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Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and justice-based responsibilities in public hospitals. The purpose of this paper is to investigate the pattern of offering discounts to the poor and the effect of Iran’s recent Health Sector Evolution Plan on it.

The authors conducted analytical research longitudinally on the data related to cash discounts offered to the poor within a teaching hospital. Data were collected through the period of four months, September to December 2013, before the establishment of the Health Sector Evolution Plan, and in the similar months through 2014, after the establishment of the Health Sector Evolution Plan, in order to compare the amount of cash discounts. The type of insurance, length of stay, amount of discounts offered to patients, and total costs of hospital charges were studied and compared by referring to the social working department. Data were analyzed using the χ²-test, Mann-Whitney U test, ANOVA, and regression analysis aided by SPSS 20.

The number of patients offered discounts or exempted from payment in 2014 reduced compared to the number in 2013. The highest rate of demand for discounts was related to patients covered by Emdad Committee followed by those who had no insurance. The ratio of discount to cost in the oncology ward was higher than other groups.

The results of the present study can contribute to the plans of health system policy makers in organizing measures for supporting poor patients toward accessing healthcare services.

Reducing health inequalities between the poor and the rich is one of the challenges that the Iranian healthcare sector is facing. One of the goals of the Iranian Government in the Healthcare Sector Evolution Plan (HSEP) is claimed to be creating an opportunity for the poor to use inexpensive services. The purpose of this paper is to provide an analysis of the status of the poor in the HSEP. Based on this evaluation, the authors will provide policy recommendations to improve the benefits of the HSEP for the poor people.

This paper is based on a qualitative study conducted in 2017. The research sample includes policymakers, experts and scholars at the macro-level of the Iranian healthcare system who were well-aware of the financial support for the poor. Overall, 35 semi-structured interviews were carried out. Data were analyzed based on the thematic analysis method.

The effects of the HSEP on the poor were studied in terms of their positive outcomes and challenges. Despite the achievements of the HSEP for all people, the most important challenge was the lack of targeted state subsidies for the poor. These subsidies should have included free insurance coverage, reducing inpatient payment and allocation of a separate budget for the poor.

Adopting some policies to target public health subsidies toward the poor such as free insurance specific for the poor (based on means testing), as well as user fee exemption and waivers could improve access to health services for them in Iran. In addition, separate funding for such policies, strengthening health prevention and health care services for marginalized populations, and improving their health literacy could help ensure the poor’s benefiting more from the health care services.

Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran’s health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing (EHCF) using the multiple streams model.

This qualitative study was conducted by 26 documents review and analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist based on the goals. All audio-taped interviews were transcribed and analyzed thematically. Data management and analysis were performed using the framework analysis in MAXQDA software.

The framework analysis identified 12 complementary sub-themes totally. Problem stream included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran World Health Organization’s report in 2000, the Targeted Subsidies Law and emphasis on equalizing healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes. Finally, political stream showed four sub-themes including strong support from the Minister of Health for HSEP, mass media, the pressure of WHO and people’s request to reduce health costs.

The limitations of the present study included paying attention to one package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of similar national and international evidence in implementation framework.

The results of this study can be used to analyze other health sector reforms around the word and can help the formulation and implementation of most practical reforms, especially in field of health system financing.

This study gives a holistic view about health system policy setting that can be used for understanding policy-making streams to population.

This is the first study that has examined HSEP (the biggest health sector reform in Iran) from the perspective of agenda setting. In addition, using the popular and well-known Kingdon’s model to explain HSEP agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views by including highly informed people increased the strength of the results of the study. In addition, the short interval between the interview and reviewing the results on reforms reduced the recall bias of the participants in the study.

Regional health care planning deals with the regional healthcare resource location‐allocation problem posed to each public healthcare administration. Up to date, the models designed to support this kind of decision failed in their application. We found that the main reason is that often these models restrict the problem to a unique aspect (such as “covering of the territory” or “technique efficiency”), leaving outside a set of very important other dimensions, even if these are usually subjective and difficult to formalise. In this paper we present a method to identify formally these dimensions, by assigning measurable attributes to each of them. At a different level, we propose a hierarchical formulation of the overall objective of the regional healthcare resource planning for the facility systems; in this hierarchy, each leaf term corresponds to a formal evaluation criterion.

Qualitative methods are not suitable to process high volumes of policy texts for exploring policy evolution. Therefore, it is hard to use qualitative methods to systematically analyze the characteristics of complex policy networks. So the authors propose a bibliometric research study for exploring policy evolution from time–agency–theme perspectives to excavate the rules and existing problems of China's medical informatization policy and to provide suggestions for formulating and improving the future medical informatization policies.

Initially, 615 valid samples are obtained by retrieving related China's medical informatization policy documents, and the joint policy-making agency network and the co-occurrence network models of medical informatization policies are defined, and then the authors research China's medical informatization policies from single-dimension and multi-dimension view.

The analysis results reveal that China's medical informatization policy process can be divided into four stages; the policy-making agencies are divided into four subgroups by community detection analysis according to the fast unfolding algorithm; the core policy theme keywords are identified based on the eigenvector centrality of the nodes in those networks; the focuses of theme terms are varied in different stages and the correlations between agencies and themes are gradually decentralized.

These findings provide experience and evidence on leveraging informatics in the medical and healthcare field of China. Also, they can help scholars and practitioners better understand the current status and future directions of medical and healthcare informatics development in China and provide a reference to formulate and improve China's future medical informatization policies.

This study proposes a quantitative bibliometric-based research framework to describe transitions and trends of China's medical informatization policy.

