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LANKARANI KAMRANBAGHERI, HONARVAR BEHNAM, SHAHABI SAEED, ZAREI FATEMEH, BEHZADIFAR MASOUD, HEDAYATI MARYAM, FARDID MOZHGAN, Rafiee FATEMEH, MARTINI MARIANO, NEJAD SOHEILARAFIEI. The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E232-E264. [PMID: 37654860 PMCID: PMC10468186 DOI: 10.15167/2421-4248/jpmh2023.64.2.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023]
Abstract
Introduction Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (organization, financing, payment, regulation, and behavior). Results The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran.
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Affiliation(s)
- KAMRAN BAGHERI LANKARANI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - BEHNAM HONARVAR
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - FATEMEH ZAREI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - MARYAM HEDAYATI
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - FATEMEH Rafiee
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - SOHEILA RAFIEI NEJAD
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Goudari FB, Rashidian A, Arab M, Mahmoudi M, Jaafaripooyan E. A trend analysis of surgical operations under a global payment system in Tehran, Iran (2005-2015). Electron Physician 2018; 10:6506-6515. [PMID: 29765576 PMCID: PMC5942572 DOI: 10.19082/6506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran. Objective The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations. Methods In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005–2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed. Results Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p<0.05) and N32, N43, N81 and N90 showed a significant downward trend (p<0.05). Similarly, all H Codes except for H18 had a significant upward trend (p<0.000). As such, K Codes including K45, K56 and K81 had an increasing movement. S Codes also experienced both increasing and decreasing trends. However, none of the O Codes changed according to time. Other global surgical codes like C61, E07, M51, L60, J98 (p<0.000), I84 (p<0.031) and I86 (p<0.000) shown upward and downward trends. Total global surgeries trend was significantly upwards (B=24.26109, p<0.000). Conclusion The varying trend of global surgeries can partly reflect the behavior of service providers in order to increase their profits and minimize their costs.
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Affiliation(s)
- Faranak Behzadi Goudari
- Assistant Professor of Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Arash Rashidian
- Ph.D. of Health Policy, Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Ph.D. of Healthcare Management, Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Mahmoudi
- Ph.D. of Medical Demography, Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Ph.D. of Healthcare Management, Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Naseriasl M, Janati A, Amini A, Adham D. Referral system in rural Iran: improvement proposals. CAD SAUDE PUBLICA 2018. [PMID: 29513863 DOI: 10.1590/0102-311x00198516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Because of insufficient communication between primary health care providers and specialists, which leads to inefficiencies and ineffectiveness in rural population health outcomes, to implement a well-functioning referral system is one of the most important tasks for some countries. Using purposive and snowballing sampling methods, we included health experts, policy-makers, family physicians, clinical specialists, and experts from health insurance organizations in this study according to pre-determined criteria. We recorded all interviews, transcribed and analyzed their content using qualitative methods. We extracted 1,522 individual codes initially. We also collected supplementary data through document review. From reviews and summarizations, four main themes, ten subthemes, and 24 issues emerged from the data. The solutions developed were: care system reform, education system reform, payment system reform, and improves in culture-building and public education. Given the executive experience, the full familiarity, the occupational and geographical diversity of participants, the solutions proposed in this study could positively affect the implementation and improvement of the referral system in Iran. The suggested solutions are complementary to each other and have less interchangeability.
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Affiliation(s)
- Mansour Naseriasl
- School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolgasem Amini
- Medical Education Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davoud Adham
- School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
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Wang Y, Shu Z, Gu J, Sun X, Jing L, Bai J, Huang X, Lou J, Zhang Q, Li M. Evidence for capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, Shanghai: A longitudinal study. Int J Health Plann Manage 2017; 32:307-316. [PMID: 28707707 DOI: 10.1002/hpm.2432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Currently, China has been experiencing rapid growth of medical costs, serious waste of medical resources, increasing disease burden for residents, and a medical insurance fund deficit. Therefore, an urgent problem that needs to be solved is to choose a rational payment for the insurance system. To empirically evaluate the long-term effects of capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, we collected and analysed data regarding financing, fund operation, medical service cost, and medical care-seeking behaviour from 2011 to 2015, a duration that includes data before and after reform. The data for financing and behaviours were compared year by year, and the monthly data for inpatient and outpatient costs were evaluated in a retrospective time series study. The capitation reform in Pudong New Area showed strong evidence of the power of medical cost control in the long run, while it was weak in reversing the number of patients flowing into secondary and tertiary hospitals. To make the payment of capitation play a bigger role in cost control in China, a tighter alignment of capitation with the general practitioner system and achieving dual referral is critical for future studies.
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Affiliation(s)
- Yanmei Wang
- School of Nursing, Fudan University, Shanghai, China.,Shanghai Pudong Institute for Health Development, Shanghai, China.,Shanghai Pudong Gongli Hospital, Shanghai, China
| | - Zhiqun Shu
- Shanghai Pudong Institute for Health Development, Shanghai, China
| | - Jianjun Gu
- Pudong New Area Commission of Health and Family Planning, Shanghai, China
| | - Xiaoming Sun
- Shanghai Pudong Institute for Health Development, Shanghai, China.,Fudan University, Shanghai, China
| | - Limei Jing
- Shanghai Pudong Institute for Health Development, Shanghai, China
| | - Jie Bai
- Shanghai Pudong Institute for Health Development, Shanghai, China
| | - Xuan Huang
- Pudong New Area Commission of Health and Family Planning, Shanghai, China
| | - Jiquan Lou
- Shanghai Pudong Institute for Health Development, Shanghai, China
| | - Qunfang Zhang
- Pudong New Area New Rural Cooperative Medical Scheme Management Office, Shanghai, China
| | - Ming Li
- Shanghai Pudong Institute for Health Development, Shanghai, China.,Pudong New Area Commission of Health and Family Planning, Shanghai, China
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