Table 2 Environmental impact and certainty (Macro environment-PESTLE analysis)
Aspects | Factors | Influence | Certainty |
|---|---|---|---|
Political | Regional competitions | − 1 | − 3 |
Policy makers’ neglect of the health sector | − 4 | − 3 | |
Centralization in the dominant attitude | − 4 | − 5 | |
Government budget-cutting structure | − 5 | − 5 | |
Implementation of the Family Physician Program | + 2 | + 3 | |
Periodic changes of politicians leading to change of plans of directors (political instability) | − 3 | − 5 | |
Lack of appropriate philosophy and viewpoint about health and its various dimensions among political parties and formations | − 3 | − 4 | |
Government downsizing based on various laws, including the 44th principle (privatization development) | + 4 | + 3 | |
Government financial corruption | − 4 | − 4 | |
Unreasonable tariffs determined for hospitals products and services | − 5 | − 5 | |
Political sanctions | − 4 | − 5 | |
Economic | Improved payment system structure (strategic services purchase by insurance companies based on quality and price) | + 5 | + 3 |
Improved tariff structures | + 4 | + 2 | |
Improved drugs and consumption products purchase control structure | + 5 | + 3 | |
Higher inflation in the health sector | − 5 | − 5 | |
Higher expenses (drugs and treatment) | − 5 | − 5 | |
Higher inflation | − 4 | − 5 | |
Higher bank interest rates | − 4 | − 4 | |
Improved financing structure | + 5 | + 3 | |
Currency rate fluctuations and multiplicity of currency rates | − 4 | − 5 | |
Supportive role of government financial policies | + 5 | + 2 | |
Providing access to capital/loans to develop hospitals’ activities by the government | + 4 | + 4 | |
Good market economic growth | + 3 | + 1 | |
Availability of required finances (from public government budget, charities, etc.) to produce hospitals products and services | + 5 | + 2 | |
Smaller budget share for the health sector | − 5 | − 5 | |
Approved national Iranian pharmacopoeia and the comprehensive list of equipment | + 3 | + 3 | |
More budget limitations for the health sector as a result of economic and health load of non-communicable and emerging diseases because of environmental changes | − 3 | − 3 | |
Economic sanctions | − 3 | − 5 | |
Social and cultural | Higher population growth | − 3 | − 5 |
Higher fertility rates | − 3 | − 4 | |
Change of diseases load towards chronic illnesses | − 5 | − 5 | |
Lower physical activity | − 3 | − 4 | |
Higher life expectancy | − 3 | − 4 | |
Higher poverty | − 4 | − 5 | |
Appropriate population distribution (young human resources to total population ratio) | + 2 | + 4 | |
Appropriate family size and structure | + 2 | + 3 | |
Higher rates of social harms and anomalies, including divorce, crimes, and violence. | − 3 | − 4 | |
Technology | Improved health information technology (home care, remote medical services, remote training, electronic medical record) | + 4 | + 2 |
Legal | Lack of legal clarity for hospitals activities development | − 4 | − 4 |
Tax and employment laws ratified by the government | − 4 | − 4 | |
Inappropriate budgeting system for hospitals (general budget, linear budget, ownership of the remaining budget resulting from frugality) | − 5 | − 4 | |
Deficiency in health technologies evaluation (import permits for high-end technologies and expensive drugs) | − 4 | − 5 | |
Poor supportive laws for attracting domestic and international investors in manufacture, equipment, and renovation of hospitals (including bank laws, facilities, loans, letters of guarantee) | − 3 | − 5 | |
The requirement for hospitals to observe scientific and local guidelines approved by the Ministry of Health and insurance companies | + 5 | + 2 | |
Environmental | Higher risks and diseases resulting from environment pollution | − 3 | − 4 |
Higher air pollution in cities in which the hospitals are located | − 4 | − 5 | |
The possibility of unexpected events in the city where the hospitals are located | − 4 | − 3 | |
Greater possibility of man-made disasters in the city where the hospitals are located | − 3 | − 3 | |
Population positive attitude toward green energy | + 3 | + 3 | |
Population positive attitude toward green and organic products | + 3 | + 3 |