Isfahan University of Medical Sciences Health Information Management 1735-7853 22 2 2025 06 22 Redesigning an Efficient Outsourcing Model for Urban Fringe Comprehensive Health Centers ofBased on Grounded Theory:a Case Study of a Metropolis Redesigning an Efficient Outsourcing Model for Urban Fringe Comprehensive Health Centers ofBased on Grounded Theory:a Case Study of a Metropolis 74 82 33107 10.48305/him.2025.45757.1342 FA Mohammad Ali Azizi Department of Health Services management ,ST.C.,Islamic Azad Unversity,Tehran,Iran 0009-0006-2850-1159 ُShaghayegh Vahdat Department of Health Services management ,ST.C.,Islamic Azad Unversity,Tehran,Iran 0000-0002-2805-8955 Soad Mahfoozpour Department of Health Services management ,ST.C.,Islamic Azad Unversity,Tehran,Iran 0000-0003-0178-679X Somayeh Hessam Department of Health Services management ,ST.C.,Islamic Azad Unversity,Tehran,Iran 0000-0001-8282-9311 Journal Article Introduction: Implementation of outsourcing strategies within the health system has been introduced as a managerial approach to enhance efficiency and equity in service delivery at urban fringe comprehensive health centers; however, it faces multiple challenges and opportunities that require systematic investigation. This study was conducted in the metropolitan area of Mashhad with the aim of developing an evidence based, data driven model for effective outsourcing implementation. Methods: Employing the Grounded Theory approach, this qualitative research utilized semi structured interviews with health system experts. Data were analyzed through open, axial, and selective coding using MAXQDA 20. During selective coding, the core category was extracted, which interacted with causal, contextual, intervening, strategic, and consequential conditions to formulate the final theoretical narrative. Results: Six conceptual categories emerged from the data analysis, including three categories (and seven subcategories) of challenges namely, limited financial resources, weak monitoring systems, and low public trust and three categories (and six subcategories) of opportunities including access to local private providers, active community participation, and policy support. Conclusion: The category of “payment and financial incentives” was identified as the central connecting axis among other structural, contextual, and intervening factors. This finding suggests that any reform in health service outsourcing policies should focus on redesigning payment systems, enhancing contract transparency, and strengthening monitoring and technological infrastructures. Introduction: Implementation of outsourcing strategies within the health system has been introduced as a managerial approach to enhance efficiency and equity in service delivery at urban fringe comprehensive health centers; however, it faces multiple challenges and opportunities that require systematic investigation. This study was conducted in the metropolitan area of Mashhad with the aim of developing an evidence based, data driven model for effective outsourcing implementation. Methods: Employing the Grounded Theory approach, this qualitative research utilized semi structured interviews with health system experts. Data were analyzed through open, axial, and selective coding using MAXQDA 20. During selective coding, the core category was extracted, which interacted with causal, contextual, intervening, strategic, and consequential conditions to formulate the final theoretical narrative. Results: Six conceptual categories emerged from the data analysis, including three categories (and seven subcategories) of challenges namely, limited financial resources, weak monitoring systems, and low public trust and three categories (and six subcategories) of opportunities including access to local private providers, active community participation, and policy support. Conclusion: The category of “payment and financial incentives” was identified as the central connecting axis among other structural, contextual, and intervening factors. This finding suggests that any reform in health service outsourcing policies should focus on redesigning payment systems, enhancing contract transparency, and strengthening monitoring and technological infrastructures.

https://him.mui.ac.ir/article_33107_cb6bea847b2e98974d305392493349f3.pdf