Volume 28, Issue 1 (5-2025)
jha 2025, 28(1): 56-75 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Ashrafi E, Mosadeghrad A, Arab M. Analysis of administrative health policies in healthcare organizations. jha 2025; 28 (1) :56-75
URL: http://jha.iums.ac.ir/article-1-4527-en.html
URL: http://jha.iums.ac.ir/article-1-4527-en.html
1- Department of Health management, policy and economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Health management, policy and economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,arabmoha@tums.ac.ir
2- Department of Health management, policy and economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,
Full-Text [PDF 954 kb]
(572 Downloads)
| Abstract (HTML) (795 Views)
Figure 1. Mosaddeghrad Policy Analysis model [8]
Table 1.Continued
Discussion
This study examined administrative health policies in Iran’s healthcare system and revealed that although the establishment of the Administrative Health Promotion Act demonestrated high-level commitment, its effectiveness was hindered by structural and operational weaknesses, such as inadequate financial support, insufficient expert input, and weak implementation mechanisms, contributing to a persistent "policy-implementation gap" [11]. Additional obstacles included poor governance, resource shortages, and frequent managerial turnover, all of which undermined institutional stability and stakeholder engagement [12].
Despite Iran’s post-war efforts and participation in international conventions, overall integrity has declined since 2003 [7], primarily due to limited transparency and political dominance. Kingdon’s "Policy Window" theory underscores the need for political consensus [13]; however, stakeholder exclusion and top-down approaches weakened supports for policies. Although some strategies from countries such as Singapore and Malaysia were adopted, public participation and intersectoral collaboration remained limited. The lack of effective advocacy, especially among the executive, judiciary, civil society, and media, further obstructed progress.
The Formulation of anti-corruption policies faced challenges such as vague objectives, institutional conflicts, and poor coordination, while major reforms introduced in 2015 failed to address socioeconomic roots of corruption. In the absences of detailed action plans, training, infrastructure, and monitoring systems, implementation efforts faltered. Frequent changes in Ministry of Health leadership further disrupted continuity and delayed outcomes [14]. Evaluation remained ineffective due to a lack of comprehensive systems, resistance to transparency, and inadequate performance indicators. Structural reforms, integrated oversight, and institutional redesign are essential to bridge the gap between policy and practice. Without strong leadership commitment, fair resource allocation, and a culture of accountability, policy reform will remain incomplete and corruption risks will persist [15].
Limitations
The main limitation of this study is the scarcity of scientific research on corruption in Iran’s healthcare sector. Therefore, caution is required when utilizing and interpreting the findings.
Conclusion
Corruption in the health system is critical because of its direct impact on people's lives and health. Administrative health policies serve as a key response to the corruption. Policy analysis provides a better understanding of the current situation, helps identify challenges, and offers practical and effective policy options for implementing these policies. Stakeholder participation, transparency, accountability, reduced management turnover, and improved financial and human resources are essential to improve administrative health.
Declerations
Ethical considerations: This study is part of a Ph.D. dissertation in Health Services Management at the School of Public Health, Tehran University of Medical Sciences, conducted under the ethical code IR.TUMS.SPH.REC.1399.012 .All efforts were made to ensure accuracy and maintain objectivity in
Funding: This study received no financial support.
Conflict of interest: The authors declared no conflicts of interest.
Authors’ contributions: Mohammad Arab: Study design, data management, data analysis, writing- original draft; Ali Mohammad Mosaddeq Rad: Study design, data management, data analysis, writing- original draft; Ensieh Ashrafi: Study design, data curation, data analysis, writing–original draft. All authors have read and approved the final text
Consent for publication: Not applicable.
Data availability: Due to the confidentiality, data can not be shared.
AI decleration: ChatGPT was used for editing and summarization of some sections of the manuscript.
