{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:05:17Z","timestamp":1790103917654,"version":"4.0.1"},"reference-count":34,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,8]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore how senior stakeholders assess Jordan\u2019s institutional readiness for universal health coverage (UHC), identify institutional pathways connecting fragmentation, purchasing strategies, accountability and public trust, and develop a bounded, phased policy roadmap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Exploratory qualitative study using semi-structured key-informant interviews and reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Jordan\u2019s national health-policy, financing, insurance, regulatory, digital-health and service-delivery institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>18 purposively selected senior stakeholders, supplemented by selective snowball referrals, representing legislative, executive, public-finance, civil-insurance, digital-health, public and private provider and technical functions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine themes were organised into four higher-order groups: (1) institutional fragmentation, governance and equitable access; (2) financing, information and digital readiness; (3) strategic purchasing and coordinated service delivery; and (4) social legitimacy, resilience and adaptive implementation. Participants described political commitment and substantial provider capacity as important foundations, but identified fragmented authority and insurance arrangements, weak purchasing, limited actuarial and integrated claims data, inconsistent public-private regulation, geographic inequities and conditional public trust as major constraints. The analysis suggests an institutional translation gap through which existing assets are not consistently converted into equitable, financially sustainable coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Jordan\u2019s readiness is multidimensional and uneven rather than binary. A phased pathway should first establish governance, legal, actuarial, data and social-protection foundations; then pilot benefit, claims, purchasing and primary-care reforms; and subsequently scale coverage subject to predefined readiness criteria. Findings concerning social acceptability reflect elite stakeholder perceptions and require direct validation with uninsured people, refugees, rural communities and frontline providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117274","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:42Z","timestamp":1790102142000},"page":"e117274","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["How do stakeholders assess Jordan\u2019s institutional readiness for universal health coverage? An exploratory qualitative interview study in Jordan"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2345-4892","authenticated-orcid":false,"given":"Mohammad S","family":"Alyahya","sequence":"first","affiliation":[{"name":"Health Management and Policy \/ Faculty of Medcine, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Abu Rumman","sequence":"additional","affiliation":[{"name":"Health Management and Policy \/ Faculty of Medcine, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Health Management and Policy \/ Faculty of Medcine, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moawiah","family":"Khatatbeh","sequence":"additional","affiliation":[{"name":"Faculty of Medcine, Yarmouk University, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211353047000_16.9.e117274.1","unstructured":"World Health Organization . Universal Health Coverage (UHC). Geneva: World Health Organization, 2025. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/universal-health-coverage-(uhc)"},{"key":"2026092211353047000_16.9.e117274.2","unstructured":"World Health Organization . Tracking universal health coverage: 2025 global monitoring report. Geneva: World Health Organization and the International Bank for Reconstruction and Development \/ The World Bank. Licence: CC BY-NC-SA 3.0 IGO, 2025. Available: https:\/\/www.who.int\/data\/monitoring-universal-health-coverage"},{"key":"2026092211353047000_16.9.e117274.3","doi-asserted-by":"crossref","first-page":"e152","DOI":"10.1016\/S2214-109X(17)30472-2","article-title":"Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services","volume":"6","author":"Hogan","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2026092211353047000_16.9.e117274.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12914-015-0056-9","article-title":"Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates","volume":"15","author":"Abiiro","year":"2015","journal-title":"BMC Int Health Hum Rights"},{"key":"2026092211353047000_16.9.e117274.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60002-2"},{"key":"2026092211353047000_16.9.e117274.6","unstructured":"Kutzin J , Witter S , Jowett M , et al . Developing a national health financing strategy: a reference guide. Geneva: World Health Organization. (Health Financing Guidance No 3) Licence: CC BY-NC-SA 3.0 IGO, 2017. Available: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/e3d41923-bda2-455f-9fb4-b848495e7ee6\/content"},{"key":"2026092211353047000_16.9.e117274.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-010755","article-title":"From Universal Health Coverage services packages to budget appropriation: the long journey to implementation","volume":"8","author":"Soucat","year":"2023","journal-title":"BMJ Glob Health"},{"key":"2026092211353047000_16.9.e117274.8","doi-asserted-by":"crossref","first-page":"132","DOI":"10.2471\/BLT.19.234153","article-title":"Pooling financial resources for universal health coverage: options for reform","volume":"98","author":"Mathauer","year":"2020","journal-title":"Bull World Health Organ"},{"key":"2026092211353047000_16.9.e117274.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-024-11467-1","article-title":"The transformation of Jordan\u2019s healthcare system in an area of conflict","volume":"24","author":"Tamimi","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026092211353047000_16.9.e117274.10","unstructured":"World Health Organization Regional Office for the Eastern Mediterranean . Health Financing Progress Matrix assessment, Jordan 2024: summary of findings and recommendations. Cairo: World Health Organization Regional Office for the Eastern Mediterranean, 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789292743628"},{"key":"2026092211353047000_16.9.e117274.11","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare11222993","article-title":"Strengthening Primary Healthcare in Jordan for Achieving Universal Health Coverage: A Need for Family Health Team Approach","volume":"11","author":"Khader","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"2026092211353047000_16.9.e117274.12","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.11.16006","article-title":"Technology and Universal Health Coverage: Examining the role of digital health","volume":"11","author":"Wilson","year":"2021","journal-title":"J Glob Health"},{"key":"2026092211353047000_16.9.e117274.13","unstructured":"Creswell JW , Poth CN . Qualitative inquiry and research design: choosing among five approaches. 