Document Type : Original Article


1 Department of Health Service Management, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Pharmacoeconomics and Pharma Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran


Objective: The aim of this study was to review the current methods of pharmaceutical 
purchasing by Iranian insurance organizations within the World Bank conceptual framework 
model so as to provide applicable pharmaceutical resource allocation and purchasing (RAP) 
arrangements in Iran.
Methods: This qualitative study was conducted through a qualitative document 
analysis (QDA), applying the four‑step Scott method in document selection, and conducting 
20 semi‑structured interviews using a triangulation method. Furthermore, the data were 
analyzed applying five steps framework analysis using Atlas‑ti software.
Findings: The QDA showed that the purchasers face many structural, financing, payment, 
delivery and service procurement and purchasing challenges. Moreover, the findings of 
interviews are provided in three sections including demand‑side, supply‑side and price and 
incentive regime.
Conclusion: Localizing RAP arrangements as a World Bank Framework in a developing 
country like Iran considers the following as the prerequisite for implementing strategic 
purchasing in pharmaceutical sector: The improvement of accessibility, subsidiary mechanisms, 
reimbursement of new drugs, rational use, uniform pharmacopeia, best supplier selection, 
reduction of induced demand and moral hazard, payment reform. It is obvious that for Iran, 
these customized aspects are more various and detailed than those proposed in a World 
Bank model for developing countries.


  1. MehralianG, RangchianM, JavadiA, Peiravian F. Investigation 
    on barriers to pharmaceutical care in community pharmacies: 
    A structural equation model. Int J Clin Pharm 2014;36:1087-94.
    2. Abachizade K, Bastani P, Abolhalaj M. A comprehensive 
    analysis of drug system money map in Islamic Republic of 
    Iran. J Econ Sustain Dev 2013;4:158‑64.
    3. LuY, Hernandez P, Abegunde D, Edejer T. The world medicine 
    situation 2011. Medicine Prices, Availability and affordability. 
    3rd ed. Geneva: World Health Organization; 2011. p. 3‑5.
    4. Winkelmann R. Co-payments for prescription drugs and the 
    demand for doctor visits – evidence from a natural experiment. 
    Health Econ 2004;13:1081-9.
    5. PrekerAS, LangenbrunnerJC. Spending Wisely Buying Health 
    Services for the Poor. 1st ed. Washington DC: The World Bank 
    Publisher; 2005. p. 18‑22.
    6. Abolhalaj M, Abachizade K, Bastani P, Ramezanian M, 
    Tamizkar N. Production and consumption financial process of 
    drugs in Iranian healthcare market. Dev Cty Stud 2013;3:187‑91.
    7. Policy Making Council of Ministry of Health and Medical 
    Education (Iran). Islamic Republic of Iran Health in the Fifth 
    Economical, Social and Cultural Plan. The Institute, Tehran; 
    2009. p. 21‑7. Available from: 
    [Last accessed on 2013 Aug 13].
    8. Noori M. The Report of 5‑years Performance of Iranian Social 
    Treatment Security, Report of Iranian Health Sector Study, the 
    Investigation of Secondary Information 2008. p. 8-16.
  2. 9. Pouragha B, Pourreza A, Heydari H. Effect of access and out 
    of pocket payment on GP’s visit utilization: A data panel study 
    among individuals covered by social security organization. 
    Hakim Res J 2011;15:101‑11.
    10. World Health Organization. The World Health Report 2000: 
    Health systems: Improving performance. Geneva: World 
    Health Organization; 2000. p. 85‑93.
    11. Ferenz M, NilsenK, Walters G. Research Methods in 
    Management. 2nd ed. Canada: SAGE Publication; 2009. p. 54‑60.
    12. Jafari M, RashidianA, Abolhasani F, Mohammad K, Yazdani S, 
    Parkerton P, et al. Space or no space for managing public 
    hospitals; a qualitative study of hospital autonomy in Iran. 
    Int J Health Plann Manage 2011;26:e121-137.
    13. Mehralian G, Rangchian M, Rasekh HR. Client priorities and 
    satisfaction with community pharmacies: The situation in 
    Tehran. Int J Clin Pharm 2014;36:707‑15.
    14. Mehralian GH, Yousefi N, Hashemian F. Knowledge, attitude 
    and practice of pharmacists regarding dietary supplements: 
    A community pharmacy-based survey in Tehran. Iran J Pharm 
    Res 2014;13:1455‑63.
    15. Khakmardani AH. Determining a Model for Strategic 
    Purchasing of Outpatient Health Care Services, World Health 
    Organization, Final Report APW: 07/38; 2007. p. 52‑65.
    16. Rosenblatt RA, Andrilla CH, Curtin T, Hart LG. Shortages of 
    medical personnel at community health centers: Implications 
    for planned expansion. JAMA 2006;295:1042‑9.
    17. Darbooy SH, Hoseini SA, Ahmadi B, editors. Pharmaceutical 
    Management in Family Physician and Rural Insurance. 
    Proceedings of the 1st National Congress of Management and 
    Pharma Economics 13‑15 June, 2012; Tehran, Iran.
    18. Zarenezhad F, Mehralian GH, Rajabzadeh Ghatari A. 
    Developing a model for agile pharmaceutical distribution: 
    Evidence from Iran. J Basic Appl Sci Res 2013;3:161-72.
    19. Levison L. Policy and Programming Options for Reducing 
    the Procurement Costs of Essential Medicines in Developing 
    Countries [Concentration paper]. Department of International 
    Health, School of Public Health, Boston University; 2003. p. 75‑82.
    20. Al Serouri AW, Balabanova D, Hibshi SA. Cost Sharing for 
    Primary Health Care. Lessons from Yemen [working papers]. 
    Oxfam University; 2002. p. 41-9.
    21. GholiZadeh A, Vahid Dastjerdi AA, editors. Survey on 
    Effective Cultural Elements on Drug Use. Proceedings of the 
    1st National Congress of Management and Pharma Economics 
    13‑15 June, 2012; Tehran, Iran.
    22. Quintal C, Mendes P. Underuse of generic medicines in 
    Portugal: An empirical study on the perceptions and attitudes 
    of patients and pharmacists. Health Policy 2012;104:61-8.
    23. Holloway KA, Gautam BR, Reeves BC. The effects of different 
    kinds of user fees on prescribing quality in rural Nepal. J Clin 
    Epidemiol 2001;54:1065‑71.
    24. Preker AS, Langenbrunner JC, Belli PC. Public Ends Private 
    Means Strategic Purchasing of Health Services. 1st ed. 
    Washington DC: The World Bank Publisher; 2007. p. 11‑25.
    25. Sermet C, Andrieu V, Godman B, Van Ganse E, Haycox A, 
    Reynier JP. Ongoing pharmaceutical reforms in France: 
    Implications for key stakeholder groups. Appl Health Econ 
    Health Policy 2010;8:7-24.
    26. Thomson S, Busse R, Crivelli L, van de Ven W, Van de 
    Voorde C. Statutory health insurance competition in Europe: 
    A four‑country comparison. Health Policy 2013;109:209‑25.