Acknowledgments: The authors thank all those who collaborated in this research. This research is based on a thesis titled "Analysis of Administrative Health Policies in Healthcare Organizations" approved by the School of Public Health, Tehran University of Medical Sciences, with registration number 462821
Full-Text: (330 Views)
Introduction
Corruption in the health system refers to the misuse of authority for personal gains in areas such as resource allocation, procurement, and service delivery [1]. It undermines public trust, wastes resources, reduces service quality, and increases healthcare inequities [2]. Factors such as limited resources and growing demands further contribute to corruption and a decline in service quality [3]. Strengthening governance, enhancing monitoring, and ensuring equitable resource distribution are essential measures to combat corruption and achieve the goals of health systems. Administrative health, or integrity in governance, emphasizes transparency, accountability, and adherence to ethical and legal standards in organizational processes [4]. Its deterioration leads to injustice, public dissatisfaction, and threats to public health. Thus, promoting administrative health through sound policy-making is vital.
Public policy-making is a structured approach to addressing societal issues through formulation, implementation, and evaluation [5]. In this context, the 2008 Administrative Health Promotion Act was introduced in Iran to combat corruption and increase efficiency by promoting transparency and accountability in public agencies [6]. Nevertheless, Iran’s low score of 23 on the 2024 Corruption Perceptions Index (ranking 151st out of 180 countries) highlights persistent challenges [7].
Analyzing administrative health policies, especially in healthcare, is essential for understanding policy outcomes and guiding future decisions [8]. Among various models, the Mosadeghrad Policy Analysis Model, with four stages and ten steps, provides a comprehensive framework by incorporating political, economic, social, and other contextual dimensions, supported by 100 open-ended questions for in-depth analysis (Figure 1). Despite the important role of administrative health in improving service quality, increasing productivity and public trust, and reducing corruption, no comprehensive and systematic research has been conducted to analyze administrative health policy, particullary in Iranian healthcare organizations. Therefore, this study aims to analyze administrative health policies in these organizations to support policy review, develop strategies to combat corruption, increase transparency, strengthen accountability, and empower managers as well as improve governance in the health system.
Corruption in the health system refers to the misuse of authority for personal gains in areas such as resource allocation, procurement, and service delivery [1]. It undermines public trust, wastes resources, reduces service quality, and increases healthcare inequities [2]. Factors such as limited resources and growing demands further contribute to corruption and a decline in service quality [3]. Strengthening governance, enhancing monitoring, and ensuring equitable resource distribution are essential measures to combat corruption and achieve the goals of health systems. Administrative health, or integrity in governance, emphasizes transparency, accountability, and adherence to ethical and legal standards in organizational processes [4]. Its deterioration leads to injustice, public dissatisfaction, and threats to public health. Thus, promoting administrative health through sound policy-making is vital.
Public policy-making is a structured approach to addressing societal issues through formulation, implementation, and evaluation [5]. In this context, the 2008 Administrative Health Promotion Act was introduced in Iran to combat corruption and increase efficiency by promoting transparency and accountability in public agencies [6]. Nevertheless, Iran’s low score of 23 on the 2024 Corruption Perceptions Index (ranking 151st out of 180 countries) highlights persistent challenges [7].
Analyzing administrative health policies, especially in healthcare, is essential for understanding policy outcomes and guiding future decisions [8]. Among various models, the Mosadeghrad Policy Analysis Model, with four stages and ten steps, provides a comprehensive framework by incorporating political, economic, social, and other contextual dimensions, supported by 100 open-ended questions for in-depth analysis (Figure 1). Despite the important role of administrative health in improving service quality, increasing productivity and public trust, and reducing corruption, no comprehensive and systematic research has been conducted to analyze administrative health policy, particullary in Iranian healthcare organizations. Therefore, this study aims to analyze administrative health policies in these organizations to support policy review, develop strategies to combat corruption, increase transparency, strengthen accountability, and empower managers as well as improve governance in the health system.
Figure 1. Mosaddeghrad Policy Analysis model [8]
Methods
The present qualitative policy analysis retrospectively examined administrative health policies in Iranian healthcare organizations. A triangulation approach, combining semi-structured interviews and document analysis, was employed to explore the policy process related to administrative health promotion, using the Mosadeghrad Policy Analysis Model [8].
