Toward Iran's health system regionalization: a qualitative approach.

Abstract Background: Regionalized health systems are expected to provide an integrated chain of services for a defined population. However, developing such systems is possible only through alignment across policy, administrative/coordinative, and operational levels. The present study aimed to identify the requirements for such alignment among various levels of Iran's health system. Methods: This qualitative study was conducted with experts in related departments of the Ministry of Health and Medical Education in Iran and selected universities over 5 months in 2023-2024. Fifteen semi-structured interviews were conducted with policymakers and academic experts to collect the study data. The data were grouped into three themes based on thematic content analysis using the MAXQDA software. Results: Three main categories of requirements for developing regionalized health systems, encompassing policy, administrative/ coordinative, and operational levels, and 23 sub-themes, were extracted. Like other hierarchical health systems, the country's health system faces fundamental challenges due to insufficient organizational infrastructure, which hinders its transition into an integrated healthcare management system. Conclusions: Given the legal obligations imposed on the Ministry of Health and Medical Education to establish an integrated regionalized health system and the failure of the relevant initiatives, it is critical to develop the essential infrastructural requirementsacross levels to achieve this goal.