Tehran University of Medical Sciences
Health Technology Assessment in Action
2645-3835
10
1
2026
05
10
How to Manage the Conflict of Interests in Health System Payment Methods? A Mixed-Method Study in Iran
343
343
Parisa
Yoshari
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Hossein
Jabbari Beirami
Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Roya
Alipour Olyaei
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Hossein
Masoumi
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Seyed Mohammad Amin
Mousazadeh
Students Research Committee, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
Rahim
Khodayari-Zarnaq
Department of Health Policy and Management, Faculty of Management and Medical Informatics, Health Service Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2024
09
27
2025
01
19
Background: Efficient payment systems are vital for reducing health system costs while improving service quality. This study aimed to examine how to manage the conflict of interests in payment methods and propose payment recommendations for the health system staff in Iran.
Methods: This mixed-method study was conducted at Tabriz University of Medical Sciences (2023) using a scoping review, semi-structured interviews, and Delphi method. The scoping review followed the Arksey and O’Malley protocol. Experts were interviewed to adapt global evidence to Iran. Thematic analysis was used to generate and evaluate policy options for managing the conflict of interests in health system payment methods. Moreover, the Delphi process and analytic hierarchy process prioritized these options based on effectiveness, feasibility, economic efficiency, and budget requirements.
Results: Overall, 1,031 articles were initially identified, with 22 meeting the inclusion criteria after a rigorous selection process. Three policy options were evaluated, including modified per capita with pay for performance (MPCP4P), modified salary with P4P, and modified fee for service with P4P. MPCP4P emerged as the top choice due to its superior economic benefits and effectiveness. It was revealed that MPCP4P mitigates financial risks for providers while ensuring high-quality care, making it the most suitable option for the country’s payment system.
Conclusion: The MPCP4P method, with risk adjustment and quality indicators, reduced conflicts and service reduction in capitation systems. The implementation solution includes determining quality and performance indicators, establishing a risk adjustment framework, and managing referrals. Rigorous oversight and continuous evaluation are also essential.
https://htainaction.tums.ac.ir/index.php/hta/article/view/343
https://htainaction.tums.ac.ir/index.php/hta/article/download/343/217
Tehran and Iran Universities of Medical Sciences in 2019.
Methods: This research is a retrospective, descriptive, and analytical study, which is considered applied in terms of its objective. First, literature reviews and expert panel discussions were held, and calculating the methods and assumptions was defined, followed by performing a quantitative study and using traditional costing methods. Data were collected from forms, hospital documents, and the hospital information system and then recorded in Excel 2016. After performing calculations, cost analysis was conducted in two scenarios.
Results: In all the operating rooms of Tehran and Iran Universities of Medical Sciences, considering depreciation, the highest and lowest unit costs of the technical component were $3.54 and $1.68 based on USD purchasing power parity, respectively. Both values exceeded the technical component rate of $0.87 in 2019,, demonstrating a negative cost-to-revenue balance in all operating rooms. Even without considering depreciation, the unit cost of the technical component in all operating rooms (except one) was higher than the monetary coefficient of the technical component of $0.87 in 2019.
Conclusion: The significant difference between the unit cost of the technical component in the operating room and the technical component rate in 2019 led to increased costs for hospitals. Given the increasing trend of consumable costs, this cost imbalance is likely to widen further. Hospitals are forced to use their own revenues to cover these costs since they are not covered by insurance organizations or patients. Therefore, it is essential to take necessary measures to adjust the percentage of the technical component of the operating room and adopt policies to prevent problems in the continuity of service delivery in public hospitals.
https://htainaction.tums.ac.ir/index.php/hta/article/view/379
https://htainaction.tums.ac.ir/index.php/hta/article/download/379/218