Abstract

Background: Purchasing health services related to advanced medical equipment is merely based on the decision of the providers in Iran as a developing country in West Asia. This passive process makes health insurance organizations reimburse the bills retrospectively. This study aimed at developing a model for the strategic purchasing of high-tech medical services in Iranian health insurance organizations. Methods: This was a mixed-method study consisting of a qualitative and a quantitative phase. In the qualitative phase, a scoping study was performed to identify the indicators and strategies of strategic purchasing of high-tech medical services in the world and then the primary model of strategic purchasing of high-tech medical services was developed for Iranian health insurance organizations by an expert panel. In the quantitative phase, the developed model was validated by the Delphi technique. Results: Narrative analysis of the articles yielded six main dimensions and 36 sub-dimensions of strategic purchasing of high-tech medical services each of which was relevant to one of the five main questions of strategic purchasing. The main dimensions were the position of strategic purchasing in the health system, organization and management, position of internal and external stakeholders, health technology assessment, pricing, and indicators of contracting. Conclusion: In the present model, six applied dimensions were achieved for implementing strategic purchasing in Iranian Health Insurance Organization. The relationship of "stewardship and position of health system" and "Position of health stakeholders" which are responsible for all resource allocation and purchasing mechanism in the health system are emphasized. Simultaneously, the model emphasized "structure and management of the provider organizations" that is important for determining the real needs of the community and managing the correct medical demand. (C) 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.