A review of achievements and challenges of Iran’s health transformation plan

Objective (s): Healthcare systems always are trying to improve accessibility, equity, service quality, and efficiency indicators within their limited resources. This study was aimed to provide a comprehensive overview of four-years achievements and challenges of Iran’s Health Transformation Plan (HTP), which began in 2014. "Thematic analysis" following interviews with health experts was carried out to identify positive and negative consequences. Subsequently, "Content analysis" was applied on published official reports. Finally, results were aggregated and analyzed through "Triangulation" method. Positive outcomes of Iran’s HTP, identified in this study, included reducing inpatients’ out-of-pocket expenditures in public sector, protecting vulnerable patients, promoting natural childbirth delivery, improving public health sector’s tangible assets, and improving access to specialized services in remote areas. In contrast, negative consequences of this plan were increasing induced demand, increase in total health expenditures, higher number of referrals in public sector services, increase in share of health expenditure in household budget, increasing disruptions in pharmaceutical supply chain, and intensification of medical personnel’s complaints due to salary inequity. Additionally, lack of feasibility studies before starting the plan, lack of sustainable resources to maintain services provision, conflicts with macro policies and conflict of interest in policymaking, prioritizing treatment over prevention, inappropriate human resource management, and inefficient policies were identified as main drivers of HTP challenges. Despite some achievements, HTP is suffering from lack of holistic approach and acceptable economic measures that resulted to fall achieving the ultimate goals of the plan. As time passing some positive outcomes acquired by immense expenses of public budget have begun a revers trend, which necessitates a major revision of HTP. It seems that a major revision of HTP based on sound health economics measures is necessity.