1. Introduction
Global population growth of the elderly and ensuring their health is a global event and one of the most important challenges of countries’ health systems, especially developing countries and Iran. In the absence of proper planning and malfunction of the health system, a lot of costs and damages in various dimensions will be imposed on society. Because the increase in the elderly population, without preparation, causes an inability to receive health care, the inefficiency of the health system and basic socio-economic problems in the whole society. Therefore, Iran must adapt to this new reality as soon as possible, and the health system should be able to plan and implement effectively in the effective confrontation with the phenomenon of future aging, from now on to better and better understand this phenomenon and strengthen itself, and compensate for any late action. In this regard, the study was conducted to explain the challenges of the Iranian health system in the face of future aging.

2. Methods
The study was performed qualitatively. Experts in the field of aging and health participated in the study. In order to obtain different backgrounds, experiences, and views on the subject, heterogeneous samples with the greatest diversity in terms of field of study and academic orientation, work experience, and place of work in both genders were selected; Therefore, participants from the provinces of Iran in organizations and centers related to elderly purposefully participated.
A semi-structured interview form was developed, and two preliminary interviews were conducted to learn about possible changes needed. Sample adequacy was determined through data saturation, and 29 interviews were finalized. Participants were invited to collaborate by calling the researcher and stating the purpose of the study. Interview sessions were held in their office, and at the job place, they suggested facilitating the interviewees’ participation (following the health guidelines and the physical distance concerning the COVID-19 pandemic).
Data from the interviews were analyzed using qualitative content analysis. During the process of reduction and abstraction, codes and the classification of similar codes, subcategories, main categories, and concepts were formed. Lincoln and Guba criteria such as credibility, dependability, confirmability, and transferability were used to assess validity. To increase credibility, in-depth interviews were conducted on the most diverse samples and peer reviewed by a fellow researcher. Efforts were made to improve dependability. The path of execution, analysis, coding, and classification of data was clearly stated in detail. Study documents and details were recorded and maintained at all stages of the study to ensure confirmability. By introducing the study implementation steps and the characteristics of the study population, others could follow the research path and apply the study data.
3. Results
According to the interview data classification, 334 codes, 30 subcategories, 8 main categories, and 2 concepts were formed. Findings in identifying the challenges of the Iranian health system in the face of future aging identified (according to Table 1) two general concepts, including “policy challenges,” including “barriers related to planning and implementation,” “financial barriers,” “perspective barriers,” “medical barriers,” “health barriers,” “educational barriers” as well as “individual social challenges,” including “cultural value barriers” and “individual barriers.” 



In identifying the challenges of the Iranian health system in the face of future aging in the field of policy-making, the main category of “barriers related to planning and implementation” emerged from the integration of 5 subcategories. These barriers included a variety of management problems, including policy-making, decision-making, planning, implementation, and monitoring.
The main category of “financial barriers” emerged from the three sub-classes, which were related to the livelihood and expenses of the elderly community and the government’s material resources. For example, it was noted that both the community to pay the insurance premium and the government to support the insurance companies face challenges.
The main category of “ Perspective barriers” emerged from the three sub-classes. Respondents believed that the country’s health system was involved in providing services to groups other than the elderly and that the system believed that providing services to the elderly was time-consuming, costly, and inefficient and defined service priorities differently.
The main category of “therapeutic barriers” emerged from four subcategories. In this regard, the participants believed that providing services to the elderly group due to some characteristics such as simultaneously contracting several diseases and the need to use various drugs, chronic disease, late treatment, lack of mastery and skill of medical staff in providing services to the elderly and the need for different specialties for therapeutic interventions was one of the challenges of the health system.
The main category of “health barriers” appeared from four subcategories, and the main category of “educational barriers” from two subcategories. In this section, participants believed that in the field of health and prevention, due to the possibility of various diseases and reduced physical and mental fitness, the quality of life of the elderly is affected and lack of timely information and adequate education are among the other challenges.
The main category of “value cultural barriers” emerged from the three sub-classes. In this area, participants pointed to the challenging situation of families, both functionally and structurally, and the weakness of society’s values and ethics towards the elderly.
The main category of “individual barriers” emerged from the three sub-classes. Participants in this section cited factors related to the characteristics of the elderly, such as the elderly’s own beliefs, reduced self-care ability, and less awareness of up-to-date knowledge and events, which themselves can be a source of more significant challenges.
4. Discussion
The results of this study can identify the challenges and threats in the path of future aging for policymakers and planners to use these findings for effective planning and implementation, in accordance with the characteristics and needs of the elderly community. With the help of effective management, specialized training for staff, and culture-making in the community and families, can be more effective in controlling the barriers mentioned in the study and gaining the opportunity to deal with the future readily and appropriately. Researchers are advised to use the context provided by this study to introduce barriers and to conduct independent studies to evaluate the various dimensions of each of these barriers and to provide practical solution models.
Ethical Considerations
Compliance with ethical guidelines
The implementation process of this study was approved by the specialized committee of the Fund for the Support of Researchers and Technologists of the country as a local ethics committee. In addition, all steps have been done with the approval of the expert supervisor of the project. Participants' trust and satisfaction were obtained regarding the confidentiality of information and the observance of ethical principles and the fact that several interview sessions may be required. Participants were informed that they had the right to withdraw from the study at any time if they wished to continue. Participants were assured that the information provided was used in a manner that respects their confidentiality and privacy.
Funding
This study is the result of research No. 98028273, and was conducted with the support of Iran National Science Foundation (INSF), Tehran, Iran. 
Authors' contributions
All authors were equally contributed in preparing this article.
Conflicts of interest
The authors declared no conflict of interest.