Table 3 Role of stakeholders in the policy process of setting medical tariffs
From: Setting health care services tariffs in Iran: half a century quest for a window of opportunity
| Â | Actor | Role in setting medical tariffs | Activity Level | Activity Area | Position | Power | Influence | Agenda setting | Formulation | Implementation | Monitoring & evaluation | Group N |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Governance Side | Parliament Health Commission | Approving macro policies such as five-year development plan and approving the basic health insurance yearly budgets for policy implementation. | National | Governmental | – | High | – | + | + | + | + | 2 |
Planning and budgetary organization | Approving proposed medical tariff revision and proposing to government, approving budget proposed by insurance organization, MoHME, and MCLSW. | National | Governmental | + | High | Moderate | ++ | + | + | + | 2 | |
MoHME | Proposing policy of relative value revision and providing its implementation infrastructure. | National | Governmental | +++ | Very high | High | +++ | +++ | +++ | ++ | 1 | |
MCLSW | Head of Insurance High Council and responsible for holding meetings and making related decisions. | National | Governmental | + | High | High | ++ | ++ | ++ | + | 2 | |
Medical Council organization | Member of Insurance High Council, attendance in the meeting. | National | Non-Governmental | +++ | Very high | Very high | +++ | +++ | +++ | + | 3 | |
Supply Side (Health care Providers) | Private hospitals and clinics/para clinic | Health care provider and implementing and executing new tariff book. | Regional/local | Private | ++ | Moderate | Very high | + | + | ++ | + | 3 |
Public hospitals and clinics/ para clinic | Health care provider and implementing and executing new tariff book. | Regional/local | Governmental | ++ | Moderate | Very high | + | + | ++ | + | 3 | |
Special Councils | Health care provider and implementing and executing new tariff book. | National/provincial | Governmental | +++ | Moderate | High | +++ | +++ | ++ | + | 3 | |
Demand Side (Health care purchasers or health caregiver) | Basic Insurance organizations | Member of Insurance High Council, attendance in meetings and executer of tariff book. | National/provincial | Governmental | + | Very high | – | ++ | ++ | ++ | ++ | 1 |
Private/ supplementary insurance organizations | Member of the secretariat of Insurance High Council, attending in meeting and executer of tariffs. | National/provincial | Governmental | – | Moderate | – | + | + | ++ | + | 4 | |
People/insured people | Health care givers and paying health care expenditures. | Regional/local | – | – | Low | – | – | – | – | + | 4 |