Volume 28, Issue 1 (5-2025)
jha 2025, 28(1): 76-94 |
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Takian A, Mohammadi S, Shamsi Gooshkih E. Conflict of Interest in the Governance of Healthcare System in Iran: Root Causes, Challenges, and Solutions (A Qualitative Study). jha 2025; 28 (1) :76-94
URL: http://jha.iums.ac.ir/article-1-4607-en.html
URL: http://jha.iums.ac.ir/article-1-4607-en.html
1- Health Equity Research Centre, Tehran University of Medical Sciences, Tehran, Iran. & Center of Excellence for Global Health, Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. , takian@tums.ac.ir
2- Public Health Law Group, The Institute for Legal Innovations, Tehran, Iran. & Center of Think Tank for Good Governance in Health, Tehran University of Medical Sciences, Tehran, Iran.
3- Research Center for Medical Ethics and History, Tehran University of Medical Sciences, Iran. & Monash Bioethics Center, Monash University, Australia.
2- Public Health Law Group, The Institute for Legal Innovations, Tehran, Iran. & Center of Think Tank for Good Governance in Health, Tehran University of Medical Sciences, Tehran, Iran.
3- Research Center for Medical Ethics and History, Tehran University of Medical Sciences, Iran. & Monash Bioethics Center, Monash University, Australia.
Abstract: (39 Views)
Introduction: The healthcare system, like other sectors of public policy, is vulnerable to conflicts of interest (COI). Considering direct impact of COI on societal health, the emergence COI in the healthcare system carries potential risks to public well-being. This study aimed to determine the origin, challenges, and solutions for managing COI within the governance framework of the Iranian healthcare system.
Method: This cross-sectional, empirical qualitative study employed a snowball sampling technique. We identified 50 health experts and conducted semi-structured interviews. We applied inductive approach for data analysis, facilitated by the Atlas Ti9 software.
Results: Three primary themes emerged: "Origins of COI", "Challenges in managing COI situations", and "Solutions for managing COI situations". Altogether, we identified 57 codes for these three themes.
Conclusion: Cultural, political, managerial, executive, supervisory, and legal contexts contribute to the emergence of COI situations. Nevertheless, challenges- particularly structural, managerial, executive, and policy-related nature in conflict management, may delay COI management. Consequently, effective management of these situations requires addressing structural, institutional, and individual factors, refining policy management, strengthening laws and regulatory mechanisms, and enhancing the role of civil institutions.
Method: This cross-sectional, empirical qualitative study employed a snowball sampling technique. We identified 50 health experts and conducted semi-structured interviews. We applied inductive approach for data analysis, facilitated by the Atlas Ti9 software.
Results: Three primary themes emerged: "Origins of COI", "Challenges in managing COI situations", and "Solutions for managing COI situations". Altogether, we identified 57 codes for these three themes.
Conclusion: Cultural, political, managerial, executive, supervisory, and legal contexts contribute to the emergence of COI situations. Nevertheless, challenges- particularly structural, managerial, executive, and policy-related nature in conflict management, may delay COI management. Consequently, effective management of these situations requires addressing structural, institutional, and individual factors, refining policy management, strengthening laws and regulatory mechanisms, and enhancing the role of civil institutions.
Type of Study: Research |
Subject:
Health Policy
Received: 2025/01/25 | Accepted: 2025/07/30 | Published: 2025/09/3
Received: 2025/01/25 | Accepted: 2025/07/30 | Published: 2025/09/3
References
1. Zhang Y. Research on the identification model of interest conflict influencing factors in PPP projects construction of smart city. Alexandria Engineering Journal. 2022;61(12):12689-98. doi: [DOI:10.1016/j.aej.2022.06.039]
2. Davis M, Stark A. Conflict of interest in the professions. Oxford: Oxford University Press; 2001. [DOI:10.1093/oso/9780195128635.001.0001]
3. Kimbrough EO, Sheremeta RM. Theories of conflict and war. Journal of Economic Behavior & Organization. 2019;159:384-7. doi: [DOI:10.1016/j.jebo.2019.02.007]
4. Schafer M. Cooperation in an objective conflict of interest? testing two psychological approaches. The Journal of Politics. 1997;59(3):729-50. doi: [DOI:10.2307/2998635]
5. Dawson M, Fletcher Watson S. Commentary: what conflicts of interest tell us about autism intervention research-a commentary on Bottema‐Beutel et al.(2020). Journal of Child Psychology and Psychiatry. 2021;62(1):16-8. doi: [DOI:10.1111/jcpp.13315]
6. Arsal T, Setyowati D, Hardati P, Atmaja H, editors. Social harmony model for social conflict management in Central Java. IOP Conference Series: Earth and Environmental Science; 2021: IOP Publishing. [DOI:10.1088/1755-1315/747/1/012087]
7. Huang D, Zhang R, He Z. Water economics. Beijing: China WaterPower Press; 2020. Chapter 5, Multi-stakeholder conflict of interest in mega-water conservancy projects risk assessment; pp. 74-80, 84.
