Exploring Determinants of Social Iatrogenesis and its Impacts on Health Promotion Programs in Iran

Abstract

Bachground: Changing the pattern of dealing with diseases and health issues, in line with present unequvalencies in supply and demand sides of health care and also deficient monitoring of performances in health sectors have lead to emergence and spread of of social iatrogenesis (SI) as one of the major challenges for many health systems including Iranian National Health Network. The phenomenon refers to creation of induced health care needs by health professionals, pharmaceutical and medical equipment companies to seek extensive financial interests by shifting patients towards unnecceessary but generally costly procedures. Induced care provision with the aim of making more profit and earning further income could have critical consequences for communities among them waste of human and financial resources, reduction of health care quality and endangering of individuals‟ life are paramont.Other side effects could be augmentation of mistrust between physicians, patients and health care delivery systems. This could negatively affect the hea;th indices in communities per se. Main aim of this study was to investigate determinants of the social iatrogenesis in Iran and envisage its probable effects on the country‟s health promotion programs. Methodology: In this multi-method study several databases including PubMed, Scopus Cochrane, Ovid, Proqueswere scrutinized within a scoping review to identify possible national and internationsl determinants of SI and their relative rank in terms of generlisability. Ordinary peoples‟ in line with physicians‟ point of views were also envisaged using the researcher constructed data collection tools to recognize strategies that could potentially halt the process. Content analysis method was used to incorporate the collected data (through face to face interview) in the qualitative phase of the study to dig deep into the particpants‟ perspectives on negative consequences of the phenomenon for health promoting programs of the country. Results: Main determinants of SI were identified in three categories of health care providers and recepeints in addition to socio-cultural factors. Based on the findingsof quanitative phase of the study which were achieved using the “The Anonymous Third Party Patient‟ Report of Exemplar Cases of Social Iatrogenesis” and “The Anonymous Third Party Physicians‟ Report of Exemplar Cases of Social Iatrogenesis” the health care provider related factors were deviation from professional ethics guidelines (24.8%), care provision based on the recepients‟ preference mostly with financial purposes (9.40%) and not beleving in perseverance of justice throughout the health system (7.73%) were main determinants of social iatrogenesis in Iran respectively. The identified care-receiver related determinatnts of SI were their preferences and believes in relation to therapeutic regiems (18.45%), trust between patients and physicians and adherence to the prescribed treatment protocols (8.93%) and health care recepeints willingness in paying undertable mony to their care providers (8.25%). According to the key informants‟ prospects SI expansion in Iran could be attributed to social contexts, the health system management, care recipients, physicians‟ social positions and the played role of Media. Evidence based healthcare delivery, strengthening supervision and evaluation system, structural and systemic reforms, empowering people and revision in medical education and professional ethics were proposed solutions for dealing with SI. The expert panel emphasized negative consequences of SI in three domains of public policies, the core health sector policies and social capital. Conclusion: The study findings indicated relative awareness of the both health care providers and receivers about the determinants and extent of SI in the country. Current deficiencies in teaching professional ethics guidelines, insufficienes in care providers‟ monitoring and their performances‟ supervision and infrastructural factors such as economic burdens were suggested to have detrimental effects on spread of SI in Iran. Iterventional programs to cutoff the phenomenon must focus on re-definition of care receivers‟ positions in the health system and re-structring of care providers‟ value system