Qom University of Medical Sciences Journal

Introduction
Health is one of the most valuable factors and the basis of sustainable social, economic, political and cultural development in all human societies. Nowadays, it is difficult to have a dynamic and growing society without an efficient health system. One of the important challenges of the health system is the increased health costs, due to changes in populations and disease patterns and the use of new and advanced technologies. Due of lack of resources, the fair allocation of resources and control of cost increase are important concerns of every health system. Efficiency and justice are the main criteria for their performance evaluation. The purpose of this study is to provide a policy model for the health system of Iran based on the guidelines of “the second phase of the revolution” and using the economic resistance approach.
Methods
This is a qualitative and exploratory study using Strauss and Corbin’s grounded theory. Participants were selected by purposive and snowball sampling techniques. The data was collected by in-depth and semi-structured interviewing of people including faculty members, deputies, and managers of Arak University of Medical Sciences and Qom University of Medical Sciences. Inclusion criteria were: at least 5 years of executive and management experience in the field of health, teaching in medical universities, and having at least a master’s degree. The interview ended when theoretical saturation was reached. The concepts for the paradigmatic model were extracted after open, axial and selective coding. To conduct the structural equation modeling (SEM), a questionnaire with 59 items was prepared. After its distribution among 751 participants from the two medical universities, finally 274 questionnaires were collected. The SEM was conducted using the non-parametric partial least squares method (due to abnormal data distribution) in PLS software.
Results
Initially, 408 codes were obtained, which were reduced to 260 after screening based on the content validity index. In this regard, 40 sub-themes and 13 main themes were extracted which included: Causal factors (management issues, human resources management, processes/methods), strategies (priority of prevention over treatment, health resource management, cultural enrichment, promotion of human capital in healthcare, and improvement of methods), intervening factors (economic, social, technological, and political), contextual factors, governance factors, and consequences (promoting the society health, economic efficiency of medical universities).
Discussion
The health system policy model based on the economic resistance approach and the statement of “the second phase of the revolution” can help promote the society health and improve the economic efficiency of medical universities in Iran. This model can show a clear path for policy makers and executive managers in Iran how to improve the economic efficiency of the health system. The results of structural equation modeling showed that intra-organizational factors and intra-provincial factors are the most important variables affecting the economic efficiency of the health system in Iran. Many weaknesses and threats can be eliminated by the cooperation of the Board of Trustees of medical universities as well as the Health and Food Safety Council of the provinces.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Council of Islamic Azad University, Saveh Branch (Code:162359169).
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like thank all participants in this research.