Designing a Strategic Purchasing Model for Health Services of the Social Security Organization

Strategic purchasing in health services has been one of the basic components in improving performance and one of the most important issues in order to improve the health system in the world. Although the Ministry of Health and insurance organizations in Iran sometimes address the issue of strategic purchasing goals, it is not possible to achieve or even implement it due to existing problems. For this purpose, this study was conducted to identify the most important factors affecting the launch of strategic procurement of health services and its implementation in the treatment department of the Social Security Organization and to provide an applicable model.

This is a qualitative study that was conducted in 2020 to identify the factors affecting the implementation of strategic procurement of health services in the Social Security Organization and provide a local model in two stages. In the first step, semi-structured interviews were used to extract important factors in the field of strategic purchasing. In the second step, the Delphi method was used to determine the approval or non-approval of the factors influencing the strategic purchase in the Social Security Organization.

In this study, 6 subjects and 40 sub-subjects were extracted. The main topics of the research include: target groups, social structure, insurance structure, management and coordination of departments, knowledge and information systems and service providers. The two main issues of interest to experts were the target groups and the structure of insurance. The highest score of consensus among experts on the following topics included health needs assessment and prioritization of target groups, equitable allocation of resources, income level of covered individuals, and strategic purchasing discourse.

According to the model, most attention is paid to the role of target groups and insurance structure as a leader in purchasing health services and a suitable distributor of services. It is important that the Social Security Administration is able to communicate with providers and select the best providers and receive price information through competition in the most appropriate mechanism. Also, with this model, it can strategically purchase the best and most effective services for its insured individuals. The practical model presented in this article can help the development of health systems to overcome the existing obstacles in the implementation of strategic purchasing progress. This model meets the need for knowledge necessary for strategic purchasing of health services.