8. Zeng X, He S. Research on public-private conflict of interest and behavior evolution game under the PPP mode of megaprojects. Construction Economics. 2019;40(12):66-72. doi: [DOI:10.14181/j.cnki.1002-851x.201912066]
9. Zeng X, He S. Research on conflicts of interest and resolution mechanisms in the development of ethnic village tourism based on stakeholder theory. Cultural Industry Research. 2017;3:270-81. Available from: https://www.qikanchina.com/thesis/view/2144891
10. Shirdel R. Surveying health system of Iran about financial structural conflict of interest. Social Security Quarterly. 2019;15(1):113-25. [In Persian]. Available from: https://qjo.ssor.ir/article_96132.html?lang=en
11. Buzarjamohri H, Mokhtari Payam M, Chivaee D, Almasi M, Parnian E, Akbari MI, Rahbari Bnab M, Sayyah SA, Khashei V, Rohani SA, Abouhamze D, Prahizkari SA. Examples of conflict of interest 1. Conflict of interest in the field of health [Internet]. Tehran: Islamic Council Research Center; 2021 [cited 2021 Aug 23]. [In Persian]. Available from: https://rc.majlis.ir/fa/report/show/1668525
12. Parsapoor A. Conflict of interest in clinical environments. Iranian Journal of Culture and Health Promotion. 2019;3(2):222-3. [In Persian]. Available from: http://ijhp.ir/article-1-174-fa.html
13. Ebrahimi A, Zand S, Amiri FB, Shahi F, Jafarian A, Kaviani A. Conflict of interest: are Iranian breast cancer specialists prone to it? Asian Pacific Journal of Cancer Prevention: APJCP. 2020;21(6):1653-8. doi: [DOI:10.31557/APJCP.2020.21.6.1653]
14. Khanjankhani K, Takian A, Shamsi Gooshki E, Mohammadi SM, Arab M. Actors in conflict of interest in Iran's health system: ranking and policy recommendations for conflict of interest management. World Medical & Health Policy. 2023;15(4):476-88. doi: [DOI:10.1002/wmh3.561]
15. Parsa M, Khorshidian A. Conflict of interest in dentistry. Journal of Medical Ethics and History of Medicine. 2017;10(1):258-71. [In Persian]. Available from: http://ijme.tums.ac.ir/article-1-5933-en.html
16. ZoghiTawana S. Investigation of the relationship between the presence or absence of conflict of interest and the reporting of positive outcomes in clinical trial research in Iranian dental journals [Thesis]. [Kerman]: Kerman University of Medical Sciences; 2016. [In Persian].
