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Background <p>Payment initiative in dental services is a key policy strategy to enhance access, affordability, and patient satisfaction. The Ghasedak project, a six-month pilot initiative at a university dental school in Iran, aimed to test a new payment model. This study analyzed the reasons for its suspension to draw lessons for future initiatives.</p> Methods <p>A qualitative study was conducted using Walt and Gilson’s policy triangle framework. Data were collected in 2024 through 19 semi-structured interviews with project stakeholders (founders, managers, providers, and philanthropists) and 28 patients, selected via purposive sampling at Alborz University of Medical Sciences, Karaj. Data were analyzed using the Elo and Kyngäs inductive content analysis approach in MAXQDA, consisting of preparation, organization, and reporting phases.</p> Results <p>From 145 initial codes, 13 themes and 61 subthemes were identified. Mapped to the policy triangle, barriers included: Context (management instability, lack of institutionalized inter-sectoral cooperation, insufficient upstream support); Content (lack of an independent and transparent structure, unsustainable funding, non-adherence to social work principles, and lack of continuity in service delivery); Process (administrative bureaucracy, decreased financial transparency, lack of service support); Actors (low patient satisfaction stemming from mistrust, lack of motivation of stakeholders, and unrealistic patient expectations).</p> Conclusions <p>Structural, managerial, and operational deficiencies undermined the pilot’s sustainability and impact. Strengthening future payment initiatives requires secure financing, coherent management, streamlined implementation, and genuine stakeholder engagement. These findings provide actionable insights for policymakers seeking to design more resilient and effective dental payment initiative.</p>

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Exploring the challenges of a pilot dental services payment initiative: a qualitative policy analysis at an Iranian dental school

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  • 发表日期：

    2026年6月29日

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  • Iman Rajaei,
  • Seyed Hadi Hosseini,
  • Saleheh Khorasani,
  • Azadeh Babaei

摘要

Background

Payment initiative in dental services is a key policy strategy to enhance access, affordability, and patient satisfaction. The Ghasedak project, a six-month pilot initiative at a university dental school in Iran, aimed to test a new payment model. This study analyzed the reasons for its suspension to draw lessons for future initiatives.

Methods

A qualitative study was conducted using Walt and Gilson’s policy triangle framework. Data were collected in 2024 through 19 semi-structured interviews with project stakeholders (founders, managers, providers, and philanthropists) and 28 patients, selected via purposive sampling at Alborz University of Medical Sciences, Karaj. Data were analyzed using the Elo and Kyngäs inductive content analysis approach in MAXQDA, consisting of preparation, organization, and reporting phases.

Results

From 145 initial codes, 13 themes and 61 subthemes were identified. Mapped to the policy triangle, barriers included: Context (management instability, lack of institutionalized inter-sectoral cooperation, insufficient upstream support); Content (lack of an independent and transparent structure, unsustainable funding, non-adherence to social work principles, and lack of continuity in service delivery); Process (administrative bureaucracy, decreased financial transparency, lack of service support); Actors (low patient satisfaction stemming from mistrust, lack of motivation of stakeholders, and unrealistic patient expectations).

Conclusions

Structural, managerial, and operational deficiencies undermined the pilot’s sustainability and impact. Strengthening future payment initiatives requires secure financing, coherent management, streamlined implementation, and genuine stakeholder engagement. These findings provide actionable insights for policymakers seeking to design more resilient and effective dental payment initiative.