Participants were selected through purposive and snowball sampling, resulting in interviews with 35 individuals, including policymakers, managers, faculty, researchers, and practitioners in the fields of administrative health and anti-corruption. Data were collected using an interview guide. Additionally, 13 relevant policy documents including laws, regulations, and directives were reviewed and analyzed using the Dalglish et al. protocol [9], which involves data collection, extraction, analysis, and interpretation. A researcher-developed checklist was applied for document analysis.
Thematic analysis was conducted using Braun and Clarke’s approach [10], with data categorized and analyzed using MAXQDA version 10. To enhance the credibility and generalizability of findings, various strategies were employed including pilot interviews, maximum variation sampling, multi-perspective analysis, document review, and peer debriefing.
Results
The present qualitative policy analysis retrospectively examined administrative health policies in Iranian healthcare organizations. A triangulation approach, combining semi-structured interviews and document analysis, was employed to explore the policy process related to administrative health promotion, using the Mosadeghrad Policy Analysis Model [8].
Participants were selected through purposive and snowball sampling, resulting in interviews with 35 individuals, including policymakers, managers, faculty, researchers, and practitioners in the fields of administrative health and anti-corruption. Data were collected using an interview guide. Additionally, 13 relevant policy documents including laws, regulations, and directives were reviewed and analyzed using the Dalglish et al. protocol [9], which involves data collection, extraction, analysis, and interpretation. A researcher-developed checklist was applied for document analysis.
Thematic analysis was conducted using Braun and Clarke’s approach [10], with data categorized and analyzed using MAXQDA version 10. To enhance the credibility and generalizability of findings, various strategies were employed including pilot interviews, maximum variation sampling, multi-perspective analysis, document review, and peer debriefing.
Results
The findings from the interviews and document analysis were categorized into 86 final codes, which were organized into four ten themes (Table 1).
Table 1. Analysis of administrative health policies in healthcare organizations
| Themes | Codes | Themes | Codes |
| Policy-making council |
|
Policy advocacy |
|
| Problem definition |
|
Policy planning |
|
| Political consensus-building |
|
Policy implementation |
|
Table 1.Continued
| Themes | Codes | Themes | Codes |
| Agenda setting |
|
Policy monitoring and evaluation |
|
| Policy content development |
|
Policy revision |
|
This study examined administrative health policies in Iran’s healthcare system and revealed that although the establishment of the Administrative Health Promotion Act demonestrated high-level commitment, its effectiveness was hindered by structural and operational weaknesses, such as inadequate financial support, insufficient expert input, and weak implementation mechanisms, contributing to a persistent "policy-implementation gap" [11]. Additional obstacles included poor governance, resource shortages, and frequent managerial turnover, all of which undermined institutional stability and stakeholder engagement [12].
Despite Iran’s post-war efforts and participation in international conventions, overall integrity has declined since 2003 [7], primarily due to limited transparency and political dominance. Kingdon’s "Policy Window" theory underscores the need for political consensus [13]; however, stakeholder exclusion and top-down approaches weakened supports for policies. Although some strategies from countries such as Singapore and Malaysia were adopted, public participation and intersectoral collaboration remained limited. The lack of effective advocacy, especially among the executive, judiciary, civil society, and media, further obstructed progress.
The Formulation of anti-corruption policies faced challenges such as vague objectives, institutional conflicts, and poor coordination, while major reforms introduced in 2015 failed to address socioeconomic roots of corruption. In the absences of detailed action plans, training, infrastructure, and monitoring systems, implementation efforts faltered. Frequent changes in Ministry of Health leadership further disrupted continuity and delayed outcomes [14]. Evaluation remained ineffective due to a lack of comprehensive systems, resistance to transparency, and inadequate performance indicators. Structural reforms, integrated oversight, and institutional redesign are essential to bridge the gap between policy and practice. Without strong leadership commitment, fair resource allocation, and a culture of accountability, policy reform will remain incomplete and corruption risks will persist [15].
Limitations
The main limitation of this study is the scarcity of scientific research on corruption in Iran’s healthcare sector. Therefore, caution is required when utilizing and interpreting the findings.