17. World Bank. Preventing and managing conflicts of interest in the public sector: good practices guide [Internet]. Washington, DC: World Bank; 2020 [cited 2025 Aug 1]. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/950091599837673013/preventing-and-managing-conflicts-of-interest-in-the-public-sector-good-practices-guide
18. Raile E. Raile E. Managing conflicts of interest in the Americas: a comparative review [Internet]. Washington, DC: US Office of Government Ethics; 2004 [cited 2025 Jul 30]. Available from: https://www.oge.gov/Web/OGE.nsf/Resources/Managing%2BConflicts%2Bof%2BInterest%2Bin%2Bthe%2BAmericas%3A%2BA%2BComparative%2BReview
19. Zamani R. The effect of political instability on economic growth in iran between two revolutions (1907-1979). Iranian Economic Review. 2021;25(4):790-77. doi: [DOI:10.22059/ier.2021.85087]
20. Hussain Z. Can political stability hurt economic growth? 2014. Available from: https://blogs.worldbank.org/endpovertyinsouthasia/can-political-stability-hurt-economic-growth
21. Moghimi J, Safavardi S, Naderpour B, Mohebbinia J. The place of the principle of accountability in the realization of citizenship rights in the political system. Medical Law Journal. 2021;15:183-95. [In Persian]. Available from: http://ijmedicallaw.ir/article-1-1387-en.html
22. WHO. Addressing and managing conflicts of interest in the planning and delivery of nutrition programmes at country level: report of a technical consultation convened in Geneva, Switzerland, on 8-9 October 2015 [Internet]. Geneva: World Health Organization;2015 [cited 2025 Jul 30]. Available from: https://www.who.int/publications/i/item/9789241510047
23. Bahmaei J, Bastani P, Keshtkaran A, Mohammadpour M, Sarikhani Y. Challenges of the Execution of Hospital Accreditation in Iran: A Critical Review. Journal of Health Research in Community. 2020;5(4):98-82. [In Persian]. Available from: http://jhc.mazums.ac.ir/article-1-444-en.html
24. Mosadeghrad A, Ghazanfari F. Iran hospital accreditation governance: Challenges and solutions. Payavard 2020;14(4):332-11. [In Persian]. Available from:: http://payavard.tums.ac.ir/article-1-7042-en.html
25. Mossialos E, Djordjevic A, Osborn R, Sarnak D. International profiles of health care systems [Internet]. New York: The Commonwealth Fund; 2017 May [cited 2025 Jul 29]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles-health-care-systems
26. Liu C, Haseltine W. The Singaporean health care system. In: Mossialos E, Djordjevic A, Osborn R, Sarnak D, editors. International profiles of health care systems. New York & Washington DC: The Commonwealth Fund; 2017. Chapter on Singapore; pp. 135-142. Available from: https://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles-health-care-systems
27. Blümel M, Busse R. Germany: health system review [Internet]. In: Mossialos E, Wenzl M, Osborn R,
28. Sarnak D, editors. International profiles of health care systems. New York: The Commonwealth Fund; 2017 [cited 2025 Aug 1]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles-health-care-systems
29. The Commonwealth Fund. The U.S. health care system [Internet]. In: Mossialos E, Wenzl M, Osborn R, Sarnak D, editors. International profiles of health care systems. New York: The Commonwealth Fund; 2017 [cited 2025 Aug 1]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles-health-care-systems
30. Allin S, Rudoler D. The Canadian health care system [Internet]. In: Mossialos E, Wenzl M, Osborn R, Sarnak D, editors. International profiles of health care systems. New York: The Commonwealth Fund; 2017 [cited 2025 Aug 1]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles-health-care-systems
31. Lo B, Field MJ. Conflict of interest in medical research, education, and practice. Washington, DC: National Academies Press; 2009.
32. Traversy G, Barnieh L, Akl EA, Allan GM, Brouwers M, Ganache I, et al. Managing conflicts of interest in the development of health guidelines. Canadian Medical Association Journal. 2021;193(2):E49-e54. doi: [DOI:10.1503/cmaj.200651]
33. Mirabasi F, Saie A, Azghandi A. Corruption syndrome and fragile bureaucracy in transitional societies. Political Strategic Studies. 2020;9(34):209-42. [In Persian]. doi: [DOI:10.22054/qpss.2020.41326.2293]
34. Alihosseini S, Haghdoost A, Ghalichi L, Goharinezhad S, Mehravi B, Barati O, et al. Reevaluation of Problems and Challenges in Iran University of Medical Sciences, the First Step to an Effective Performance Improvement. Razi Journal of Medical Sciences. 2022;29(4):1-9. [In Persian]. Available from: http://rjms.iums.ac.ir/article-1-6137-fa.html
35. Khanjankhani K, Takian A. A foreword to conflict of interest dimensions and its management strategies in the stewardship of health systems. Hygiene and Health Strategy Quarterly. 2021;1(1):35-50. [In Persian]. Available from: https://rushd.ir/?p=9817
36. Igbokwe-Ibeto C. Examining the interface between bureaucratic conflict and public interest in Africa. The Journal for Transdisciplinary Research in Southern Africa. 2021;17(1):a874. doi: [DOI:10.4102/td.v17i1.874]
