The 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 double importance of health in military societies and its importance in the national security of countries has made maintaining, promoting and restoration of the military society’s health has become one of the fundamental concerns of countries.

Methods: The current comparative qualitative study based on Perker and Harding's model has investigated and compared the organizational structure of military hospitals in 9 countries: Germany, Brazil, Turkey, South Korea, South Africa, China, Pakistan, Italy and Iran by means of semi-structured interviews.
Results: The findings of the study 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: decision rights, market exposure, residual claims, accountability and social functions that in the dimension of the decision-making right, the findings indicate 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, residual claimant is propelled through creating committees or supervisory boards, while hospitals have some authority on their residual claimant, and in other studied countries, the authority of all residual claimants are with the highest level of military health and treatment sector of the relevant country. In countries such as Germany, Italy, and South Korea, the accountability towards stakeholders has become decentralized. The dimension of social functions is not considered among the military hospitals’ duties; nevertheless, all the studied countries practically had a relatively active presence in the field of social functions and assistances.
Conclusion: Considering the importance of the health of the military community and the lack of available and published data and studies, it is necessary to enable mutual use of the experiences and learnings of this field by conducting studies of the military health system.