Razi Journal of Medical Sciences

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Background and Aim: One of the subjects related to social policy is the study of the approaches, and actions of governments towards welfare states. Health is considered as a special commodity, and a prerequisite for every person's performance as a citizen, and its lack not only loses one's welfare, but also deprives him of his freedom and prevents him to stand by his responsibilities and commitment. Health policy has been stated as one of the main dimensions of social policy. Policy-making is a complex communication process involving the participation and impact of stakeholders and the solution of problems that can be solved through a wide range of issues. Policy-making actions are influenced by recent developments and changes. Policy-making is a political, dynamic and complex process. One of the basic roles of the governance is policy-making for the organization's subsidiaries in large organizations such as Social Security. According to the studies and the results of the background, no executive model has been designed in the field of policy-making development for the treatment department of the Social Security Organization in the country so far. On the other hand, it is the first time that the method of designing a policy-making model in the Social Security Organization will be performed according to the systematic model of Strauss and Corbin in this study. Also, since the Social Security Organization is a social organization that covers different sections of society, every policy in this organization can have many consequences multiplying the responsibility of this organization. As regards the performance of a policy should be based on an acceptable comprehensive model for the majority of active members in the group and its stakeholders in an organization, in this research, it is necessary to question the design of a policy-making development model and seeks to answer the question of what development model can be used for policy- making in the treatment department of the Social Security Organization?
Methods: This study is a quantitative and sequential exploratory strategy, in which first, the method of Grounded theory, and Strauss and Corbin Systematic Approach are used to identify and design a policy-making development model in the treatment department of the Social Security Organization through Open Coding, Axial Coding, Selective Coding, and then Semi-structured interviews with the statistical population that include researchers and university professors specializing in public administration and senior managers of the Social Security Organization reach the theoretical saturation in order to identify the issues, causative conditions, background conditions, interventionist conditions, strategies and policy- making development consequences in the treatment department of the Social Security Organization and these interviews were conducted in 5 periods. The systematic research scheme emphasizes the use of data analysis steps through open coding, axial coding, and selective coding, as well as providing a logical paradigm or representational image of an evolving theory. The statistical sample size was 20 people through semi-structured Delphi interviews to reach theoretical saturation. That is, the data from the twentieth person was duplicated and no new open coding was added. Sampling was done randomly and theoretically to select experts and thinkers because the selection of these people was based on the judgment of the research group and it seemed that the samples selected by the research group were in the best position to provide the required information. Thus, whenever a part of a statistical population is selected based on the judgment of certain individuals or the researcher himself to examine, such sampling is called theoretical or judgmental sampling. This method is mostly used when expert samples are needed. The instruments of the research data collection include the use of semi-structured questions and researcher-made coding sheets for open coding, axial coding, and selective coding for semi-structured and in-depth interviews with experts and professors of public administration and senior managers of the Social Security Organization using qualitative analysis software (MAXQDA).
Results: The Results in the form of 45 categories and 268 conceptual codes in the six dimensions of the paradigmatic model as causal causes (5 categories), main and pivotal phenomenon (6 categories), strategies (5 categories) at 3 individual, intermediate and macro levels, Contextual conditions (7 categories), intervention conditions (6 categories) and outcomes (5 categories) were placed in 3 levels: individual, intermediate and macro.
Conclusion: The first finding of the study was the effect of contextual conditions on health policy-making and treatment in the Social Security Organization. Other studies have confirmed the significant role of contextual conditions in the policy-making of various reform programs in order to strengthen the health system and achieve universal health coverage, in addition they have introduced various factors in the contextual dimension that can influence health reform policy-making. In the present study, three categories including human-centered factors, support factors and macro-factors were identified as contextual efficient factors in the treatment policy-making in the Social Security Organization. In the group of macro factors, the legal environment has been identified as one of the factors that has two effects on the policy-making of the treatment sector. The first aspect refers to the legal framework needed to modify the health reform plan in the field of treatment. Other political factors are causative conditions that indicate the impact of the prevailing political environment in the country and they are at the request and approval of the country's political leaders and managers regarding the policy-making of the treatment sector. The fact that the political environment strongly influences the policy-makings of the country's health reform programs has been reported in the experiences of health reform in different countries. This group of factors seems to be one of the main factors that can alone affect the development and implementation of the health policies and the treatment and overshadow their sustainability and continuity. Economic and social factors have been identified as another causative factor. Based on the findings of the present study, not only the reform health and treatment is an issue related to the health system but also various socio-economic variables of society affect it ,and also policy-making in the treatment sector of the Social Security Organization is affected by the socio-economic conditions of the country; in this regard, if there is a disorder in the socio-economic conditions of the country, it will cause severe disturbance in the provision of health services, especially in the field of medicine and treatment and the performance will be failed and at the result, it is necessary to be reformed. Another finding of the present study distinguishes different aspects of policy-making process of the health and treatment sector in the Social Security Organization. According to this finding, the occurrence of three specific issues that affect each other caused the field of treatment in order to be on the agenda of the Social Security Organization. The issue of health problems and the issue of health system reform policy have been formed for a long time ago and have had reciprocal effects on each other.
 

Keywords: Development, Treatment, Social Security Organization, Iran

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