Abstract
BACKGROUND: In recent decades, healthcare purchasing has been continuously searching for new approaches to improve performance. The pressure of expensive services resulting from more advanced health technology has increased the necessity of these changes. Strategic purchasing of health services, as a recommended approach, remains unknown in diagnostic imaging services. This study explores the potential determinants of strategic purchasing in the context of diagnostic imaging services. METHODS: This was a qualitative study conducted through framework analysis (applying five stages of familiarization, identifying a thematic framework, indexing, mapping, and interpretation) in 2023 based on the World Health Organization for strategic purchasing. This framework includes 5 questions: what to buy? From whom to buy? For whom to buy? what mechanism to buy? At what price to buy? A dimension of what structure to buy? Data were gathered through semi-structured interviews with key informants in which data saturation was reached in 18 interviews. After transcribing each interview, data were analyzed using MAXQDA software. RESULTS: A total of 32 factors were identified to be influencing the strategic purchasing of diagnostic imaging services. Development of an evidence-based service package using a prospective combined payment system, consideration of the burden of disease and health needs, implementation of a referral system and family physician program integrated with the electronic health record, and most importantly, political belief and technical capacity are the most important identified factors. CONCLUSION: The implementation of a strategic purchasing policy requires a systemic approach to the factors affecting it. A number of specific and sometimes interconnected activities must be carried out in different areas of strategic purchasing. Governance of purchasing is the foundation of strategic purchasing. It is suggested that this item should be investigated more in countries like Iran.