Document Type : Original Article

Authors

• mahsa akbari ¹
• Ali Mouseli ²

¹ PhD in Public Administration, Comparative Management and Development, Faculty of Management, Allameh Tabataba'i University

² Associated Professor, Department of Health Services Management, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

Abstract

Budgeting in Iran’s health system, due to the involvement of multiple institutions and the absence of effective coordinating mechanisms, faces deficiencies that undermine the system’s efficiency and financial sustainability. Drawing on public governance literature and the perspectives of network and financial governance, the budget is not the outcome of a single authority’s decision; rather, it results from interaction and bargaining among the Ministry of Health, the Plan and Budget Organization, basic insurance funds, and other relevant stakeholders. This study adopts a documentary–analytical design using a framework-based document analysis approach. Accordingly, official and policy documents related to Iran’s health budgeting and planning for the period 2015–2025, along with 32 scientific studies published in the same timeframe, were reviewed. Findings were interpreted through the lens of network governance, the World Health Organization’s (WHO) principles of financial governance, and the Public Expenditure and Financial Accountability (PEFA) framework.
The findings indicate that three structural deficiencies are most influential in producing persistent inefficiencies: first, a gap between development plans and actual budget allocations, such that health policy objectives are not reflected in budget formulation and approval stages; second, conflicts among the institutional logics of decision-making bodies, leading to inconsistency in needs assessment, priority setting, and resource forecasting; and third, fragmented health financing and increasing reliance on unstable revenue sources, which weaken sustainability and medium-term planning capacity. These patterns are inconsistent with desirable financial governance principles, including transparency, institutional coordination, accountability, and linkage between budgeting and health outcomes.
In conclusion, the core challenge of health budgeting in Iran is institutional rather than merely technical. It stems from the lack of horizontal coordination mechanisms, the absence of shared criteria for needs assessment, and shortcomings in tracking resource flows. The study suggests that improving health budget governance requires reforming inter-institutional interaction mechanisms and strengthening transparency and accountability across the entire financial cycle.