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ORIGINAL ARTICLE
J Edu Health Promot 2020,  9:237

A roadmap for implementing general policies of resistance economy in the Isfahan Universities of Medical Sciences


1 Health Management and Economics Research Center, Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission16-Mar-2020
Date of Acceptance29-Apr-2020
Date of Web Publication28-Sep-2020

Correspondence Address:
Dr. Yasamin Molavi Taleghani
Health Management and Economics Research Center, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Second Floor, Hezar Jarib Street, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jehp.jehp_217_20

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  Abstract 


CONTEXT AND AIMS: The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences.
MATERIALS AND METHODS: This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively.
RESULTS: Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people-centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health.
CONCLUSION: The implementation of resistance economy policies entails planning in the long run, culture-building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

Keywords: Health system, policy, resistance economy, road map, University of Medical Sciences


How to cite this article:
Ferdosi M, Rezayatmand R, Taleghani YM. A roadmap for implementing general policies of resistance economy in the Isfahan Universities of Medical Sciences. J Edu Health Promot 2020;9:237

How to cite this URL:
Ferdosi M, Rezayatmand R, Taleghani YM. A roadmap for implementing general policies of resistance economy in the Isfahan Universities of Medical Sciences. J Edu Health Promot [serial online] 2020 [cited 2020 Oct 22];9:237. Available from: https://www.jehp.net/text.asp?2020/9/1/237/296383




  Introduction Top


Iran's economic system is a vulnerable economic system, and in the past few years, the word “economic resistance” or “economic resilience” has been added to our economic literature due to the intensification of economic sanctions.[1] Economics resistance means identifying areas of pressure under the current sanction conditions and then attempting to control and inactivate them in an idealized manner, turning these pressures into opportunities. Inevitably, it required macroeconomic stability, social development, public participation, and rational and thoughtful management as prerequisites.[2] In other words, a resistance economy is defined as the capacity of an economy to improve or adapt to the effects of exogenous shocks.[3] Therefore, resilience-based planning requires addressing any disruptive factors of sustainable growth and selecting strategies that minimize the risks and uncertainties of achieving goals.[4]

In Iran, the general policies of the Resistance Economy with a jihadist, flexible, opportunity-generating, endogenous, progressive, and extravagant approach were notified on 2014–2018 within twenty-four paragraphs by the Supreme Leader, aiming at providing dynamic growth and improving the resistance Economics indicators and achieving the goals of the 20-year perspective document.[5] Resistance economy policies as a documented system are backed theoretically and legally supported.[6] Resistance economy policy packages often have a long-term view and are designed to support long-term goals.[7] In other words, these policies are not unique to the current state of the country, but are a long-term strategy for the country's economy and can be complemented and adapted to the various conditions that may arise at any time. What has been requested by the supreme leader in this announcement is to provide the appropriate context and opportunity for the role of the people and all economic actors by preparing the necessary rules and regulations and formulating a roadmap for different areas.[8] According to the topic of resistance economics, the role of different sectors of the country in this field is very important and it is expected that all sectors play their role well in solving problems. In Iran, however, resilience issues are more confined to the field of psychology, engineering, and urban management, and only to some extent have some government agencies discussed economic resilience. That is while the importance of resilience in development, literature is increasing day-by-day and neglecting it will be detrimental to the country.[9],[10],[11] Therefore, the health system of the country as one of the development infrastructures of the country is a high-risk industry due to its working nature and structural, physical and technological complexities.[12] Therefore, health-care structures must cope with risky situations by increasing their flexibility, which means the same goals of a resistance economy.[13],[14] Implementing resistance economy policies in the health system and universities can promote the general development of the country, as the resistance economy can improve the efficiency and effectiveness of the health system and academia, and this efficiency will also affect other elements of the country's economy management.[15],[16]

In view of the above, despite the importance of the subject of resistance economics, there is still no clear understanding of the concept of resistance economics, especially in the health field. Therefore, by determining the contribution of the health system in the resistance economy, the necessary background for reinforcement and resilience against various internal and external risks affecting the components of resources and consumption in different areas of the health system of the country should be provided. In this regard, for implementation of the goals and policies of the resistance economy, an integrated tool in the health field is required. A tool that, while respecting security considerations and removing vulnerabilities in the health system, provides principled management at all levels of strategic, operational, and executive health structures. Therefore, this article aims to provide a scientific analysis of resistance economy policies and provide a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences (MUI) in 2020.


