Experts’ analysis of the improvement spaces of the first phase of reform in health system financial management: A qualitative study

  Background: Health financial reforms began in 2005 through four phases in order to achieve the maximum efficiency and effectiveness in this sector. The first phase was accrual accounting implementation instead of cash method.   Objective: The aim of this study was to determine the most important improvement spaces of the first phase of reform in financial management (accrual accounting) in the viewpoints of financial experts employed in middle and operational levels of Universities of Medical Sciences.   Methods: This qualitative study was conducted in Universities of Medical Sciences in 2013 using non-probability sampling method (snowball). Saturation was achieved only after 25 semi-structured interviews. Data were analyzed using content analysis by Kruger model.   Findings: Seven areas of improvement including staffs, managers, information system, organizational culture, structure, process, and financial were identified as main themes. Each theme contained several sub-themes.   Conclusion: Attempts and planning should be considered by decision makers in order to improve modifiable determinants through practical mechanisms in the first phase of health system financial management.