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Consultants(2024-2025)

Institutional Analysis of the Budgeting Process in Iran’s Health System: An Analytical–Documentary Study

Document Type : Original Article

Authors

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

10.22054/spsa.2025.89797.1089

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.

References
  1. . Abolhallaj, M., Jafari, M., Seyedin, H., Salehi, M., Pourtaleb, A., Rahmani, K., & Hosseini, S. E. (2021). New financial management system for Iran public health sector: A qualitative study. Journal of Education and Health Promotion, 10, 356.https://doi.org/10.4103/jehp.jehp_1201_20
  2. Banik, B., Roy, C. K., & Hossain, R. (2023). Healthcare expenditure, good governance and human development. EconomiA, 24(1), 1–23. https://doi.org/10.1108/ECON-06-2022-0072
  3. Barbazza, E., & Tello, J. E. (2014). A review of health governance: definitions, dimensions and tools to govern. Health policy, 116(1), 1-11https://doi.org/10.1016/j.healthpol.2014.01.007
  4. Barroy, H., Yameogo, P., Blecher, M., Sabignoso, M., Piatti, M., & Kutzin, J. (2024). Public financial management: a pathway to universal health coverage in low-and-middle income countries. Health Systems & Reform, 10(3), 2368051.https://doi.org/10.1080/23288604.2024.2368051.
  5. Bevir, M., & Rhodes, R. A. W. (2003). Interpreting British governance. Routledge.
  6. Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative research journal, 9(2), 27-40. https://doi.org/10.3316/QRJ0902027
  7. Brennan, M. (2024). Geoff Brennan and Public Policy. History of Economics Review, 88(1), 4-5.https://doi.org/10.1080/10370196.2024.2387894
  8. Danaeefard, H., & Golverdi, M. (2024). Governance and Administrative Reforms in Contemporary Iran: Challenges and Opportunities. Comparative Governance Reforms: Assessing the Past and Exploring the Future, 235-264.https://doi.org/10.1007/978-3-031-70306-5_13
  9. De Carvalho, G. (2022). The World Bank and Healthcare Reforms: A Cross‐National Analysis of Policy Prescriptions in South America.Social Inclusion, 10(1), 5-18.https://doi.org/10.17645/si.v10i1.4734
  10. Eneje, B. C., Ogbu, I. I., & Nnam, H. I. (2024). Accountability and Budget Implementation in an Emerging Economy: A Study of Nigerian Health Sector. Global Journal of Finance and Business Review 7(2), 49-62https://doi.org/ 10.5281/zenodo.10927230
  11. Ghanbari, S., & Jafari, D. D. (2025). Modeling the Budget Deficit in Different Funds of the Iran Health Insurance Organization and the Factors Affecting It. Iranian Journal of Economic Research, 30(102). https://doi.org/10.22054/ijer.2023.69378.1127
  12. Greer, S. L. (2025). Why Must We Keep Discussing Strategic Purchasing and Managed Competition? Comment on" Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands". International Journal of Health Policy and Management, 14, 9248.https://doi.org/10.34172/ijhpm.9248
  13. Kutzin, J., Sparkes, S. P., Earle, A. J., Gatome-Munyua, A., & Ravishankar, N. (2024). Objective-oriented health systems reform. Health Systems & Reform, 10(3), 2428415https://doi.org/10.1080/23288604.2024.2428415
  14. Kuzmenko, O., Kozhura, L., & Omelchenko, A. (2025). Economic efficiency of volunteer programs to support persons with disabilities as a result of war: Ways of integration into the labor market. Baltic Journal of Economic Studies, 11(3), 320–329.https://doi.org/10.30525/2256-0742/2025-11-3-320-329
  1. Lanford, D., Petiwala, A., Landers, G., & Minyard, K. (2022). Aligning healthcare, public health and social services: a scoping review of the role of purpose, governance, finance and data. Health & Social Care in the Community, 30(2), 432-447. https://doi.org/10.1111/hsc.13374
  2. Lassou, P. J., Ostojic, M., Barboza, J. U., & Moses, O. (2024). Participatory budgeting in francophone Africa: a comparative perspective between Benin and Niger. Journal of public budgeting, accounting & financial management, 36(1), 81-104.https://doi.org/10.1108/JPBAFM-04-2022-0070
  3. Mahdiyan, S., Amini-Rarani, M., Rezayatmand, R., & Shaarbafchizadeh, N. (2025). Understanding challenges of primary healthcare financial resource allocation in Iran. Health Research Policy and Systems, 23(1), 82. https://doi.org/10.1186/s12961-025-01331-x
  4. Moradi, T., Kabir, M. J., Pourasghari, H., Ehsanzadeh, S. J., & Aryankhesal, A. (2023). Challenges of budgeting and public financial management in Iran’s health system: A qualitative study. Medical Journal of the Islamic Republic of Iran, 37, 80. https://doi.org/10.47176/mjiri.37.80
  5. Nayak, D. K., & Jena, P. R. (2025). Bridging the Budget Divide: How PEFA Assessments and PFM Reforms Diagnose the Budget Reliability (No. 25/435).
  6. Ssennyonjo, A., Osoro, O., Ssengooba, F., Ekirapa-Kiracho, E., Mayora, C., Ssempala, R., & Bloom, D. (2022). The government budget: an overlooked vehicle for advancing strategic health purchasing. Health Systems & Reform, 8(2), 2082020. https://doi.org/10.1080/23288604.2022.2082020
  7. Vammalle, C., Rivadeneira, A. M. R., James, C., Prieto, L., & Montañez, V. (2018). Financing and budgeting practices for health in Peru. OECD Journal on Budgeting, 17(2), 25-64A.http://dx.doi.org/10.1787/budget-v17-2-en
  8. World Health Organization. (2024). Programme budget 2024–2025: Executive summary. Geneva: WHO. from https://www.who.int/teams/health-financing-and-economics/health-financing/health-financing-policy/budgeting-in-health/programme-budgets-in-health-country-evidence
  9. Amiri-Nia, S., Sepahvand, M., Hakkak, M., Mousavi, S. N., & Seyed-Najmaldin, S. (2024). Designing a model for institutionalizing a culture of transparency at Lorestan University of Medical Sciences. Journal of Guilan University of Medical Sciences, 33(1), 78–97. [In Persian]
  10. Behrouz, A., Pourazat, A. A., Dezhpasand, F., & Amiri, M. (2019). Pathology of research and technology budgeting in Iran using a meta-synthesis approach. Quarterly Journal of Research and Technology Policy, 8(4), 85–122. [In Persian]
  11. Parkan, H. (2025). The contextual role of operational budgeting in transforming the governance system: An action-research approach with attention to general administrative policies. Islamic Governance Studies, 1(1), 380–428.

