Designing a Semi-Centralized Model of Health Governance in Iran

Document Type : Original Article

Authors

1 Professor of Political Geography, Faculty of Geography, University of Tehran

2 Department of Political Geography, Faculty of Geography, University of Tehran, Tehran, Iran.

3 Department of Management, Faculty of Management, University of Tehran, Tehran, Iran.

4 Department of Political Geography, Faculty of Geography, University of Tehran

Abstract

Iran’s healthcare system, as a fundamental pillar of public governance, faces several challenges, including imbalances in resource distribution, centralization, disparities in service access, and a lack of transparency in business models. This study aims to propose an optimal governance model for the healthcare system by comparing three governance models: centralized, decentralized, and semi-decentralized. A mixed-methods approach was employed in this study. Qualitative data were collected through expert interviews, while quantitative data were obtained using standardized questionnaires. To analyze the data, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) was applied to evaluate and rank different healthcare governance models. Accordingly, the three governance models were assessed based on 30 quantitative and qualitative criteria. Some of the most significant criteria included spatial justice, quality of healthcare services, accessibility, geographical distance, the effectiveness of the family physician program, and the role of traditional and alternative medicine. For each criterion, positive and negative ideals were defined, and the distance of each model from these ideals was calculated. The findings indicate that the semi-decentralized model, with a relative proximity scores of (Ci = 0.6859), is the most optimal option for healthcare governance in Iran. This model establishes a balance between centralized policymaking and decentralized implementation, effectively aligning local needs with national standards while simultaneously leveraging the advantages of both centralization and decentralization. Moreover, by harmonizing national-level governance with delegated regional authority, this model addresses region-specific requirements while maintaining national standards, thereby contributing to the enhancement of healthcare quality and efficiency.

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History

  • Receive Date: 08 February 2025
  • Revise Date: 25 February 2025
  • Accept Date: 28 February 2025
  • Publish Date: 19 February 2025

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