Assessing the Development of Health Technology Assessment in Iran: A Policy Analysis Using Kingdon’S Multiple Streams Framework: A Qualitative Study Publisher Pubmed



Behzadifar M¹ ; Shahabi S² ; Bakhtiari A³ ; Azari S⁴ ; Ehsanzadeh SJ⁵ ; Yarahmadi M⁶ ; Behzadifar M¹ Show Affiliations
Source: BMC Public Health Published:2025

Abstract

Background: Health Technology Assessment (HTA) is crucial for optimizing healthcare investments and improving system efficiency. In Iran, the rising costs of healthcare technologies and systemic inefficiencies have highlighted the need for a structured HTA framework. However, despite academic discussions, HTA has not yet been fully integrated into formal health policy. This study explores the development of HTA in Iran using Kingdon’s Multiple Streams Framework to identify challenges and opportunities for its advancement. Methods: The study employed qualitative methods, including 16 semi-structured interviews with key stakeholders in Iran’s healthcare system. Participants, consisting of 12 males and 4 females with an average age of 41.56 years and an average work experience of 14.37 years, provided insights into the current state of HTA. The participants included individuals in key leadership roles within public and private institutions, such as the Ministry of Health and Medical Education, hospital managers, policymakers, and senior academics. Data were analyzed using Kingdon’s framework to examine the problem, policy, and politics streams, as well as the role of policy entrepreneurs and potential policy windows. Results: Findings revealed that the rising costs of healthcare technologies, particularly imported ones, and inefficiencies in technology use were major concerns. Participants indicated that HTA could address these issues by ensuring cost-effectiveness and better health outcomes. Despite the technical feasibility of implementing HTA in Iran, there is a significant gap between theoretical discussions and policy action. Resistance from the private sector and the need for political backing were identified as major barriers. However, the political climate in Iran is becoming increasingly favorable, with growing interest in healthcare efficiency and transparency. The Covid-19 pandemic and healthcare shortages have exposed vulnerabilities, presenting potential opportunities for HTA’s adoption. Leadership roles in key institutions, including the Ministry of Health and Medical Education, were identified as vital to advancing HTA initiatives. Policy entrepreneurs play a crucial role in advocating for HTA and capitalizing on these opportunities. Conclusion: HTA is recognized as a valuable tool for improving healthcare efficiency and equity in Iran. However, significant challenges remain in transitioning from academic discussions to formal policy. The political environment and recent healthcare crises offer opportunities to advance HTA. To successfully integrate HTA into Iran’s healthcare system, it is essential to address existing barriers, leverage political interest, and support policy entrepreneurs. The experiences of other countries, especially those with strong institutional leadership in HTA, provide useful models for Iran to follow in its HTA development journey. © The Author(s) 2025.