  Materials and Methods Top


The present study is a qualitative study in which document review method, group discussion and Delphi method was used as required in each step of the work. This study is categorized in the applied class based on the results, and is among cross-sectional studies in terms of time. In this study, first the axes related to health care were extracted from the issued policies of the resistance economy by the research team.

The research population was all key experts in the field of health care in MUI with maximum diversity (in terms of age, education, employment status, and executive background). Due to the fact that in the present study, participants' knowledge was important for providing data, objective-oriented sampling, and based on sampling from individuals was important.

In continue, the details of the work of each step of the study are explained.

Step 1: Identifying the capacity of the healthcare sector in implementing resistance economy policies

First, 24 clauses of the issued policies of the resistance economy were examined using the document review method and policy research in the expert meetings of the research group members, and the clauses related to the field of health care were extracted based on the in-depth study method. Brief and practical definitions about the basic concepts of each policy clause were then determined and various issues raised in these policies were identified. Subsequently, the strategic objectives of each one of the policy clauses were identified by the members of the research team by rereading the text of the policy.

Step 2: Initial identification of examples related to resistance economy policies about healthcare

At this step, the necessary permits were firstly obtained from MUI and the necessary coordination was made with the participants to conduct a group interview. This step of the study involved collecting the views of the experts using a focused group discussion method. At this step, 55 experts were invited to participate in the group discussion, out of which 49 individuals (89%) participated in the group discussion sessions. The 49 experts were among the staff of the University of Medical Sciences (including 10 experts from the department of health, 15 experts from the department of treatment, 10 experts from the department of food and drug, 7 experts from the department of development, and 7 experts from the department of education and research). The group discussion sessions were held as face-to-face by a supervisor (M. F AND M. R) for “Introducing the question and topics discussed”, a facilitator (Y. MT) for “helping experts to respond the questions” and a secretary as “meeting coordinator and curriculum”. At the beginning of each session, the supervisor provided some explanations to the participants about the objective and method of the study. Group discussion sessions were structured using a guide and done separated by each policy clause. In the first session of the group discussion, the experts were asked to mentions the plans and indicators effective in the field of health care at the University of Medical Sciences to achieve the objectives and strategies of each clause of the resistance economy policy. Effective examples and components were proposed with the method of brainstorming by the experts to achieve the objectives and strategies of each clause of the resistance economy about health care at the university of medical sciences. The content of the group discussion was recorded by the consent of the participants and the conversations and brainstorming continued until data saturation. In total, for each group of different areas of the university staff, 244 min group discussions were held. Each focus group discussion with an average time of 45–60 min was held at Faculty of Management and Information of MUI. Participants used the review method to increase the accuracy of the data. The review process was such that the researcher provided a summary of his notes and perceptions to the participants for recommendations in the second group discussion. It should be noted that before the start of the study, the guide questionnaire, which was designed in the form of questions appropriate to the study objectives, was examined in two interviews as a pre-test in terms of the reliability of the questions, the time required to implement the questions and discuss them and the its problems were eliminated so that the questions could be understood by the participants. By identifying commonalities and differences of the recommendations among the experts, a preliminary draft of effective plans and indicators in the field of health care of the University of Medical Sciences to achieve the objectives and strategies of each policy clauses of the resistance economy were identified.

The frame analysis was used to analyze the data of this step. In the frame analysis, the policies of the resistance economy were divided into eight classes based on thematic objectives. The strategies and objectives of each category subject were extracted by rereading the policy clauses of the resistance economy and set as a framework for continuing the research. Then, the plans and indicators obtained from the recommendations of the experts in the group discussion sessions were separately coded and selected, and a relationship was established between the codes and the objectives of each of the policy clauses. By holding the next group discussion session, the codes were reviewed and agreed on. It is necessary to explain that the present research is not an explanatory and inferential research. Here, the policy of resistance economy has been available, and finally, plans and indicators for achieving the policies of resistance economy about health care is extracted based on people's recommendations.

