Previously submitted to: JMIR Formative Research (no longer under consideration since Dec 16, 2025)
Date Submitted: Sep 9, 2025
Open Peer Review Period: Sep 10, 2025 - Nov 5, 2025
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Dimensions of the accountable care organization in Iran’s health system: A qualitative approach
ABSTRACT
Background:
Iran’s healthcare system is currently confronting significant challenges, including fragmented service delivery across different levels of care, lack of an integrated care framework, and rising treatment costs. These issues underscore the urgent necessity of adopting innovative service delivery models.
Objective:
This study aimed to identify and explore the core dimensions of an Accountable Care Organization (ACO) as a novel framework to enhance efficiency within the health system.
Methods:
This qualitative study employed a grounded theory approach. Data were collected through semi-structured interviews with 26 experts spanning policymakers, physicians, healthcare managers, university professors, and representatives from health insurance organizations. Participants were selected via purposive sampling, and interviews continued until theoretical saturation was achieved. Data analysis was conducted through open, axial, and selective coding stages.
Results:
Analysis of the interview transcripts yielded 326 initial codes, which were refined into 61 concepts and 15 subcomponents, subsequently grouped into six overarching dimensions. The principal dimensions constituting an accountable care organization framework in Iran’s healthcare system were identified as governance, socio-cultural, economic, information technology and digital transformation, and patient ethics and rights.
Conclusions:
The findings indicate that the Accountable Care Organization framework holds substantial potential to address systemic challenges in Iran’s health sector. The identified dimensions provide a foundation for developing a localized model aimed at enhancing efficiency, effectiveness, and accountability in healthcare delivery.
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