Stakeholder-Driven Cost Management Approaches in Iranian Hospitals: A Qualitative Thematic Analysis

Inflation, delayed insurance reimbursements, demographic aging, and bureaucratic inefficiency drive Iran's escalating healthcare spending, threatening hospital sustainability and universal health coverage (UHC). This study aims to identify the cost control strategies and to explore the factors that promote and impede their usage.

This qualitative descriptive study (January-June 2024) used semi-structured interviews with 80 participants. Thematic analysis followed Braun and Clarke's framework, validated via peer debriefing, member checking, and inter-coder reliability using MAXQDA software.

Five themes were present: (1) Information Technology and Transparency, (2) Process and Resource Management, (3) Human Resource Management and Organizational Culture, (4) Systematic Approaches and Policy Development, and (5) Overcoming Structural and Economic Barriers. Cross-cutting concerns highlighted the importance of a cost-conscious culture, evidence-driven decision-making, market-oriented strategies, and continuous process monitoring.

The study outlines 11 strategic areas for Iran's healthcare, emphasizing digital transformation, workforce management, process optimization, policy reform, and structural adjustments. Findings offer practical guidance for hospital executives and policymakers in resource-constrained systems, applicable globally (e.g., Brazil, India), promoting low-cost improvements without quality compromise.