Step 3: Final approval of examples related to resistance economy policies about healthcare

At this step, a questionnaire was designed based on the initial draft and presented to the experts to determine the necessity and appropriateness of the proposed plans and indicators. This questionnaire was sent to 30 qualified academic experts through E-mail or in person for approval. Three follow-ups were conducted as E-mail or phone call by a researcher to increase the rate of response to the questionnaire. After collecting 25 distributed questionnaires (83% response rate), content validity index (CVI) and content validity ratio (CVR) were calculated for each item. CVI is calculated by aggregating the corresponding scores for each item that scored “related but needs revision” and “fully related” divided by the number of specialists. To determine the CVR, experts were asked to examine each plan based on the three-part spectrum of “necessary, useful but not necessary, not necessary.”[17] The scores obtained in the questionnaire were entered in the SPSS software version 21. The second step of Delphi questionnaire was also sent to the participants of the first step and by collecting 25 questionnaires and analyzing them, plans and indicators related to each of the resistance economy policies to implement in the field of health care of MUI was approved.

Descriptive statistics (frequency distribution tables and mean ratios) were used to analyze the data of this step. Based on the responses provided, CVI and CVR indicators were calculated for each indicator. Plans and indicators with CVI and CVR scores above 0.7 were selected and entered into the model. Plans and indicators with a CVI and CVR score of 0.4–0.7 entered the second step of Delphi, and plans and indicators with a CVI or CVR score of 0–0.4 were removed from the model.

Step 4: Identifying beneficiary departments

At this step, the beneficiary domains of the university were determined to implement each of the final plans through documentary review and interviews with relevant experts.

Determining the content validity of all aspects of the subject matter was identified based on expert discussion sessions. Content indicators were used in the Delphi steps to determine the content validity. Sufficient time was provided for proper communication and real understanding of the data between experts so as increase the breadth and depth of the data. Issues of difficulty level (difficulty in understanding phrases and words), appropriateness (appropriateness and desirable relevance of phrases to the dimensions of the questionnaire), and ambiguity (the possibility of misinterpretations of phrases or the presence of failures in the meanings of the words) were examined. Finally, examples inconsistent with the subject of the research was identified and eliminated or modified. Regarding reliability, quoting Ahmadi et al.'s study, “even if similar information or questions are given to panelists, obtaining the same results is not certain,” so in this study, as in other Delphi studies, reliability cannot be examined.

Inclusion criteria of this study are: 1-Policymakers, faculty members, and beneficiaries in the field of healthcare who are familiar with the meaning and policies of resistance economy (or) experts who have educational and research knowledge in the field of resistance economy; 2-Having enough desire and time to attend meetings; 3-Having a background in the field of staff at the University of Medical Sciences. Furthermore, exclusion criteria of this study were the inability and unwillingness of the experts to continue cooperation at any step of the research.

The ethical considerations in this study were the willingness to participate in the meetings, the observance of the principles of confidentiality of information, and the acquisition of informed consent. Individuals were also assured that their individual words are not reflected anywhere and that recommendations were made only in groups. It should be noted that this research is registered in MUI with the code of ethics of IR. MUI. REC.1396.3.527.


  Results Top


The results of the first phase of the research

In the first phase, out of 24 clauses of the resistance economy policies, 19 clauses were related to the field of health. Clauses of resistance economy were determined in terms of thematic communication and were classified by the researchers in eight thematic areas of people-centered, economic growth, economic justice, and support for internal services, economic resilience, economic stability, economic influence, and economic health. Furthermore, at this step, by reading the text of the resistance economy policies, 39 strategic objectives and 54 strategies were identified. [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8] describe the objectives and strategies of each of the 19 clauses of the resistance economy.
Table 1: Proposed policies and plans of the resistance economy in the field of people-centered at MUI

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Table 2: Proposed policies and plans of the resistance economy in the field of economic growth at MUI

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Table 3: Proposed policies and plans of the resistance economy in the field of economic justice at MUI

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Table 4: Proposed policies and plans of the resistance economy in the field of support for internal services at MUI

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Table 5: Proposed policies and plans of the resistance economy in the field of economic flexibility at MUI

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Table 6: Proposed policies and plans of the resistance economy in the field of economic stability at MUI

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Table 7: Proposed policies and plans of the resistance economy in the field of economic influence at MUI

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Table 8: Proposed policies and plans of the resistance economy in the field of economic health at MUI

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The results of the second phase of the research

By identifying commonalities and differences of the recommendations among experts, 243 initial plans in the field of health and medical sciences were identified to achieve the objectives and strategies of each clause of the resistance economy policies.

