Financing of physical rehabilitation services in Iran: a stakeholder and social network analysis

Abstract

Background: Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision-and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran. Methods: The present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders. Results: The findings showed that there are different stakeholders in PRF-related decision-and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders. Conclusion: As many powerful and influential stakeholders had low interest levels to warrant participate in the FPRrelated decision-and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can be helpful.

Prioritizing solutions to incorporate Prosthetics and Orthotics services into Iranian health benefits package: Using an analytic hierarchy process

“…Evidence has demonstrated the preventative effects of certain orthoses, such as some foot and spine orthoses [30][31][32]. Although the prevailing view of policy-makers recognize these services as tertiary-level interventions [13], they can prevent many secondary aftereffects. For instance, providing orthoses to individuals with adolescent idiopathic scoliosis during their growth period can slow down its progression significantly [33].…”

“…In Iran, as a developing country facing substantial economic and social issues, P&O services are rarely covered by health insurance companies or only a small portion of the costs are considered in specific cases [13]. In addition, that small coverage is provided mainly through private and supplementary insurances, which are only available to high-income groups [14].…”

Physical rehabilitation in Iran after international sanctions: explored findings from a qualitative study

“…In accordance with the government’s reports, only one-sixth of the Disability Protection Act budget has been allocated. Therefore, OOP payments are the common mechanism of payment for health care services, especially physical rehabilitation [ 31 ]. As a result, a significant proportion of households has confronted with CEs and also refuse to receive services [ 7 ].…”

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

“…The present study was conducted in the Islamic Republic of Iran, as the second most populous country in the Middle East region. The following institutions and stakeholders are involved in financing of PRS in Iran: Social Security Organization (SSO), State Welfare Organization, the Ministry of Health and Medical Education (MHME), Iran Health Insurance Organization (IHIO), Planning and Budget Organization, the Parliament, Social Security Office of the Armed Forces, Foundation of Martyrs and Veterans Affairs, Iranian Red Crescent Society, government, and private supplementary insurance companies [ 16 , 24 ]. Given that a limited portion of PRS is covered by insurance (especially supplementary insurers), the coverage of costs is very low for all individuals, except for special groups such as veterans [ 25 ].…”