This paper explores the Adoption of Technological Innovation (ATI) in the healthcare industry. It investigates how the literature has evolved, and what are the emerging innovation dimensions in the healthcare industry adoption studies.

We followed a mixed-method approach combining bibliometric methods and topic modeling, with 57 papers being deeply analyzed.

Our results identify three latent topics. The first one is related to the digitalization in healthcare with a specific focus on the COVID-19 pandemic. The second one groups up the word combinations dealing with the research models and their constructs. The third one refers to the healthcare systems/professionals and their resistance to ATI.

The study’s sample selection focused on scientific journals included in the Academic Journal Guide and in the FT Research Rank. However, the paper identifies trends that offer managerial insights for stakeholders in the healthcare industry.

ATI has the potential to revolutionize the health service delivery system and to decentralize services traditionally provided in hospitals or medical centers. All this would contribute to a reduction in waiting lists and the provision of proximity services.

The originality of the paper lies in the combination of two methods: bibliometric analysis and topic modeling. This approach allowed us to understand the ATI evolutions in the healthcare industry.

The research aims to describe the foundation of healthcare organizations’ past and present sustainability endeavors; describe the direction of a health-care organizations’ sustainable development; reveal and characterize what determines the foundation and direction in a public health-care sector; and provide some insights into social marketing for sustainability endeavors.

Based on a semi-inductive approach, judgmental sampling was applied to select relevant health-care organizations. Informants were identified according to their knowledge of their organizations’ sustainability initiatives.

Offer insights into the foundation of sustainability endeavors and the direction of sustainable development for upstream social marketing in the studied public sector. The social marketing perspective is a common factor of relevance for the studied public hospitals.

The foundations of sustainability endeavors undertaken across the studied health-care organizations have not so far been homogenous. The direction of sustainable development has also varied across the studied public healthcare organizations and there is a need to move beyond individuals and shift from a micro to a macro/structural environment of sustainable development, so as to observe the effectiveness of any social marketing intervention.

This study highlights the importance of applying an upstream social marketing approach and programs, as part of a social marketing strategy, to promote and stimulate sustainable change in health-care organizations.

Contrary to the common sense predominating in many societies nowadays regarding sustainability endeavors and sustainable development, we conclude that neither the foundation of such endeavors nor the direction of sustainable development has progressed adequately in the studied public healthcare sector. As social marketing is intended to benefit society and foster social change, the macro level of intervention of the upstream approach clearly reveals its usefulness in the public health area.

Reveals two axes based on a social marketing approach. One is of micro and macro determinants characterizing the direction of sustainable development in a public sector. Another is of homogeneous and heterogeneous foundations of sustainability endeavors.

The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.

Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.

Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.

By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.

The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population.

Quality improvement is imperative for healthcare organisations. Despite the importance of the topic, many efforts have been wasted on failed improvement programs. Various studies have tried to identify the failure factors in improvement programs, but the divergences in the results hamper this research field’s evolution. This study reviews scientific activity from 2000 to 2019 on failure factors in Healthcare Quality Improvement Programs (HCQIP) to help academics and managers understand the field’s evolution better. This research intends to answer four questions on failure factors in HCQIP: Who are the most active authors in this field?; Which journals have been used as diffusion channels?; What are the themes addressed the most in this field?; and What are the themes considered to be emerging?

The authors conducted a bibliometric-based literature review on a sample of 5,137 articles, and 104 studies were included in this review, covering a longitudinal analysis in two periods (P1: 2000–2010 and P2: 2011–2019). Performance analysis, citation, co-citation, co-words analysis and network mapping identified the authors in this scientific field, the journals, the number of articles, along with the current and emerging themes that reveal the latent structure of the factors associated with failures in HCQIP.

The number of articles in P2 (83 studies) is almost four times higher than in P1 (21 studies). The results reveal a dynamic field attracting more authors since 2013, expanding from 5 to 42 journals that publish on the topic. Furthermore, research has evolved from comprehensive manufacturing programs to more theory-based and contextualised health care. In this sense, the recent literature (P2) suggests that failure factors related to quality improvement programs can be minimised if these initiatives align with the human centrality paradigm.

Analysing the evolution of failure factors in HCQIP helps redesign research and management for better quality health outcomes. Knowledge of the scientific community trajectory over nearly 20 years enables better planning from the patient's perspective and contributes to reducing failures in quality programs.

This study contributes to developing the field of failure factors in HCQIP by providing researchers and managers with an evolutionary, systematic and pioneering view of the theme.

The purpose of this paper is to undertake an examination of the Local Health Integration Network (LHIN) Health Policy proposal. This policy established a decentralized approach to health system management in the province of Ontario, Canada by creating 14 crown agencies, LHINs.

This policy is examined against the five policy stages of the Stages Model: agenda setting, formulation, legitimation, implementation and evaluation. The examination was based on a review of grey literature, including key government reports and briefs.

This policy did not follow the Stages Model sequentially: the policy was implemented while it was still undergoing its legitimacy phase. Formal reviews were undertaken following implementation and found areas for improvement: poor integration amongst all the LHINs; poor patient navigation persists; LHINs lack the capacity and competency to engage in regional capacity planning; and planning and integration is not centered around patient needs. As a result, a decade after the introduction of LHINs, the Ontario HealthCare System has not achieved systems improvement when measured against accepted government indicators of performance.

This integration policy highlights the context and evolution of Ontario’s healthcare system governance in the past decade and contributes to the body of knowledge on the impact of regionalization on health systems and patient care.