This research article, titled “Assessing the development of health technology assessment in Iran: a policy analysis using Kingdon’s Multiple streams framework: a qualitative study,” explores the current state and potential future of Health Technology Assessment (HTA) in Iran. HTA is presented as a crucial tool for optimizing healthcare investments and enhancing system efficiency by providing evidence-based evaluations of medical technologies, interventions, and procedures. The authors, Behzadifar et al., highlight that Iran’s healthcare system, a mixed model facing challenges like resource constraints, rising costs, and inequalities in access, critically needs a structured HTA framework.
The study employs Kingdon’s Multiple Streams Framework to analyze the factors influencing HTA’s progression towards becoming a formal health policy in Iran. This qualitative study involved 16 semi-structured interviews with key stakeholders including policymakers, hospital managers, and academics within Iran’s healthcare system. Findings reveal that rising costs, particularly of imported technologies, and inefficiencies in their use are significant problems recognized by participants. While academic discussions around HTA are robust and its technical feasibility is acknowledged, a substantial gap exists between these discussions and concrete policy action, partly due to resistance from the private sector. However, the political climate in Iran is becoming increasingly favorable, showing growing interest in healthcare efficiency and transparency. Focusing events like the COVID-19 pandemic and healthcare shortages have exposed system vulnerabilities, creating potential “policy windows” for HTA’s adoption. The study emphasizes the critical role of “policy entrepreneurs”—individuals actively advocating for HTA—in bridging the problem, policy, and politics streams to advance HTA initiatives. Ultimately, the article concludes that despite significant challenges, the political environment and ongoing crises present opportunities to integrate HTA formally into Iran’s healthcare system, with policy entrepreneurs being key to this transition.
Reference: Behzadifar, M., Shahabi, S., Bakhtiari, A., Azari, S., Ehsanzadeh, S. J., Yarahmadi, M., & Behzadifar, M. (2025). Assessing the development of health technology assessment in Iran: a policy analysis using Kingdon’s Multiple streams framework: a qualitative study. BMC public health, 25(1), 226.
