Study of the Organizational Structure of Military Hospitals in Selected Countries of the World Based on the World Bank Model - a Qualitative Study

Abstract

Background: The health has turned into one of the most important issues in different societies; hence, the demand for health-medical services has increased. Objectives: The present study aimed to investigate and use the experiences of the military health system of other countries regarding the organizational structures of their hospitals based on the World Bank Model. Methods: This study based on the model of Perker and Harding investigated and compared the organizational structure of military hospitals in nine countries, namely Germany, Brazil, Turkey, South Korea, South Africa, China, Pakistan, Italy, and Iran through semi-structured interviews. Results: The findings showed that in 18 interviews, 61% of the participants were specialist and subspecialist doctors, and the work experience of 39% of the participants was between 25 and 30 years. The World Bank Model (Preker and Harding), for hospital structure, considers five dimensions, including decision rights, market exposure, residual claims, accountability, and social functions. In the dimension of the decision-making right, the findings indicated the focus of this dimension in the studied countries. Facing the goods and supplies market in a country like South Korea is left to the hospital; however, in South Africa, it is centrally conducted by the Health and Medical Commander. In countries, like South Korea, Pakistan, China, and Iran, the residual claimant is propelled through the creation of committees or supervisory boards, while hospitals have some authority over their residual claimant. In the other studied countries, the authority of all residual claimants is with the highest level of military health and treatment sector of the relevant country. In countries, such as Germany, Italy, and South Korea, accountability towards stakeholders has become decentralized. The dimension of social functions is not considered among the duties of military hospitals; nevertheless, all the studied countries practically had a relatively active presence in the field of social functions and assistance. Conclusion: Given the importance of the health of the military community and the lack of available and published data and studies, it is necessary to make use of the experiences and learnings of this field by conducting studies on the military health system.