4th edn. Thousand Oaks, CA: SAGE Publications, 2018."},{"key":"2026092211353047000_16.9.e117274.14","unstructured":"Patton MQ . Qualitative research & evaluation methods: integrating theory and practice. 4th edn. Thousand Oaks, CA: SAGE Publications, 2015."},{"key":"2026092211353047000_16.9.e117274.15","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2026092211353047000_16.9.e117274.16","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026092211353047000_16.9.e117274.17","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2026092211353047000_16.9.e117274.18","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"2026092211353047000_16.9.e117274.19","unstructured":"Mathauer I , Dale E , Meessen B . Strategic purchasing for Universal Health Coverage: key policy issues and questions. A summary from expert and practitioners\u2019 discussions Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO, 2017. Available: https:\/\/www.who.int\/publications\/i\/item\/strategic-purchasing-for-universal-health-coverage-key-policy-issues-and-questions"},{"key":"2026092211353047000_16.9.e117274.20","unstructured":"World Health Organization . Political economy analysis for health financing: a \u2018how to\u2019 guide. Geneva: World Health Organization. License: CC BY-NC-SA 3.0 IGO, 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240092099"},{"key":"2026092211353047000_16.9.e117274.21","doi-asserted-by":"crossref","DOI":"10.1080\/23288604.2022.2051794","article-title":"The Strategic Health Purchasing Progress Tracking Framework: A Practical Approach to Describing, Assessing, and Improving Strategic Purchasing for Universal Health Coverage","volume":"8","author":"Cashin","year":"2022","journal-title":"Health Syst Reform"},{"key":"2026092211353047000_16.9.e117274.22","unstructured":"World Bank . National Health Insurance (JKN) Reforms and Results Program (P172707): implementation status and results report, sequence no.7. Washington, DC: World Bank, 2024. Available: https:\/\/documents1.worldbank.org\/curated\/en\/099051725073040000\/pdf\/P172707-2d117512-820e-4212-8aab-055b71815c76.pdf"},{"key":"2026092211353047000_16.9.e117274.23","unstructured":"World Health Organization Indonesia . Indonesia health accounts 2024: strengthening evidence for sustainable health financing. Jakarta: World Health Organization Indonesia, 2026. Available: https:\/\/www.who.int\/indonesia\/news\/detail\/12-02-2026-indonesia-health-accounts-2024--strengthening-evidence-for-sustainable-health-financing"},{"key":"2026092211353047000_16.9.e117274.24","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1093\/heapol\/czab015","article-title":"Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia","volume":"36","author":"Sambodo","year":"2021","journal-title":"Health Policy Plan"},{"key":"2026092211353047000_16.9.e117274.25","unstructured":"World Health Organization . Health Financing Progress Matrix assessment: Kenya 2023: summary of findings and recommendations. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO, 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240094307"},{"key":"2026092211353047000_16.9.e117274.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-085903","article-title":"Social Health Insurance for Universal Health Coverage in Low and Middle-Income Countries (LMICs): a retrospective policy analysis of attainments, setbacks and equity implications of Kenya\u2019s social health insurance model","volume":"14","author":"Nungo","year":"2024","journal-title":"BMJ Open"},{"key":"2026092211353047000_16.9.e117274.27","unstructured":"Tangcharoensathien V . Thailand health system review. Manila: World Health Organization, Regional Office for the Western Pacific, 2024. Available: https:\/\/apo.who.int\/publications\/9789290620457"},{"key":"2026092211353047000_16.9.e117274.28","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czu120"},{"key":"2026092211353047000_16.9.e117274.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61051-X"},{"key":"2026092211353047000_16.9.e117274.30","unstructured":"World Health Organization . Country case studies on primary health care: Turkey: family practice for quality in universal health coverage, 2018. Available: https:\/\/www.who.int\/teams\/primary-health-care\/evidence-and-innovation\/primary-health-care-case-study-compendium\/detail\/country-case-studies-on-primary-health-care--turkey--family-practice-for-quality-in-universal-health-coverage?utm_source=chatgpt.com"},{"key":"2026092211353047000_16.9.e117274.31","doi-asserted-by":"crossref","unstructured":"Bump J , Sparkes S , Tatar M . Celi.Turkey on the way of universal health coverage through the health transformation program (English). Washington, DC: World Bank Group, 2014. Available: http:\/\/documents.worldbank.org\/curated\/en\/704941468338368780","DOI":"10.1596\/21059"},{"key":"2026092211353047000_16.9.e117274.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-016-1758-y","article-title":"The \u201cUniversal\u201d in UHC and Ghana\u2019s National Health Insurance Scheme: policy and implementation challenges and dilemmas of a lower middle income country","volume":"16","author":"Agyepong","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2026092211353047000_16.9.e117274.33","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1057\/s41271-024-00470-9","article-title":"Segmentation and fragmentation of health systems and the quest for universal health coverage: conceptual clarifications from the Mexican case","volume":"45","author":"Becerril-Montekio","year":"2024","journal-title":"J Public Health Policy"},{"key":"2026092211353047000_16.9.e117274.34","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311x00094618","article-title":"Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision","volume":"35Suppl 2","author":"Lima","year":"2019","journal-title":"Cad Saude Publica"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-117274","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:50Z","timestamp":1790102150000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-117274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-117274"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-117274","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}