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Developing a Framework for Diagnosing the National Health System's Pathologies
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Alireza Shakibaeifar1   , Mehrdad Hamrahi2 , Moslem Sharifi1 , Rahim Ostavar3 |
1- Yasuj University of Medical Sciences
2- Islamic Azad University, Kazerun Branch
3- Department of Health Management and Medical Services, Shiraz Branch, Islamic Azad University, Shiraz, Iran , rahimostavar@yahoo.com |
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Abstract: (8 Views) |
Abstract
Background and Objective: The Iranian health system faces multifaceted challenges at managerial, structural, economic, and social levels, which have affected its efficiency and responsiveness. Previous studies have largely focused on describing these issues rather than examining their underlying causal relationships. The present study aimed to design and validate a comprehensive hierarchical model for diagnosing the pathologies of Iran’s health system, emphasizing the identification of root causes to provide an analytical framework for policy interventions.
Methods: This study adopted a mixed-methods approach. In the qualitative phase, Glaser’s grounded theory was used to extract concepts through semi-structured interviews with 25 health system experts selected via snowball sampling. Data were analyzed using ATLAS.ti software. In the quantitative phase, the relationships among extracted factors were analyzed using DEMATEL and Interpretive Structural Modeling (ISM) to determine causal levels. Finally, the model was validated using Structural Equation Modeling (SEM) with data collected from 384 health managers and experts.
Results: The study identified 37 key components organized into 8 dimensions. DEMATEL results indicated that “Managerial and Governance Factors,” “Economic and Political Factors,” and “Educational/Technological Factors” have the highest causal influence. ISM analysis classified these factors into three levels: roots, intermediates, and outcomes, revealing the systemic nature of the pathologies. SEM findings confirmed the goodness of fit for the proposed model.
Conclusion: The findings suggest that improving Iran’s health system requires a shift from short-term interventions to structural reforms, sustainable financing, managerial decentralization, and a transition from a treatment-oriented to a prevention-oriented approach. The proposed model provides a practical framework for policymakers to prioritize interventions based on root causes.
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| Keywords: Health System, Pathology, Mixed Methods Study, Grounded Theory, Health, Governance. |
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Type of Study: Research |
Subject:
Health Management
Received: 2025/05/7 | Accepted: 2026/02/3 | Published: 2026/05/23
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