a Policy Package for Preventing Overuse and Underuse of Healthcare Services in the Iranian Healthcare System

Abstract

Introduction: Medical overuse and underuse are two issues that have a great impact on the cost and quality of services and, also they can have an impact on universal health coverage and health outcomes. Objective: The purpose of this study was to formulate a policy package to prevent medical overuse and underuse for the Iranian health system. Materials and Methods: This multi-method research was carried out in five steps between 2016 and 2018 in Tabriz University of Medical Sciences. Different approaches used in this study, including literature review, systematic review, qualitative study including interview, expert panel and Policy Delphi. Results: In the literature review, 27 studies examined the drivers, 21 studies looked at preventive ways and 14 studies have been designed to formulate frameworks and models. According to systematic review results, 70 papers were included in the study, 54 of which examined overuse, 9 papers of examined underuse and 7 papers studied both cases. According to the results of the qualitative study, the driver factors categorized in six factors include physician, patient, organizational, socio-cultural, media and market. Also, preventive factors categorized in seven factors include service delivery, health workforce, health information system, access to medical product and technologies, healthcare financing, leadership/governance and social interventions. The final prevention strategies included 11 policy options. Conclusion: This study showed that medical overuse and underuse is common in Iran's health system. Identifying services that are potential to overuse and underuse and determining the driving factors can help policymakers to determine appropriate prevention policies.