Analysis of the Health Sector Evolution Plan from the Viewpoint of Out-of-pocket Payment: A Multiple Streams Model

Document Type : Original Article


1 Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of Health Technology Assessment, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Introduction: Health Sector Evolution Plan (HSEP) is regarded as one of the most dominant
reforms in the health system in Iran. This study aimed to review the agenda setting of Outof-
Pocket Payment (OOP) reduction in HSEP plan by using the multiple streams Kingdon’s
Methods: This is a qualitative study conducted through ten semi-structured interviews.
Sampling was purposeful and continued until reaching data saturation based on snowball
sampling method. To formulate a theoretical structure and review the potential explanations,
we used the framework analysis.
Results: A higher proportion of growth in OOP expenditures and catastrophic health costs
among Iranian population in the years 2002-2012 was identified as the Problem stream.
Emphasis on establishing an equitable financing system to reduce the problems of getting
access to health services based on population health needs led to the Policy stream which
has been considerably supported by the Islamic Consultative Assembly and Iran Ministry of
Health and Medical Education. Such supports were made possible by approving the budget
in 2014 and allocating appropriate resources (Political stream).
Conclusion: By examining the method of setting the policy of OOP reduction as agenda, we
can make a precise analysis of the basis of this policy, and by emphasizing these three streams
in order to introduce corrective policies, we can improved it, if necessary.