Conclusion
Corruption in the health system is critical because of its direct impact on people's lives and health. Administrative health policies serve as a key response to the corruption. Policy analysis provides a better understanding of the current situation, helps identify challenges, and offers practical and effective policy options for implementing these policies. Stakeholder participation, transparency, accountability, reduced management turnover, and improved financial and human resources are essential to improve administrative health.
Declerations
Ethical considerations: This study is part of a Ph.D. dissertation in Health Services Management at the School of Public Health, Tehran University of Medical Sciences, conducted under the ethical code IR.TUMS.SPH.REC.1399.012 .All efforts were made to ensure accuracy and maintain objectivity in
Funding: This study received no financial support.
Conflict of interest: The authors declared no conflicts of interest.
Authors’ contributions: Mohammad Arab: Study design, data management, data analysis, writing- original draft; Ali Mohammad Mosaddeq Rad: Study design, data management, data analysis, writing- original draft; Ensieh Ashrafi: Study design, data curation, data analysis, writing–original draft. All authors have read and approved the final text
Consent for publication: Not applicable.
Data availability: Due to the confidentiality, data can not be shared.
AI decleration: ChatGPT was used for editing and summarization of some sections of the manuscript.
Acknowledgments: The authors thank all those who collaborated in this research. This research is based on a thesis titled "Analysis of Administrative Health Policies in Healthcare Organizations" approved by the School of Public Health, Tehran University of Medical Sciences, with registration number 462821
Type of Study: Research |
Subject:
Health Services Management
Received: 2024/12/11 | Accepted: 2025/07/29 | Published: 2025/09/3
Received: 2024/12/11 | Accepted: 2025/07/29 | Published: 2025/09/3
References
1. Mosadeghrad AM. Rethinking health reforms in Iran. Tehran University Medical Journal. 2020;78:473-4 [In Persian]. Available from: http://tumj.tums.ac.ir/article-1-10750-en.html
2. World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action [Internet]. Geneva (CH):WHO; 2007 [cited 2025 Aug 15].Available from: https://www.who.int/publications/i/item/everybody-s-business
3. Kaufmann D, Kraay A, Zoido-Lobatón P. Aggregating governance indicators [Internet].Washington (DC): World Bank; 1999 [cited 2025 Aug 15]. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/352561468739447838/aggregating-governance-indicators [DOI:10.2139/ssrn.188548]
4. Vian T. Review of corruption in the health sector: theory, methods and interventions. Health Policy and Planning. 2008;23(2):83-94. [DOI:10.1093/heapol/czm048]
5. Hutchinson E, Balabanova D, McKee M. We need to talk about corruption in health systems. International Journal of Health Policy and Management. 2018;8(4):191. [DOI:10.15171/ijhpm.2018.123]
6. Mosadeghrad AM, Ferlie E. Total quality management in healthcare. In: Management innovations for healthcare organizations: adopt, abandon or adapt. New York (NY): Routledge; 2016. p. 378-96. [DOI:10.4324/9781315739786]
7. Neu D, Everett J, Rahaman AS. Preventing corruption within government procurement: constructing the disciplined and ethical subject. Critical Perspectives on Accounting. 2015;28:49-61. [DOI:10.1016/j.cpa.2014.03.012]
8. Mosadeghrad AM. A practical model for health policy making and analysis. Payesh (Health Monitor) [Internet]. 2025;21(1):7-24 [In persian]. Available from: http://payeshjournal.ir/article-1-1801-en.htm [DOI:10.52547/payesh.21.1.7]
9. Islamic Republic of Iran. Law on Promoting Administrative Health and Combating Corruption [Internet]. Official Gazette of the Islamic Republic of Iran. 2008; Issue No. 18686 [cited 2025 Aug 15]. Available from: https://rc.majlis.ir/fa/law/show/802617
10. Transparency International. Corruption Perceptions Index [Internet]. Berlin: Transparency International; c2025 [cited 2025 May 12]. Available from: https://www.transparency.org/en/countries/iran
11. Khayatzadeh-Mahani A, Ruckert A, Labonté R, Kenis P, Akbari-Javar MR. Health in all policies (HiAP) governance: lessons from network governance. Health Promotion International. 2019;34(4):779-91. [DOI:10.1093/heapro/day032]
12. Bowen GA. Document analysis as a qualitative research method. Qualitative Research Journal. 2009;9(2):27-40. [DOI:10.3316/QRJ0902027]
13. Dalglish SL, Khalid H, McMahon SA. Document analysis in health policy research: the READ approach. Health Policy and Planning. 2020;35(10):1424-31. [DOI:10.1093/heapol/czaa064]
14. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. [DOI:10.1191/1478088706qp063oa]
15. Rhodes RA. Understanding governance: policy networks, governance, reflexivity and accountability. Buckingham: Open University Press; 1997. ISBN 0-335-19728-0.