37. Akhakpe IP. Bureaucracy and good governance: Pumark Nigeria Limited; 2014.
38. Rutter J. Overcoming short-termism in policymaking after COVID-19, 2020. Available from: https://www.health.org.uk/news-and-comment/newsletter-features/overcoming-short-termism-in-policymaking-after-covid-19
39. Grundy Q, Habibi R, Shnier A, Mayes C, Lipworth W. Decoding disclosure: comparing conflict of interest policy among the United States, France, and Australia. Health Policy. 2018;122(5):509-18. doi: [DOI:10.1016/j.healthpol.2018.03.015]
40. Rahman-Shepherd A, Balasubramaniam P, Gautham M, Hutchinson E, Kitutu F, Marten R, et al. Conflicts of interest: an invisible force shaping health systems and policies. The Lancet Global health. 2021;9:e1055-e6. doi: [DOI:10.1016/S2214-109X(21)00202-3]
41. Bion J. Financial and intellectual conflicts of interest: confusion and clarity. Current Opinion in Critical Care. 2009;15(6):583-90. doi: [DOI:10.1097/MCC.0b013e328332f53a]
42. Conway M. Does clinical pharmacology & therapeutics' conflict of interest policy protect the reader? Clinical Pharmacology & Therapeutics. 2007;82(5):495-6. doi: [DOI:10.1038/sj.clpt.6100387]
43. Crigger NJ. Pharmaceutical promotions and conflict of interest in nurse practitioner's decision making: the undiscovered country. Journal of the American Academy of Nurse Practitioners. 2005;17(6):207-12. doi:
https://doi.org/10.1111/j.1041-2972.2005.00034.x [DOI:10.1111/j.041-2972.005.00034.x]
44. Cain DM, Loewenstein G, Moore DA. The dirt on coming clean: perverse effects of disclosing conflicts of interest. The Journal of Legal Studies. 2005;34(1):1-25. Available from: https://www.journals.uchicago.edu/doi/abs/10.1086/426699 [DOI:10.1086/426699]
45. Goedendorp A, Struijk PA. Police and pressure groups. Tijdschrift Voor De Politie. 1978;40(14):581-8. Available from: https://www.ojp.gov/ncjrs/virtual-library/abstracts/police-and-pressure-groups
46. Parhizkari A RA. Parhizkari A, Rezghi A. Conflict of Interest: Prevention and Management Strategies [Internet]. Tehran: Research Center of the Islamic Consultative Assembly of Iran; [cited 2018 Mar]. [In Persian]. Available from: https://report.mrc.ir/article_7203.html
47. Gong T, Ren J. Hard rules and soft constraints: regulating conflict of interest in China. Journal of Contemporary China. 2013;22(79):1-17. doi: [DOI:10.1080/10670564.2012.716941]
48. Lobbying Act. Available from: https://laws-lois.justice.gc.ca/eng/acts/l-12.4/page-1.html
49. Code of conduct for ministers and parliamentary secretaries. Available from: https://www.vic.gov.au/code-conduct-ministers-and-parliamentary-secretaries Labour Law of the People's Republic of China. Available from: http://www.npc.gov.cn/zgrdw/englishnpc/Law/2007-12/12/content_1383754.htm
50. Mahdavi G, Karimipoor I. Identifying Factors Influencing the Employee's Corruption of Governmental Organizations Based on Court of Auditor's Viewpoint of Fars and Kerman Provinces. Governmental Accounting. 2019;4(1):73-86. [In Persian]. Available from: https://dor.isc.ac/dor/20.1001.1.24234613.1396.4.1.6.2
51. Khedri B, Mohammadzadeh aghdam AMa, Momeni Masoleh FS. The effective factors of curroption in governmental organizations of Sanandaj city. Social Welfare. 2016;16(60):137-67. [In Persian]. Available from: http://refahj.uswr.ac.ir/article-1-2479-en.html
52. Schwartz LM, Woloshin S, Moynihan R. Who's watching the watchdogs? The BMJ. 2008;337:1202-4. Available from: https://www.bmj.com/content/bmj/337/7680/Observations.full.pdf [DOI:10.1136/bmj.a2535]
53. Boyd EA, Bero LA. Defining financial conflicts and managing research relationships: an analysis of university conflict of interest committee decisions. Science and Engineering Ethics. 2007;13:415-35. doi: [DOI:10.1007/s11948-007-9041-6]
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