Stewardship as a Fundamental Challenge in Strategic Purchasing of Health Services: A Case Study of Iran

Objective: To understand the stewardship challenges in strategic purchasing of health care in Iran's health system from the viewpoints of experts, policy makers, and decision makers. Study design: This was a qualitative study. Methods: Researchers used interviews and FGDs for collecting and framework analysis for analyzing data. Results: Stewardship challenges were classified into three themes and nine subthemes. A lack of management information systems, a lack of enforcement for rules and laws, a lack of stewardship units, and the conflict of interest between the Ministry of Health and insurers as care purchasers in the health system are among the main challenges identified in the implementation of the strategic purchasing of health care in Iran. Conclusion: A strong stewardship is needed for implementing strategic purchasing of health care, which requires participation of all stakeholders.