Mohammadreza Rezaee, Said Daei-Karimzadeh, Mehdi Fadaei, Akbar Etbarian, Hamid Bahrami,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: The family physician program and the referral system in health insurance of Iranian villagers and nomads were implemented in 2005 by the Iran Health Insurance Organization, after being approved by the Islamic Consultative Assembly. Financial resources and other physical and legal infrastructures as well as human resources are the essential requirements for implementing this program. The present study aimed at examining the factors contributing to the success of this national program in the described areas, considering their ease, accessibility, and role in the success of the family physician program and the referral system in health insurance of Iranian villagers and nomads in 2017.
Methods: In the current study, the variables involved in the physical and legal infrastructures, manpower, and provision of financial resources were first examined using Delphi method according to the experts' opinion including practitioners involved in the rural programs, inspectors, and supervisors of health insurance plan as well as experts and managers of Khuzestan, Isfahan, Lorestan, Ilam, Kermanshah, Chaharmahal va Bakhtiari, and Kohgiluyeh va Boyer-Ahmad provinces selected based on the purposive and chain sampling methods. Student t-test was then used to compare the responses with standard tables.
Results: In the provision of financial resources, physical and legal infrastructure and manpower after several years of implementating the program were approved by the indices such as the timely allocation of funds and provision of service packages, the determination of the actual per capita and the payment of services per capita, approval of referral system law and upstream laws, the payment of franchises at levels 2 and 3, and the number of specialists in the villages, their appropriate distribution on the basis of population density and the expansion of health centers based on this density, appropriate training, and long-term contracts, which create a sense of usefulness and ease of using services in insures and has a significant relationship with changing the family physician program and the success of the project.
Conclusions: After several years of implementing rural family physician program, the project has a relatively appropriate performance in terms of financing and other infrastructures. However, the referral system is still not implemented properly and feedbacks from specialized physicians are not sent to family physicians.
Sudeh Bagheri Rizi, Mohammad Ahmadi, Mahtab Shahbazi, Rohollah Javadi,
Volume 6, Issue 1 (6-2023)
Abstract
Introduction: The implementation of the family physician program in Iran Health Insurance Organization will change the payment system, reduce payments at the first level of service provision, and create a referral system. This study has been conducted with the aim of investigating the factors influencing the adoption of the referral system and the family physician of health insurance, including the adoption of the referral system, the creation of infrastructure and reforms, management factors, public interests, appropriate health system policies, appropriate health insurance structure and satisfaction.
Methods: The current research is descriptive and correlational in terms of applied purpose and data collection method. 184 people were included in the study by census. The data collection tool is a questionnaire with closed questions. After confirming the face validity and construct validity and reliability of the research instrument (Cronbach’s alpha 0.848), data analysis was performed using structural equation modeling (PLS-SEM).
Results: The findings of this research showed that the insurance structure in the health system was the most influential factor on the acceptance of the referral system and the family physician, and the effect path coefficient was estimated at 0.231. In addition to these policies included in the guidelines of the family physician program, infrastructure and reforms in society, management factors, public interest and satisfaction are other factors that have been confirmed to have an effect on the adoption of the family physician and referral system.
Conclusion: According to the findings, in addition to the appropriate health insurance structure, management and satisfaction factors are more important in accepting the referral system and the family physician. It seems that the insurance structure can create a sense of justice for people regarding health insurance because the plan of the referral system and family physician is based on necessities such as establishing proper access to the people of the country, equality in benefiting from health and treatment services, as well as the purposefulness of providing services and productivity. It is formed from the available human resources.
