Strategies for controlling the health system prices in Iran: a qualitative study

Health system price inflation poses significant barriers to achieving universal health coverage, particularly in low- and middle-income countries. Iran faces substantial price-related challenges, with out-of-pocket payments accounting for approximately 43.2% of health expenditure in 2023. Despite various reform efforts, effective price control strategies remain inadequately explored, especially from multi-level stakeholder perspectives. This study aimed to explore strategies for controlling health system prices in Iran through a qualitative approach. This qualitative study employed semi-structured in-depth interviews with 15 key informants selected through purposive and snowball sampling. Participants represented diverse stakeholder groups, including senior policymakers, health insurance representatives, pharmaceutical industry leaders, healthcare providers, and health policy experts across top-level, mid-level, and frontline positions. Data were collected between October 2024 and October 2025 and analyzed using thematic analysis following Braun and Clarke’s framework. Rigor was ensured through strategies including investigator and data source triangulation, member checking, peer debriefing, and an audit trail to address credibility, transferability, dependability, confirmability, and authenticity. Three main themes and six sub-themes emerged. Macroeconomic strategies included mandatory exchange rate control and preferential currency for essential goods, though only temporarily effective. Financial strategies involved tax exemptions and conditional subsidies. Insurance strategies focused on fund integration and strategic purchasing. Regulatory strategies comprised competitive tendering, price transparency, and unified national tariff-setting. Medicine-related strategies included Health Technology Assessment (HTA), restricting drug list additions, limiting licensed products, and enforcing generic prescribing. Human resources strategies centered on strengthening the public sector, eliminating dual practice, and balancing specialist supply. The findings suggest that controlling health system prices in Iran requires a coordinated, multi-layered approach rather than single technical interventions. Sustainable price containment depends on interactions between macroeconomic stability, health financing reforms, regulatory governance, and human resource policies. While certain strategies are context-specific to Iran’s economic and political circumstances, underlying principles of strengthened purchasing power, evidence-based resource allocation, and transparent regulation offer transferable lessons for other health systems facing similar affordability challenges.