16. Grindle MS. Good enough governance revisited. Development Policy Review. 2007;25(5):533-74. [DOI:10.1111/j.1467-7679.2007.00385.x]
17. Quah JS, editor. Curbing corruption in Asian countries: An impossible dream? Bingley (UK): Emerald Group Publishing Limited; 2011. [DOI:10.1108/S0732-1317(2011)0000020020]
18. Schalk J. Linking stakeholder involvement to policy performance: nonlinear effects in Dutch local government policy making. The American Review of Public Administration. 2015;47(4): 479-495. [DOI:10.1177/0275074015615435]
19. Quah JS. Combating corruption in six Asian countries: a comparative analysis. Asian Education and Development Studies. 2016;5(2):244-62. [DOI:10.1108/AEDS-01-2016-0011]
20. Kingdon JW, Stano E. Agendas, alternatives, and public policies. Boston (MA): Little, Brown; 1984. [DOI:10.1017/S0143814X00003068]
21. Daneshfard K. Investigating effective strategies in administrative integrity system. Strategic Management Research. 2017;24(68):65-87 [In Persian]. https://sid.ir/paper/513498/fa
22. Khoini G, Rahimi A. A practical review of the implementation of the Law on Promoting the Health of the Administrative system and Combating Corruption. Journal of Audit Science. 2019;16(62):5-24 [In Persian]. https://www.magiran.com/p1542116
23. Scott WR. Institutions and organizations. Thousand Oaks (CA): Sage; 1995..
24. Stiglitz JE. The contributions of the economics of information to twentieth century economics. Quarterly Journal of Economics. 2000;115(4):1441-78 [DOI:10.1162/003355300555015]
25. Hudson B, Hunter D, Peckham S. Policy failure and the policy-implementation gap: can policy support programs help? Policy Design and Practice. 2019;2(1):1-4. [DOI:10.1080/25741292.2018.1540378]
26. Mosadeghrad AM, Ferdosi M, Afshar H, Hosseini-Nejhad SM. The impact of top management turnover on quality management implementation. Medical Archives. 2013;67(2):134-40. [DOI:10.5455/medarh.2013.67.134-140]
27. Rose-Ackerman S, Palifka BJ. Corruption and government: Causes, consequences, and reform. Cambridge (UK): Cambridge University Press; 2016. [DOI:10.1017/CBO9781139962933]
28. Hatry HP. Transforming performance measurement for the 21st century. Washington (DC): Urban Institute; 2014. [cited 2025 Aug 15]. Available from: http://www.urban.org/research/publication/transforming-performance-measurement-21st-century
29. North DC. Institutions, institutional change and economic performance. Cambridge (UK): Cambridge University Press; 1990. [DOI:10.1017/CBO9780511808678]
30. Lipsky M. Street-level bureaucracy: dilemmas of the individual in public service. New York (NY): Russell Sage Foundation; 2010 [cited 2025 Aug 15]. Available from: https://www.jstor.org/stable/10.7758/9781610447713
31. Howlett M, Ramesh M, Perl A. Studying public policy: Policy cycles and policy subsystems. Toronto (CA): Oxford University Press; 1995. [cited 2025 Aug 15]. Available from: https://archive.org/details/studyingpublicpo0000howl
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Site Keywords
Health, Administration, Scientific Article, Iran University of Medical Sciences,
