Table 4 Priority inefficiency causes in Iran’s health system

Hospitals

Inefficiency in the number and distribution of hospital beds

0/861

1/000

0/886

0/943

0/913

Pharmaceuticals and medical equipment

Overuse of medicines and health care services

0/854

1/000

0/865

0/916

0/903

Human resources

Health human resources mismanagement

0/889

0/886

0/829

0/771

0/900

Health service delivery

Inefficiency in delivering services, not using the referral system

0/944

0/914

0/914

0/914

0/891

Healthcare financing

Lack of using strategic purchasing of health services in health insurance organizations

0/917

0/943

0/886

0/914

0/890

Healthcare financing

The inefficiency of payment and tariff methods

0/833

0/914

1/000

0/886

0/884

Information technology

Inefficiency of e-health in the country’s health system

0/750

0/971

0/857

0/743

0/884

Healthcare financing

Illness and treatment-centered health insurance system instead of Preventive approaches

0/806

0/943

0/943

0/943

0/884

Corruption

Induced demand

0/861

0/943

0/914

0/829

0/882

Quality of health services

Multiple medical errors

0/944

0/886

0/857

0/829

0/881

Pharmaceuticals and medical equipment

Lack of a suitable model for medical guideline

0/917

0/943

0/771

0/800

0/876

Hospitals

Inappropriate hospital sizes

0/750

0/857

0/714

0/771

0/876

Managerial factors

Administrative inefficiency

0/806

0/914

0/943

1/000

0/873

Pharmaceuticals and medical equipment

Not using Health Technology Assessment (HTA) methods

0/833

0/829

0/829

0/743

0/872

Corruption

Informal payments

0/833

0/914

0/829

0/771

0/868

Healthcare financing

Not using economic analyses to achieve efficient intervention in distribution of resources

0/917

0/857

0/743

0/800

0/864

Pharmaceuticals and medical equipment

A growing number of usable but inoperative medical equipment

0/917

0/829

0/829

0/943

0/864

Pharmaceuticals and medical equipment

Using ineffective or wrong medicine or using medicine at the wrong time

0/861

0/914

0/686

0/857

0/862

Healthcare financing

The inefficiency of payment methods

0/944

0/886

0/743

0/743

0/860

Healthcare financing

Dependence of health insurance funds on governmental resources

0/917

0/829

0/914

0/771

0/856

Healthcare financing

Non-evidence-based decision-making in the utilization and coverage of health technologies and services

0/806

0/886

0/829

0/857

0/853

Pharmaceuticals and medical equipment

Low generic medicine usage or paying high prices for certain and rare medicine

0/861

0/857

0/743

0/829

0/847

Human resources

Lack of a comprehensive health human resource database

0/806

0/857

0/629

0/771

0/843

Pharmaceuticals and medical equipment

Coverage of costly imported medicine which have a local and cheaper alternative

0/861

0/914

0/743

0/714

0/843

Human resources

Ineffectiveness of human resource performance evaluation;

0/861

0/857

0/829

0/857

0/838

Managerial factors

Consecutive government changes, unstable long-term policy implementations and management periods

0/861

0/914

0/714

0/743

0/833

General health system issues

Prioritizing treatment services over prevention

0/750

0/943

0/886

0/857

0/832

Information technology

Not using a universal information system for the proper gathering and reporting of data

1/000

0/857

0/829

0/829

0/831

Healthcare financing

High cost of health services in public and private hospitals

0/833

0/886

0/886

0/829

0/829

General health system issues

Health system management is physicians -oriented

0/917

0/886

0/771

0/800

0/826

Information technology

Difference in sharing information among stakeholders

0/889

0/886

0/800

0/829

0/824

Managerial factors

Centralized hospital management

0/917

0/857

0/829

0/714

0/821

Human resources

The high ratio of administrative human resources to clinical human resource

0/778

0/686

0/743

0/657

0/821

Pharmaceuticals and medical equipment

Irrational medicine prescriptions

0/833

0/857

0/657

0/714

0/819

Corruption

Fee splitting

0/833

0/800

0/943

0/857

0/818

Healthcare financing

Lack of -based payment for performance system

0/750

0/800

0/829

0/743

0/816

Managerial factors

Inefficient hospital management

0/778

0/829

0/857

0/829

0/811

Corruption

Income differences among various professions and majors of the health system

0/806

0/829

0/886

0/829

0/803

Health service delivery

Lack of alternative health care provision models for distance or low-populated areas

0/694

0/886

0/886

0/829

0/801

Environmental factors

Government budgeting style

0/889

0/800

0/800

0/743

0/800

Information technology

Lack of an efficient information system in the healthcare system

0/972

0/800

0/629

0/657

0/796

Corruption

Excising conflict of interests in the policy-making

0/833

0/943

0/914

0/800

0/792

General health system issues

Separation of policy-making from implementation; vague, unclear, and unstable policies

0/722

0/771

0/800

0/771

0/790

Managerial factors

Not using modern management methods

0/750

0/829

0/829

0/771

0/780

Pharmaceuticals and medical equipment

Insufficient control of medicine supply, distribution, and prescription chain agents

0/861

0/857

0/743

0/771

0/779

Pharmaceuticals and medical equipment

Freedom of choice in using commercial and costly medicine

0/667

0/771

0/829

0/800

0/775

Quality of health services

Not using appropriate quality indicators

0/750

0/714

0/829

0/886

0/770

Health service delivery

Using traditional treatments

0/806

0/686

0/800

0/743

0/755