واکاوی زمینه های شکل گیری و شیوع فساد در نظام بهداشت و درمان ایران (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
زمینه و هدف: فساد به عنوان معضل جهانی، وقت و هزینه زیادی را از دست اندرکاران قضایی، اجتماعی و سیاسی کشورها به خود اختصاص داده است و هزینه بسیاری را نیز در ابعاد مختلف، به مردم وارد می کند. هدف اصلی این تحقیق، واکاوی زمینه های شیوع فساد در نظام بهداشت و درمان ایران است. روش بررسی: پژوهش حاضر با رویکرد کیفی و روش نظریه زمینه ای انجام شد. میدان تحقیق، خبرگان حوزه ستادی وزارت بهداشت و درمان و آموزش پزشکی بود. برای این منظور، با 13 نفر از خبرگان این حوزه، مصاحبه عمیق انجام شد و نمونه ها نیز با شیوه نمونه گیریِ نظری و گلوله برفی انتخاب شدند. یافته ها: براساس تحلیلِ داده ها، شش مقوله مرتبط با فرآیندِ شیوع فساد در نظام بهداشت و درمان ایران، عبارت اند از: ضعف آموزش رسمی و غیررسمی، ضعف سیاست گذاری، مدیریت و حکمرانی در نظام بهداشت و درمان، اقتصاد معیوب و فاقد نظام توزیع عادلانه در نظام بهداشت و درمان، ضعف قوانین و ناکارآمدی دستگاه های نظارتی، ساختارهای ضعیف و فسادپرور در نظام بهداشت و درمان و حوزه دارویی فسادزا در نظام بهداشت و درمان. مقوله های ذکرشده، ذیلِ مقوله هسته «سیستم فسادزای بهداشت و درمان» دسته بندی شد. نتیجه گیری: این تحقیق نشان می دهد فساد در سیستم بهداشت و درمان ایران، ساختاری و نظام مند شده است و بسیاری از فسادها در رویه های کاملاً قانونی انجام می شوند و به دلیل ضعف ها و خلأهای قانونی، قوانین بازدارندگی لازم را برای جلوگیری از وقوع فساد ندارند.Analyzing the Foundations of Formation and Prevalence of Corruption in Iran's Healthcare System
Introduction Corruption as a universal problem has taken up substantial time and money from judicial, social, and political officials of many countries imposing lots of cost on people from different dimensions. In the last few decades, the issue of corruption has attracted the attention of many researchers from different fields, such as sociology, law, economics, etc., and much research literature has been produced on this issue. It can be said that corruption is a global phenomenon that exists more or less in all countries of the world, but its existence and extent differs from one society to another according to social and economic development and based on the effectiveness of moral, religious, and cultural values. Although corruption has extensive negative consequences, its importance is more evident in the healthcare system. It can have many negative effects because it deals with human lives. Therefore, the aim of the current research was to analyze the causes of occurrence and spread of corruption in the healthcare system from the experts’ perspectives in the context of sociological framework. Materials & Methods The current research tried to identify the conditions and contexts related to the prevalence of corruption in Iran's healthcare system from the staff experts’ perspectives in this field by using a qualitative approach and the grounded theory method. Therefore, the research field was the headquarter of the Ministry of Health, in which the following criteria were adopted for selecting the samples: working in the headquarter of the Ministry of Health and Medical Education, having information and awareness of some corruption in this area, and having an experience of responsibility in the executive and general positions of the Ministry of Health and Medical Education. The sampling process was such that the researcher first started with someone, who was easier to communicate with. One of the authors’ colleagues was introduced to the interviewing researcher. Therefore, the first sample became available. Based on the logic and nature of the issue, the next samples were determined via snowball sampling. To achieve a comprehensive understanding of the conditions and action strategies of activists, theoretical sampling and maximum diversity methods were also employed. To select the samples, their various characteristics, such as work history, age, level of education, marital status, and ethnicity, were also determined as the criteria for sample selection. Discussion of Results & Conclusion Based on the data analysis, 6 categories related to the process of spread of corruption in Iran's healthcare system were identified: "weakness of formal and informal education", "weakness of policy, management, and governance in the healthcare system", "glitch economy and lack of a fair distribution of the healthcare system", "weakness of laws and inefficiency of the regulatory bodies", "weak and corrupt structures in the healthcare system", and "existence of a corrupted pharmaceutical field in the healthcare system". The aforementioned categories were all nested under the core category of "corrupting healthcare system".This research showed that corruption in Iran's healthcare system had become structured and systematic and therefore, many corruptions took place with completely legal procedures. Moreover, due to legal weaknesses and loopholes, the laws did not provide the necessary deterrence to prevent the occurrence of corruptions. Overall, the results of this research revealed that what was seen as corruption in Iran's healthcare system had less to do with individual aspects, i.e., individual control mechanisms were not very effective in this regard though they were not separable from the conditions of corruption in Iranian society. To deal with corruption seriously, there was no other way around but to reform the official and unofficial structures of corruption and procedures.
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