Background: A significant share of medical care, primary health care, and health-related education and research in Iran is provided by the Ministry of Health and its affiliated universities of medical sciences. We aimed
to identify a set of key metrics for monitoring their efficiency in the four areas of medical care, primary health
care, education and research.
Methods: A combination of scoping review, expert panel and Delphi method was used. First, the relevant
keywords were searched in the appropriate databases between 2000 and 2020. The final extracted indicators
then reviewed, reduced and refined through the expert panel meetings. The last metrics were established following a three-stage Delphi study.
Results: Out of 2327 studies, 155 were selected following the different screening stages of scoping review. After summarizing and refining the indicators via several expert panel meetings and the Delphi method, a total of
36 key indicators were considered appropriate for measuring efficiency of the health system, 23 of which were
for the sub-systems of public health (4 indicators), medical services (10 indicators), education (4 indicators) and
research (5 indicators) and 13 indicators for the whole system efficiency.
Conclusion: The set of indicators presented representing both the technical and allocative efficiency, might be
a reliable basis for designing information systems and management dashboards for periodic monitoring of
health system efficiency at national, regional and local levels.


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