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Designing a Pathology Model of the Country’s Health System
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A Shakibaeifar1   , M Hamrahi2 , R Ostovar3 , M Sharifi4 |
1- Department of Public Administration, UAE.C., Islamic Azad University, Dubai UAE
2- Department of Public Administration, Islamic Azad University, Kazeroon, Iran
3- Department of Management, Zand Higher Education Institute, Shiraz, Iran , rahimostavar@yahoo.com
4- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran |
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Abstract: (2778 Views) |
Background & aim: 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: The present mixed-method (qualitative-quantitative) study was based on Glaser's grounded theory approach. In the qualitative part, data were collected through semi-structured interviews with 25 health system experts, including university professors, senior managers of the Ministry of Health, university presidents, and managers of health and medical centers using snowball sampling. Data analysis was performed with ATLAS.ti software, and the reliability of coding was confirmed with Holst, P-Scott, Cohen's kappa, and Krappendorff's alpha indices. In the quantitative part, DEMATEL and structural-interpretive modeling (ISM) techniques were used to analyze causal relationships and rank the extracted factors. Then, the final model was validated using structural equation modeling (SEM) and data from a researcher-made questionnaire in a sample of 384 health managers and experts across the country.
Results: The results indicated that out of the 330 initial items, 37 selected codes were extracted and organized into 8 theoretical dimensions. DEMATEL analysis revealed that management and governance factors, economic-political factors, and educational, research, and technological factors have the greatest causal role in health system inefficiency. Moreover, ISM results classified the factors into three levels of roots, mediators, and consequences, which reflects the nonlinear and systemic nature of the harms. SEM findings furthermore confirmed the appropriate fit of the model.
Conclusion: The findings suggested that improving Iran’s health system required 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 provided 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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Full-Text [PDF 1010 kb]
(24 Downloads)
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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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