The results of the third phase of the research

Of the 198 plans proposed, 67 were accepted in the first step of Delphi and were considered as final plans, and 81 were removed. Fifty plans entered the second step of Delphi. In the second step of Delphi and the analysis of its results, 31 plans were approved and 19 plans were rejected. In general, in the steps of Delphi, out of 198 initial identified plans, 98 were identified as priority and final plans for implementation in the fields of health care of MUI. The results of the priority plans, access indicators, and the unit responsible for implementing the plans are shown separately in each clause of the resistance economy in [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]. It should be noted that due to the large number of plans, only plans that have been accepted by experts in the Delphi steps are mentioned in the tables.

In the following, the subdomains and themes of each of the clauses of the resistance economy policy are described.

List the topics of policies and plans related to the field of people-centered

Customers and stakeholders in the health system have a special place in advancing the goals of the health system. In the health system, as in other organizations and industries, for any major social change to happen, the presence of a huge mass of people is needed. The policies, plans, and indicators of the priority plan to achieve the field of people-centered are presented in [Table 1].

List of topics of policies and plans related to economic growth

Economic growth consists of labor, physical capital, and human capital. Human capital in the economic literature also includes education, health, skills, experience, and other capital that increase labor productivity and thus increases economic growth.

As shown in [Table 2], by rereading the text of the resistance economy policies, issues such as: improving the economic position of the university, achieving the first rank of knowledge-based economy in the region, improving the share of health and export services and knowledge-based services and increasing productivity in the health economy are placed in the axis of economic growth. The policies, plans, and indicators of the priority plan to achieve the field of economic growth are presented in [Table 2].

List of topics of policies and plans related to economic justice

Economic justice is a situation in which every client and beneficiary of the health system has achieved their right to wealth and income in society. Accordingly, justice in choosing different ways of providing resources, reimbursement of costs and insurance coverage of the community plays an important role in achieving justice and fulfilling the mission of the health system.

By rereading the text of the resistance economy policies, the objectives and strategies of the clauses number four and five of the policies of the resistance economy are placed in the field of economic justice. The policies, plans, and indicators of the priority plan for achieving the field of economic justice are presented in [Table 3].

List of topics of policies and plans related to self-reliance and support for internal services

Self-reliance and support for internal services may be the main goal of the resistance economy. Every health system in the world must be self-dependent to achieve internal authority. This is even more serious for a country like Iran which is facing sanctions.

By rereading the text of resistance economic policies, it is understood that by achieving the objectives and strategies of clauses six, seven, and 24 of the resistance economy, it is possible to support internal services at the level of MUI. The policies, plans, and indicators of the priority plan to achieve the field of support for internal services are presented in [Table 4].

List of topics of policies and plans related to economic flexibility

In order to create efficient economic flexibility conditions, the health system needs to be able, on the one hand, to reduce its inherent vulnerabilities and on the other hand, to provide flexibility against external crises and pressures under sanctions.

By rereading the text of the resistance economy policies, the objectives and strategies of clauses eight, twelve, and twenty-two of the policies of the resistance economy are placed in the field of economic flexibility. The policies, plans and indicators of the priority plan for achieving the field of economic flexibility are presented in [Table 5].

List of topics of policies and plans related to economic stability

Another goal of the health system is to create economic stability and confidence in the future. Therefore, achieving sustainable economic stability and strengthening the health system against the effects of positive and negative shocks is one of the priorities of policymakers in the health system.

As shown in [Table 6], by rereading the text of the resistance economy policies, issues such as: meeting the needs of the health economy, stabilizing the health economy, pioneering the strengthening of the real sector, saving public expenditure, and reforming the government's revenue system are placed on the axis of economic stability. The policies, plans, and indicators of the priority plan for achieving the field of economic stability are presented in [Table 6].

