer, 2019), with the median age at death being 72 years (National Cancer Institute, 2019). This disease affects not only the patient, but also their family and society. Cancer patients, especially those in late stages, are confronted with many challenges, both because of the disease and complications of treatment (Saberzadeh-Ardestani et al ., 2019; Wong et al., 2018). Healthcare providers need to support older cancer patients with a palliative care plan that involves symptom management and psychosocial adaptation (

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“…This plurality of institutions is unbalanced with regards to their linkages and has created challenges for coordination, responsibility, e ciency, and performance. For instance, for single moms and Orphans there is 19 organizations and for disabled persons 17 organizations are Obliged to cooperate (10,11). The aim of this research is to map an optimal policy network model for supporting poor.…”

Section: Introductionmentioning

confidence: 99%

Network Governance Theory as Basic Pattern for Promoting Financial Support System of the Poor in Iranian Health System

Etemadi

Kenis

Ashtarian

et al. 2021

Preprint

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Background: The share of out-of-pocket payments in Iranian families have the greatest burden on the poor and lead to impoverishment caused by catastrophic health expenditures. It increased pressure on households’ budget, delayed treatment, distrust of health insurance systems, and rapid poverty growth in Iranian society. In order to improve access of the poor to public resources, it is necessary to create better governance system and effective policy-making. In this article, we are looking for a theoretical framework to overcome the challenges of Iranian health network. Based on network governance theory, the purpose of this study is to improve network effectiveness of Iranian health system and to design a financial protection network for the poor.Methods: we are using both qualitative and quantitative method with a network analysis approach. To draw an optimal network, we conducted interviews with experts by focusing on the arrangement and relationship among different institutions. The research sample was purposefully selected. We used UCINET software for data analysis and NetDraw software to draw networks.Results: In this article, the authors propose an optimal network with following characteristics. First, the problem of density of relationships among several central institutions and the isolation of the other institutions have been solved. Second, in our model, the relationships have been distributed in a balanced manner among all institutions in the network. Third, the number of participants has been reduced and consensus on poor people support policies has been achieved in this optimal network. Forth, executive organizations keep their central positions and upper institutions are not at the central position, so that the power is distributed in favor of more balanced governance. However, in order to increase efficiency and to have coherent decision-making, it is necessary to establish a “core” for this optimal network. The “core” has to include the organizations with the most relationship with others.Conclusion: The result revealed that the usefulness of network analysis as a tool for proposing an effectiveness of governance. By strengthening the relationship among the main actors, an organized system of network management can be achieved. The network has to include all actors from different levels, from policy-making to implementation. The network also has to clarify the tasks from identifying the poor to covering costs. From an academic perspective, this study showed the adequacy of network analysis as a tool for policy sciences. Governance in our optimal health financial protection model follows the shared-governance pattern due to its high density, low centralization and distance. The model of network governance can be the source of changes in health governance system. It is a necessary structural condition to provide access to universal health coverage.

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Power structure among the actors of financial support to the poor to access health services: Social network analysis approach

Cited by 15 publications

References 14 publications

Which groups of the poor are supported more by the law? Pro‐poor health policy network in Iran

Which groups of the poor are supported more by the law? Pro‐poor health policy network in Iran

Experiences of End-of-Life Care of Older Adults with Cancer From the Perspective of Stakeholdersin Iran: A Content Analysis Study

Network Governance Theory as Basic Pattern for Promoting Financial Support System of the Poor in Iranian Health System

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