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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.

The importance of champion leaders including tech-savvy leaders to digital government has been highlighted in the literature. Meanwhile, what was in the authors’ interest to explore was the role of business-savvy leaders or non-governmental digital champions as units of analysis, those who mobilized people's interest in digitalization and bypassed governmental barriers through this popular mobilization. They could be considered policy entrepreneurs for understanding policy change in the digitalization of the health sector. This study sought to shed light on the barriers and drivers of digital health in Iran.

The researchers conducted interviews with actors of digital health businesses in Iran, including the Health Information Technology Center affiliated to the Ministry of Health and Medical Education (MOHME) administrative body and authorities, private companies active in digital health and health service providers. The purposive sampling method was applied, and 15 experts with relevant and valuable experiences as well as maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were also used to assure the quality of the results. The data were analyzed based on directed content analysis using the MAXQDA10 software.

It was found out how popular diffusion was effective to overcome barriers to health digitalization. Access to the internet and diffusion of information technology helped the net-enabled businesses to connect directly to people and provide services to them. Diffusion of these services forced the public sector to adjust itself, and thus MOHME banned digital consultation services because of the so-called “insecure and unknown physicians”, following the increased popularity of digital services diffusion, but they were not able to resist popular diffusion of new technology. Hence, it was allowed to work. The main barriers to telemedicine spreading in Iran have been divided into five main categories including government incapacity for digital health governance, conflict of interest, professional obligations for information transparency, protection of patients' rights and data security and privacy.

As a game changer in digital health governance in Iran, popular diffusion will determine the future of digital health. To the best of the authors’ knowledge, this study is among the first ones to explore digital health governance in relation to the private digital health business in Iran with a public policy approach.

Reducing inequity in health between the poor and the rich is one of the challenges of the Iranian health sector. Access to health services in Iran is lower in the lowest-income quarter, and the rich use health services more. The purpose of this study is to provide a comprehensive framework for enabling financial access by the poor to health services in Iran.

Policy options were validated and approved by experts and specialists in two stages using the Delphi technique. The sample was consisted of 22 well-known experts on the subject who were selected based on purposive sampling. To evaluate the reliability of the questionnaire, a pilot study was conducted with five participants. Dimensional validity of the policy model, which was agreed upon by more than 75% of the participants was acceptable.

The main aspects of the model were divided into five categories: identifying the poor, policymaking to prevent the aggravation of health poverty, providing targeted funding, highlighting the importance of coherent regulation and ensuring financial accessibility to health services for the poor. This model could align the activities of all stakeholders in the form of a network and considers its prerequisites.

Prevention of dire financial consequences in the case of referral to follow up the treatment alongside exemption and financial protection policies through the networking activities of organizations involved in this field is a crucial step in securing financial support for the poor. Although the researchers included a wide range of policymakers in the Delphi study to gather all perspectives about options for financially support the poor, there may be some potential neglected policy advices.