List of topics of policies and plans related to economic influence

The world today is a world without borders and it is impossible to progress in the health system without interacting with other health systems in the Islamic world and elsewhere. Therefore, proper interaction with other health systems should be established through active diplomacy.

By rereading the text of the resistance economy policies, the objectives and strategies of clauses 10 and 11 of the resistance economy policies are placed in the field of economic influence. The policies, plans, and indicators of the priority plan to achieve the field of economic influence are presented in [Table 7].

List of topics of policies and plans related to economic health

One of the most effective objectives for achieving the objectives of the resistance economy in the field of health care was the economic health domain. By implementing appropriate programs in the health system, we should eliminate the opportunity for corruption, reduce the pressures and increase the resistance to corruption, and ultimately bring about economic health in the health system.

As shown in [Table 8], by rereading the text of the resistance economy policies, issues such as: clarifying and modifying the economy and market control are placed at the axis of economic health. The policies, plans, and indicators of the priority plan to achieve economic health are presented in [Table 8].

In [Table 9], the frequency of policies and plans proposed by the resistance economy is presented as a roadmap for implementing the resistance economy policies in the fields of health care at MUI.
Table 9: Implementation of resistance economy policies in the field of health and treatment at MUI

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According to Diagram 1, 98 programs were identified as the final program for implementing the policies of the resistance economy in the field of health and treatment at MUI. The highest frequency of the program was related to the axes of support for internal services and economic flexibility with 19 programs, and the lowest program was related to the axes of people-centered and economic justice with seven programs.


  Discussion Top


The general policies of the resisting economy, in addition to being “general policy” and hence serving as a policy for policy making, have a coherent scientific map of various subject areas and objectives that, if misunderstood, may lead to unfavorable results for the policy maker and even lead to negative results. Therefore, the present study was conducted with the aim of scientific analysis of policies and identifying the most important instances and performance indicators in realization of general policies of resistance economics in the field of health of university of medical sciences. The central question of the paper was “what are the general objectives of the resistance economics which consist of general goals, thematic goals and strategies, and in what forms and indicators can the resistance economics policies be pursued in the field of health?”

In the first step, after rereading the text of resistance economy policies, the eight fields of people-centered, economic growth, economic justice, strategic self-reliance and support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as general objectives of the issued policies in the in the field of healthcare of MUI. Furtermore, by rereading the text of the resistance economy policies, 39 strategic objectives and 54 strategies were identified. In general, limited studies are done to determine the roadmap for the resistance economy in other industries and organizations, but unfortunately there is no comprehensive plan to implement resistant economy policies in health care.

Seif in his study considered a model of resistance economy to deal with anomalous circumstances. This model has four essential components including economic growth, economic stability, economic justice, and economic flexibility.[18] Whereas, based on the results of the present study, the eight areas of people-centeredness, economic growth, economic justice, strategic self-reliance and support for domestic services, economic flexibility, economic stability, economic influence, and economic health were identified as the overall goals of notified health policy in the field of health care in university of medical sciences. Seif's proposed model had the most similarity to the roadmap for resistance economy in the health department of the university, and most of the elements of this model are seen under similar headings in the roadmap proposed by the present study. In addition, according to the Vaezi and Fadaei study, 10 themes of understanding the importance of strategic management improvement, understanding the importance of resistance economy model, planning and rationalization of management, systematization, development of education, humanism, need orientation, self-sufficiency, entrepreneurship and extraversion were identified as the strategic management components of the Islamic University based on the Resistive Economics Model.[19] The model of the study by Vaezi and Fadai on elements such as self-sufficiency, populism with the axes of supporting domestic production and people-centeredness that are obtained based on the results of the present study is similar. The reasons for the difference in the model of resistance economy in this research with the findings of other researches was that in the present study, rereading of the policy text was used to determine the overall objectives of the resistance economy policies, while in Seif's study the model formulation was done based on research literature. Furthermore, understanding and making a discourse of the concepts of resistance economy may differ based on the research environment and the recommendations of scientific and executive experts.

