In this study, 25 people (20 men and 5 women) were interviewed. The participants’ working conditions and work experience are presented in Table 1. After analyzing the obtained data from the interviewees, the results were classified into four main and 21 subsidiary categories (Table 2).
Table 1.
Demographic Characteristics of the Participants
Characteristics, Categories | No. (%) |
---|
Job status | |
At the Ministry of Health level (manager, policymaker) | 13 (52) |
At the University of Medical Sciences level (manager, faculty) | 7 (28) |
At hospital level (chief executive officer, faculty) | 5 (20) |
Total | 25 (100) |
Work experience, y | |
5 - 15 | 6 (24) |
15 - 20 | 8 (32) |
> 20 | 11 (44) |
Total | 25 (100) |
Table 2.
The Important Criteria in Health Resources Allocation
Category | Sub-Category |
---|
Criteria related to the type of disease | Severity of disease |
Prevalence of disease |
Preventive aspect of the disease |
Emergency or non-emergency dimensions of the disease |
Communicable or non-communicable aspects of the disease |
Quality of life after treatment |
Criteria related to patients’ qualities | The onset of disease |
Cultural and socio-economic conditions |
Risky behaviors leading to diseases |
Being the head of the family |
Patient’s gender |
Criteria related to the type of treatment | The effectiveness of treatment |
The cost of treatment |
The probability of undesirable side effects |
Dependency of treatment on para-clinical services |
Criteria related to ethical and responsiveness issues | Availability of effective substitute care |
Waiting time |
The place of providing services |
Excessive costs for rural or distant areas |
The age of death in case of not being treated |
The number of services that a person has used in the past |
4.1. Criteria Related to the Type of Disease
The majority of the participants believed that the type of disease is one of the important criteria in the allocation of resources. Acuteness, prevalence, and prevention of the disease were among the criteria related to the type of disease. In addition, emergency cases, being contagious, and the patient’s living standard after treatment were among the other factors related to the type of disease.
Concerning the significance of the emergence of disease as one of the important criteria for allocating resources, one of the interviewed faculty members stated:
“Given the fact that the most valuable aspect of treatment systems is to save human life, the riskiest diseases must be given the highest priority. We always give the first priority to patients at the risk of imminent death in terms of allocating resources” (participant No. 13).
Concerning the significance of patients’ living standard after treatment, one of the other policymaking participants believed that:
“In order to allocate the resources effectively, the way a patient continues his/her life after treatment should be investigated. If the standard of living is low in terms of efficiency, it is not logical to allocate resources to this group of patients” (participant No. 7).
One of the other policymaking participants stated:
“The issues related to endemic and prevalent diseases in society should be taken into account. For instance, in our country, trauma and accidents are more prevalent and they definitely need to have a bigger share of health resources” (participant No. 24).
One of the hospital managers said:
“Treating some diseases has just an individual aspect but there are some groups of diseases whose treatment has highly important social effects. We prefer to push resources toward a direction that is of higher social importance; in this case, we can have a better health condition in the long run by making use of our limited resources” (participant No. 18).
Furthermore, several other interviewees (No. 1, 2, 4, 8, 9, 10, 11, 12, 14, 17, 19, 21, and 25) pointed to the importance of some criteria related to the type of disease.
4.2. Criteria Related to Patients’ Qualities
The majority of the participants in this study believed that the allocation of health resources to specific groups of patients with different qualities is of considerable importance. Age, the onset of disease, socioeconomic and cultural conditions, risky behaviors that might lead to diseases, being the head of the family, and the patients’ gender were among the mentioned items. Concerning patients’ qualities, a deputy director of treatment in one of the medical universities stated:
“When an infant is afflicted by a disease, we should pay more attention to him/her because it will take more DALY from society and it will impose a huge burden on society. Besides, women require more health care at specific ages; consequently, all these factors need to be taken into consideration” (participant No. 1).
Another participant who was in charge of the health economics committee at a medical university said:
“Productive population should be given a high priority for allocating resources because the treatment of younger people has a higher rate of return on investment; therefore, they have to be given a higher priority. In addition, we should pay attention to the fact that disability and death among productive people or people at working age can affect more people” (participant No. 19).
