How to Manage the Conflict of Interests in Health System Payment Methods? A Mixed-Method Study in Iran

Parisa  Yoshari; Hossein Jabbari  Beirami; Roya Alipour  Olyaei; Hossein  Masoumi; Seyed Mohammad Amin  Mousazadeh; Rahim  Khodayari-Zarnaq

doi:10.18502/htaa.v10i1.21559

Parisa Yoshari Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Hossein Jabbari Beirami Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Roya Alipour Olyaei Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Hossein Masoumi Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Seyed Mohammad Amin Mousazadeh Students Research Committee, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
Rahim Khodayari-Zarnaq Department of Health Policy and Management, Faculty of Management and Medical Informatics, Health Service Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

DOI: https://doi.org/10.18502/htaa.v10i1.21559

Keywords: Conflict of interests, Health services, Reimbursement, Incentive, Fee-for-service plans, Health

Abstract

Introduction: Efficient payment systems are vital for reducing health system costs while improving service quality. This study aimed to examine how to manage the conflict of interests in payment methods and propose payment recommendations for the health system staff in Iran.

Methods: This mixed-method study was conducted at Tabriz University of Medical Sciences (2023) using a scoping review, semi-structured interviews, and Delphi method. The scoping review followed the Arksey and O’Malley protocol. Experts were interviewed to adapt global evidence to Iran. Thematic analysis was used to generate and evaluate policy options for managing the conflict of interests in health system payment methods. Moreover, the Delphi process and analytic hierarchy process prioritized these options based on effectiveness, feasibility, economic efficiency, and budget requirements.

Results: Overall, 1,031 articles were initially identified, with 22 meeting the inclusion criteria after a rigorous selection process. Three policy options were evaluated, including modified per capita with pay for performance (MPCP4P), modified salary with P4P, and modified fee for service with P4P. MPCP4P emerged as the top choice due to its superior economic benefits and effectiveness. It was revealed that MPCP4P mitigates financial risks for providers while ensuring high-quality care, making it the most suitable option for the country’s payment system.

Conclusion: The MPCP4P method, with risk adjustment and quality indicators, reduced conflicts and service reduction in capitation systems. The implementation solution includes determining quality and performance indicators, establishing a risk adjustment framework, and managing referrals. Rigorous oversight and continuous evaluation are also essential.