In the next step, the draft plan was prepared and the roadmap of the implementation of the general policies of the resistance economy in the field of health care of MUI with eight thematic axes, 39 strategic objectives, 54 strategies, and 98 plans was approved by the experts. Based on the results, the most load of the plans to achieve the overall objectives were in the areas of self-reliance and support for internal services with a frequency of 19 plans (19.3%), economic flexibility with a frequency of 19 plans (19.3%) and the lowest load of the plans were the axes of people-centered with a frequency of 7 plans (7.1%) and economic justice with a frequency of 7 plans (7.1%).

By rereading the text of the resistance economy policies, 7 objectives and 6 strategies were placed in the field of people-centeredness. Seven plans were also identified as key plans in this field. One of the indicators of the resistance economy is people-centeredness and people founded economy, and the foundation of the resistance economy comes from the economic behavior of the people.[20] Being popular means that the participation of the classes of the society in economic activities and the circulation of economies is maximized by different classes of the society. In the health system, it is clear that without the support and empathy of the people, the government and the officials of the system, the development of the health system and the objectives of the resistance economy will not be realized. In fact, the role of the people in realizing the policies and plans issued must be uttered in a simple and tangible way.[21]

By rereading the text of the policies of the resistance economy, 5 objectives and three strategies were placed in the field of economic justice. Seven plans were also identified as key plans in this field. Justice is one of the most important social criteria and values in the health sector, which, although its full establishment is impossible even for developed countries, but most societies seek to achieve it in social affairs, including health.[22],[23] The starting point of economic justice is the observance of civil rights.[24] In the Iranian health system, several measures are always taken to achieve relative justice for the general public, especially the weak and vulnerable classes. In this study, according to the experts, plans such as reviewing the value of health services, referral system, inclusive social security and modifying the payment gap were proposed as effective plans to increase economic growth at the university of medical sciences.

Economic growth with 4 objectives, 8 strategies, and 10 plans was identified as another axis in achieving the policies of the resistance economy in the field of health care of the MUI. A common early empirical approach to examining the effect of health on economic growth involves regressing income per capita growth against initial level of health for a cross-sectional sample of countries, controlling for initial income and other factors believed to influence steady-state income.[25] According to Butkiewicz and Yanikkaya, developing countries need to limit their governments' spending expenditure and invest in infrastructure to stimulate economic growth.[26] In this study, according to the experts, plans such as creating a knowledge-based company, activating the innovation system, strengthening and empowering factors and developing tourism were proposed as effective plans to increase economic growth at the University of Medical Sciences.

Economic stability is related to the interaction between total supply and demand in the economy. In their study, Briguglio et al. examined the concepts and criteria of economic resistance and economic vulnerability, and considered the four main indicators of strengthening economic resistance as economic stability, microeconomic market efficiency, good governance, and social development.[27] Amiri et al., in their study as estimating the vulnerability and resistance indicators in the Iranian Economy, mentioned economic stability as one of the most important indicators of economic stability.[28] In this study, economic stability with 10 plans was identified as one of the axes in achieving the resistance economy policies in the field of health care.

Economic health with 2 objectives, 4 strategies, and 12 plans was identified as another axis in achieving the resistance economy polices in the field of health care of MUI. Corruption is a phenomenon that is more or less present in all countries, but its type, rate, form, and extent are different in each country.[29] Often, something is violated as a result of corruption, which may be a moral or legal principle or procedure.[30],[31] Therefore, with the measures taken in the healthcare systems, it is necessary to control the crime-prone contexts and flow the economic health.

