The purpose of this sociological study is to investigate the obstacles to reforming medical tariffs in Iran's health system. To comprehend the impediments to reforming medical tariffs, we will employ Habermas' theory of dialogue democracy and conduct an analysis of stakeholders. This theory emphasizes the importance of open dialogue and participatory processes in complex system decision-making, such as the health system.
This study employs in-depth interviews as its primary method of data acquisition. The data was analyzed using the stakeholder analysis table, which included the dimensions of knowledge, position, interest, and influence. This study collects data from both existing and new interviews.
The findings indicate that transparency is a significant obstacle in the policymaking process, and that stakeholders need more knowledge and information about the policymaking process. The position of stakeholders toward the proposed reforms is one of opposition and resistance. Conflicting interests within the health system pose the greatest barrier to policymaking, according to an analysis of interests. The power analysis reveals that the health system's power structure is centralized, with a limited number of influential policymakers having competing interests in regulating the system. The conclusion of the study is that the top-down approach to policymaking in the health system, which is dominated by competing interests and the erosion of public spheres and civil institutions, results in the concentration of power. On the other hand, a participatory and dialogue-based approach increases the likelihood of successful policy implementation and the protection of the interests of all stakeholder groups. To establish a collaborative public sphere within the health system, policymakers should restore the authority of civil and professional organizations, such as the medical council.
The top-down approach to policymaking, which is influenced by competing interests and centralized authority, has led to opposition from healthcare providers. Service providers must be involved in the successful implementation of health equity policies. Consequently, their participation in the policymaking process is essential to its success.