Qom University of Medical Sciences Journal

Introduction
Health is one of the most important human needs for sustainable social, economic, political and cultural development. The health system of a country is responsible for the health of the society, and policy-making and developing regulations. For optimal management of health resources and continuous improvement of health system performance in Iran, it is necessary to pay attention to "the second phase of the revolution" statement. This study aims to assess the factors affecting the policymaking of the health system in Iran based on this statement using interpretive structural modeling (ISM) approach.
Methods
This is qualitative study that was conducted in two stages. In the first stage, by conducting interviews with 11 experts in health, the most important components related to the policy-making based on the "the second phase of the revolution" statement were identified. In these interviews, the experts were asked about the economic efficiency of medical universities, causal factors of the existing situation, strategies to improve the efficiency of health system services according to the statement, intervening and contextual factors affecting the strategies and the consequences of implementing the strategies.
Finally, the components were classified as causal factors, strategies, contextual factors, intervening factors, and consequences. In the second step, the identified components were analyzed using the ISM method. To determine the key components, the influence power and dependence power in the final reachability matrix were evaluated. In this matrix, the influence power indicates the number of criteria that is affected by the corresponding element and the dependence power refers to the number of elements that affect the corresponding element. The autonomous variables of the matrix have a weak dependence and influence power. The dependent variables have a weak influencing power, but a high dependence power. The linkage variables have strong influence and dependence power. The independent variables have a strong influence power, but weak dependence power.
Results
Nineteen main components were identified at three levels (Lower levels have more influence on higher levels). The third-level components included the managerial factors, human resources, processes and methods. macro policies, supportive role, tenure role, stewardship role, exclusive services, economic factors, social factors, technological factors, and political factors. The second-level components included prevention priority, health resource management, cultural enrichment, health promotion, and modification of methods and processes. The first-level components included promotion of community health and the economic efficiency of the health system and medical universities.
 Conclusion
Paying attention to the identified components and their use by the health system of the country in making policies can help achieve the transcendental goals of the health system. Internal organizational factors and provincial factors are the most important variables affecting the economic status of medical universities in Iran. By relying on the Board of Trustees of medical universities as well as the Health and Food Security Council of the provinces, many weakness and threats to the health system can be eliminated.
Ethical Considerations
Compliance with ethical guidelines
TIn this study, no experiments on human or animal samples were conducted. In this regard, no ethical approval code was obtained.
Funding
This article was extracted from a PhD thesis at Islamic Azad University, Saveh Branch. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. This research has no financial sponsor.
Authors contributions
The authors contributed equally to preparing this paper.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank and appreciate the participants for their cooperation in this research.