Diplomacy and economic influence are other effective and strategic overall objectives of the resistance economy to gain scores in the global economic competition for economic progress. According to the participants' recommendations, fourteen plans were identified as key plans in this area. Economic influence in the Health Sector is the chosen method of interaction between different stakeholders of the health system to represent, collaborate, resolve disputes, improve health systems, and guarantee the right to health for vulnerable groups.[32] The basic need for economic diplomacy and the conversion of existing sources of economic power into real power is to identify the principles and strategies of diplomacy and economic influence. In the studies of Mohsenzadeh and Danesh Ja'fari, the diversity of countries' exports and their dependence on a particular commodity are the proper infrastructures for diplomacy and economic influence.[33] Mohammadi Siah Boumi also cited the discontinuance of monopolistic economics and alternative production and exports as goals and foundations of a resistance economy in the field of economic diplomacy.[34] In general, facilitating cross-border trade, improving and enhancing nongovernmental organizations and foundations as health diplomats, globalizing, and enhancing cooperation between low- and middle-income countries contribute to promote economic influence in the field of health.[35] All results were consistent with the results of the present study. Based on the results of the present study, a deep understanding of the target markets of health services helps to increase exports and effective presence in foreign markets. Therefore, it is important to know the real needs and capabilities of the country, as well as to recognize the relative advantage of the country in shaping world trade, and thus the results of the present study are consistent with the above studies.

In the present study, support for internal services and strategic self-reliance with 19 plans was identified as the most important axis in achieving the resistance economy policies in the field of health care at the MUI. According to the results of Hasani and Dehzari's study, a resistance economy is aimed at reducing dependencies and emphasizing the advantage of domestic production and self-reliance.[36] In their research, Mohsenzadeh M also cited the reduction of external dependence and the increase of domestic production as the main foundations of the resistance economy.[37] In addition, Seif[38] and Eidelkhani et al.[39] also cited support for domestic production and strategic self-reliance in resisting economy requirements in their studies. In general, most governments tend to support the production and delivery of domestic services, in particular special products.[40] The results of these studies were in line with the results of the present study. That is because Iran has been experiencing economic crises, technological change, recession, and unemployment in recent years, and thus supporting domestic services and improving the quality of economic services have a significant impact on growth and dealing with economic sanctions.

Economic flexibility is another general objective related to the resistance economy, which was identified by 19 plans as another important axis in achieving the resistance economy policies in the field of health care at the MUI from the viewpoint of the experts. Economic flexibility is a way that organizations can maintain or enhance their flexibility with respect to their workforce, capital goods, natural resources, and location of economic activity after the shock occurs.[41] Economic flexibility has a positive impact on the performance of organizations after a crisis and help organizations maintain their effectiveness in different conditions.[42] To determine the reasonable extent to achieve the ideal economic flexibility in the economic system, the ratio of international trade to Gross Domestic Product (GDP) should be determined.[27] According to Seif's study, economic flexibility strategies include the four elements of deterrence, neutralization, absorption and restoration, and the strategy of dispersal and weakening.[38] Therefore, in the present situation, saving is considered as the driving force in any activity and is of particular importance in the process of economic flexibility of countries.

One of the limitations of the study was that the determination of the plans and executive indicators of the resistance economy policies in each organization are based on its organizational atmosphere and the results cannot be compared with other institutions. However, this program and the relevant specified indicators can be used as a roadmap for other universities of medical Sciences in Iran. Besides, like other qualitative researches, changing the experts may somewhat change the results due to their different understanding. It is suggested to collect information by other methods such as observation and interviews for comprehensiveness. Another limitation of the study was the lack of scientific studies in this field due to the emerging issues of resistive economics in the health issues.


  Conclusion Top


In this study, main goals, thematic goals, strategies, programs, and programmatic indicators of resistance economy policies in the field of health were identified. Resistance economics is not a goal, but it needs to be incorporated into the goals and strategies of policymakers in the health system. The specific and important suggestion of the paper is to identify the programs identified in policymaking to implement health-resistive policies, and to try to act in a balanced way.

Implementing resistance economy policies and achieving its results also requires planning in the long run, building a culture of resistance economics, integrating different sectors and institutions, changing the educational system at different levels of the health system, and training entrepreneurs to implement resilience-driven programs. Finally, implementing programs for a resistance economy is not without cost. Thus, it is suggested that future studies should analyze the cost-benefit of each program to determine the optimal limit of resistance economy.

Acknowledgment

This article is registered with the code R13963527 in the research board of the Isfahan University of Medical Sciences. We want to express a special recognition to the specialists who have participated in the study without whom the study could not be possible.

Financial support and sponsorship

This study was financially supported by Isfahan University of Medical Sciences, Isfahan, Iran.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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