International Journal of Health Policy and Management

International Journal of Health Policy and Management

More Patients or Healthier Populations? Institutionalised Conflict of Interest, Health System Governance, and Population Health

Document Type : Editorial

Authors
1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
2 National Centre for Health Insurance Research, Tehran, Iran
3 School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
4 Department of Management Development, Resources and Planning, Hamadan University of Medical Sciences, Hamadan, Iran
5 School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
6 Department of Family Medicine, McMaster University, Hamilton, ON, Canada
Abstract
Conflict of interest (CoI) in health systems is commonly viewed as an individual ethical issue but may also become institutionalised when governance arrangements align policy-making authority with professional or financial self-interest. Using Iran as an illustrative case, this article examines how institutionalised CoI can gradually shape policy priorities and distort health system missions towards provider-centred rather than population-centred goals, often without deliberate intent. A comparative analysis of health ministers’ professional backgrounds suggests substantial variation across countries in governance arrangements and leadership models. The article discusses how institutionalised CoI may contribute to policy distortions including persistent reliance on fee-for-service (FFS) payment, weakened gatekeeping, dual practice, and inadequate transparency, ultimately affecting healthcare utilisation, financial protection, and health system performance. Addressing these challenges requires governance reforms that strengthen leadership, align provider incentives with population health, and improve transparency, accountability, and institutional independence.
Keywords

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Articles in Press, Corrected Proof
Available Online from 24 August 2026

  • Received Date 12 June 2026
  • Revised Date 13 August 2026
  • Accepted Date 15 August 2026
  • First Published Date 24 August 2026
  • Published Date 24 August 2026