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Table 1 The main categories and themes/sub-themes involved in the strategic purchasing needed for health services for breast cancer patients in Iran in 2020

From: Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran

Main category

Themes/sub-themes

Supply management

Strategic purchasing infrastructures (Scientific and cultural infrastructure/Information infrastructure/Political and social infrastructure/Economic infrastructure/Legal infrastructure/Policy and decision making infrastructure)

Practical guidelines (Therapeutic guidelines/Insurance guidelines)

Trusteeship structure (Ministry of Health as a policy maker and health system supervisor/Providers independence from trusteeship/financiers Independence from trusteeship/Decentralization in health system)

Service package (Definition of special patients groups/Definition of type of service/Designing benefits package (smaller and basic Package)/Level of services/Payment system/Purchase of specialized services)

Service quality (Use of new technology/Infrastructures of human resources, equipment and special care/ranking of care quality and selection of top providers)

Service quantity (services availability/Access to services)

Role of other organizations and groups (Use of the capacity of NGOs to cover supporting and supplementary services at levels two and three/The role of the medical system organization in managing and contracting with the private sector/The role of insurance companies in the purchase of complementary services)

Training (Training and strengthening providers, producers, policymakers’ knowledge on the insurance)/Patients education/Training service purchasers (Awareness of new therapies)

Insurance trusteeship

Establishment of an insurance thinking (Integrated and coordinated insurance policies (resources, structure, payment model)/Defining insurance identity for providers/Changing the Providers attitudes (insurances are not fund, differentiating between supportive thinking and insurance)/Changing the therapeutic' s approaches to the health perspective (prevention system and screening)/Changing the conflicting policies and personal interests of decision-makers)

Strategic management (Managerial determination to execute strategic purchasing/Purchase prioritization based on needs/Process modification/Contract management/Strong control system/Creating Competition (by using the motivational issues)/Necessity of managing the insurance system by non-physicians)

Communication (Internal communication (between purchasers and importers of equipment and pharmaceuticals, etc.)/International communications/Cross-sector collaboration (between purchasers and supplier))

Financial performance

Price (Setting the services price (Service price correct)/Cost classification/Bargaining power and mass purchasing)

Efficiency and effectiveness (Economic assessment/Dissimilar payment to different providers)

Resource provision (Investment (income generation)/resource pooling

Proper purchase (optimal allocation of fund)/Expert human resources/care Management)