One of the managers of the Ministry of Health said in his interview:
“There are some groups in society who are more susceptible to diseases and they do not posse the required awareness and ability to fight against the disease. It is better to identify such groups and the reasons behind their disability to help them become more immune to diseases” (participant No.12).
Some other interviewees (No. 3, 7, 8, 9, 11, 16, 18, 20, 22, and 25) also pointed to the importance of patients’ qualities.
4.3. Criteria Related to the Type of Treatment
Apart from who the patient is or what the illness is, the type of treatment that should be used is basically important. The qualities related to the type of treatment included the effectiveness of treatment, dependency of treatment on para-clinical services, the probability of undesirable side effects, and the cost of treatment. One of the hospital managers said:
“For instance, take a patient into consideration who has referred to a dentist. If the dentist implants his teeth with around 5 million Tomans, he can repair his teeth and the patient will not suffer from long-term complications such as digestive disorders and infections. However, given the health resources or the patient’s conditions, the dentist may only do the dental scaling that may cause more infections in the future and the patient requires to spend more money on health” (participant No. 5).
An authority in charge of the treatment economics committee at a hospital believed that:
“Effectiveness of treatment is one of the main qualities in allocating resources; spending money in a way that has low effectiveness is equal to wasting health resources” (participant No. 10).
One of the other interviewees said:
“In equal conditions, if an intervention or medicine has fewer side effects, it has to be given a higher priority and more resources have to be allocated to that” (participant No. 3).
The other participants (No. 1, 4, 6, 9, 12, 14, 23, and 25) also pointed to the criteria relevant to this category.
4.4. Criteria Related to Ethical and Responsiveness Issues
Ethical challenges have always been a controversial issue in allocating health resources although discussing different levels of the remaining criteria is an ethical issue per se. The availability of effective substitute care, waiting time, the place of service provision, excessive costs for rural or distant areas, the age of death in case of not being treated, and the number of services that a person has used in the past was among the mentioned factors. One of the managers who has been working in the Ministry of Health for over 20 years said:
“One of the most important criteria that should be given special attention is the people and populations with low income. Fortunately, in recent years, the government has given a high priority to providing services for a population of 11 million living in the suburbs because this class of society is the neediest with the least facilities” (participant No. 20).
One of the other participants said:
“Taking an ethical doctrine into consideration is of high importance for determining the characteristics of resource allocation. For instance, some people believe that we should just take the total benefit of each intervention as the most important factor; some others believe that all people in the society should have access to the required services. I believe that all people in the society should be able to take the advantage of services without considering their financial status but it must not be in such a way that some patients use health services during their lives because of their high demands and on the other hand, some people remain deprived of the limited required services” (participant No. 17).
Another participant who was a policymaker in the Ministry of Health stated:
“A big population of society lives in rural areas and acting based on justice and without any prejudice requires paying special attention to this part of society. The only service provider in villages is the government sector and we should not sacrifice justice for efficacy. In my view, villages, suburbs, and distant areas must be given special attention to resource allocation” (participant No. 16).
Another participant stated:
“Distant and rural areas often require more health resources but providing services to these areas imposes higher expenses on the health system…one of the other important issues in resource allocation is paying attention to the fact that when substitute services are available and they have suitable efficacy, we will be able to use them according to the expenses of each service.” The health systems that provide effective substitute care have higher accountability and satisfaction. He added, “In similar conditions, a group of people who have received a smaller share of health care will be given a higher priority in resource allocation” (participant No. 11).
Some other participants (No. 1, 3, 10, 14, 15, 18, 19, 21, and 23) pointed to the criteria related to this category
The results from the prioritization of resource allocation criteria are presented in Table 3 in two groups with the highest and lowest priority.
Table 3.
Prioritization of Resources Allocation Criteria
Type of Criteria, Criteria | Score of Criteria |
---|
Criteria with the highest priority | |
Emergency or non-emergencya | 88 |
Severity of disease | 85 |
The onset of disease | 84 |
The effectiveness of treatment | 81 |
Preventive aspect of the disease | 79 |
Criteria with the lowest priority | |
The probability of undesirable side effects | 42 |
Risky behaviors that might lead to diseases | 37 |
The place of providing services | 36 |
Patient’s gender | 33 |
Waiting timeb | 32 |
aThe highest priority.
bThe lowest priority.
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