https://doi.org/10.22081/JISLAMICGO.2025.71124.1012[In Persian]

  1. Jafari, M. M. (2024). Budgeting in international experiences (2): The budget approval process in the Canadian Parliament. Majlis Research Center, Tehran. [In Persian]
  2. Government of the Islamic Republic of Iran. (2023). Full text of the national budget bill for fiscal year 2025. Tehran: Government of the Islamic Republic of Iran. [In Persian]
  3. Rostami, V., & Sohrabi, S. (2024). A review of governing principles of the budgeting system in Iran and France. Research and Development in Comparative Law Quarterly, 7(22), 57–99.https://doi.org/ 10.22034/law.2024.2015999.1276[In Persian]
  1. Rezvani-Far, M., & Salimi, Z. (2024). Challenges of sustainable development–based governance in Iran’s budgeting system. Legal Civilization Quarterly, 7(20), 195–216.https://doi.org/ 10.22034/LC.2024.460597.1498[In Persian]
  1. Plan and Budget Organization of Iran. (2017). Sixth National Economic, Social and Cultural Development Plan of the Islamic Republic of Iran (2017–2021). Tehran: Plan and Budget Organization of Iran. [In Persian]
  2. Plan and Budget Organization of Iran. (2023). Seventh National Development Plan of the Islamic Republic of Iran (2023–2027). Tehran: Plan and Budget Organization of Iran. [In Persian]
  3. Plan and Budget Organization of Iran. (2024a). Executive regulations of the national budget law for fiscal year 2025. Tehran: Plan and Budget Organization of Iran. [In Persian]
  4. Plan and Budget Organization of Iran. (2024b). National Budget Law for fiscal year 2025. Tehran: Plan and Budget Organization of Iran. [In Persian]
  5. Abdollahi, N., Shahrayini, N., Nabavi-Fard, B., & Banafi, N. (2024). Evaluating the realization of the general policies of the system based on international indicators: Guidelines for improving Article 83 of the Civil Service Management Law. Strategic and Macro Policies, 12(48), 721–756.https://doi.org/ 10.30507/jmsp.2024.411329.2624[In Persian]
  6. Ghaffari-Fard, H. (2024). Examining the rules and conditions for implementing the new system of regional budget governance in Iran. Exalted Governance Quarterly, 5(3), 105–125. [In Persian]
  7. Mirshakari, N., & Boroumand Kakhki, A. (2024). Emerging health issues in Iran. Majlis Research Center, Tehran. [In Persian]
  8. Ministry of Health and Medical Education. (2019). Financial and transactional regulations of medical universities and health service institutions. Tehran: Ministry of Health and Medical Education. [In Persian]
  9. Yousefvand, S. (2024). The social nature of budgeting: A sociological analysis of Iran’s budgeting system. Majlis Research Center Expert Reports, 32(7), 1–10. [In Persian]
Studies in Public Service Administration
Volume 3, Issue 7
March 2025
Pages 121-162
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History
  • Receive Date: 21 November 2025
  • Revise Date: 12 December 2025
  • Accept Date: 14 December 2025
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