Volume 22, Issue 2 (March-April 2023)
Payesh 2023, 22(2): 185-197 |
Back to browse issues page
Ethics code: IR.GOUMS.REC.1399.157
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Kabir M J, Heidari A, Moeini S, Khatirnamani Z, Rafiei N, Moradi T. Executive instruction for the payment mechanism of outpatient services in the electronic referral system in Iran. Payesh 2023; 22 (2) :185-197
URL: http://payeshjournal.ir/article-1-1925-en.html
URL: http://payeshjournal.ir/article-1-1925-en.html
Mohammad Javad Kabir1 
, Alireza Heidari * 2, Sajad Moeini2 , Zahra Khatirnamani2 , Narges Rafiei2 , Tayebeh Moradi1
, Alireza Heidari * 2, Sajad Moeini2 , Zahra Khatirnamani2 , Narges Rafiei2 , Tayebeh Moradi1
1- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
2- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
2- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Abstract: (1260 Views)
Objective: The payment system of specialist physicians has significant effects on the country's health costs and the provision of medical care at a fair, sufficient and high-quality level. This study was conducted to design the payment system's implementation guidelines for providing specialized services in the electronic referral system.
Methods: A qualitative study was conducted in 2021. The participants were hospital managers, top managers and experts in charge of health, treatment and development departments of Ministry of Health and Golestan University of Medical Sciences, Health Insurance Organization of Golestan province, specialist physicians and faculty members. Fourteen focus group discussion and six in-depth individual interviews were conducted. The content analysis method was used to analyze the data.
Results: The requirements for the establishment of an efficient and effective payment system were classified into 6 main themes (legal, political, managerial, executive, economic, cultural and social) and 32 subcategories. The executive mechanism was classified into 3 main themes (executive structure, executive process and monitoring and evaluation method) and 16 subclasses.
Conclusion: The implementation of the designed instruction can lead to increasing the access and benefit of services, improving the quality of providing specialized services, cost management and finally increasing the satisfaction of service providers and receivers.
Methods: A qualitative study was conducted in 2021. The participants were hospital managers, top managers and experts in charge of health, treatment and development departments of Ministry of Health and Golestan University of Medical Sciences, Health Insurance Organization of Golestan province, specialist physicians and faculty members. Fourteen focus group discussion and six in-depth individual interviews were conducted. The content analysis method was used to analyze the data.
Results: The requirements for the establishment of an efficient and effective payment system were classified into 6 main themes (legal, political, managerial, executive, economic, cultural and social) and 32 subcategories. The executive mechanism was classified into 3 main themes (executive structure, executive process and monitoring and evaluation method) and 16 subclasses.
Conclusion: The implementation of the designed instruction can lead to increasing the access and benefit of services, improving the quality of providing specialized services, cost management and finally increasing the satisfaction of service providers and receivers.
Keywords: Executive Instruction, Payment Mechanism, Outpatient Services, Specialist Physician, Electronic Referral System
type of study: Descriptive |
Subject:
Helath Services Management
Received: 2022/08/6 | Accepted: 2023/02/23 | ePublished ahead of print: 2023/02/26 | Published: 2023/04/9
Received: 2022/08/6 | Accepted: 2023/02/23 | ePublished ahead of print: 2023/02/26 | Published: 2023/04/9
References
1. Mojahed F, Vahidi RGh, Asgari Jafarabadi M, Gholipoor K, Mehri N. Payment Mechanisms Effect on Performance Indicators of Family Physician Program. Health Information Management 2015; 12:98 [In Persian]
2. Doshmangir L, Rashidian A, Takian A, Doshmangir P, Mostafavi H. Payment system of urban family physician programme in the Islamic Republic of Iran: is it appropriate? Eastern Mediterranean Health Journal 2018;24:611-617 [DOI:10.26719/2018.24.7.611]
3. Vujicic M. How you pay health workers matters: A primer on health worker remuneration methods. Washington DC: The World Bank, 2009. Available from: https://documentos.bancomundial.org/es/publication/documentsreports/documentdetail/723301468154474794/how-you-pay-health-workers-matters-a-primer-on-health-worker-remuneration-methods (accessed: 2023 12 February)
4. Oliver-Baxter J, Brown L. Primary health care funding models. Adelaide: Primary Health Care Research & Information Service, 2013. Available from: https://core.ac.uk/download/pdf/43335693.pdf (accessed: 2023 12 February)
5. Organization WH. The world health report 2000: health systems: improving performance. 1st Edition, World Health Organization: Geneva, 2000
6. Liu X, Mills A. Payment mechanisms and provider behavior. Alexander S. Preker Xingzhu Liu Edit V. Baris E, The World Bank, Washington DC,2007:259-278
7. Rahmany K, Barati M, Ferdosi M, Rakhshan A, Nemati A. Strategies for reducing expenditures in Iran's health transformation plan: A qualitative study. Medical Journal of the Islamic Republic of Iran 2018; 32:102 [DOI:10.14196/mjiri.32.102]
8. Jourmard I, Hoeller P, André C, Nicq C. Health care systems: Efficiency and policy settings. 1st Edition, OECD Publishing: Paris, 2010
9. Lankarani KB, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Medical Journal of the Islamic Republic of Iran 2013;27: 42 [In Persian]
10. Gheibi R, Nourizadeh Tehrani P, Alipanah Dolatabad M, Alihosseini S, Aryankhesal A. Staff Satisfaction Level of the Performance-Based Payment Plan (Qasedak) in Hospitals of Iran University of Medical Sciences:2019. Journal of Health Administration 2021; 23:70-79 [In Persian] [DOI:10.29252/jha.23.4.70]
11. Kabir MJ, Vatankhah S, Delgoshaei B, Ravaghei H, Jafari N, Heidari A, et al. Determinant criteria for designing Health benefit package in selected countries. Life Science Journal 2013; 10:1392-1403
12. Berenson RA, Upadhyay DK, Delbanco SF, Murray R. Payment methods: How they work.: 1st Edition, Urban Institute: Washington DC, 2016
13. Shami R, Gholamzadeh D, Vedadi A. Explaining the Performance-based Payment Model with an Educational Approach in Iranian Educational and Medical Centers and its Comparison with the Existing Models in the Health Care System of the Countries Implementing this scheme. Journal of Medical Education Development 2020; 13:15-30 [In Persian] [DOI:10.29252/edcj.13.37.13]
14. Kazemian M, Babarahim A. Comparative Assessment of Payment Methods of Fee-for-Services and Per Capita for Household's Health Insurance Services: Theoretical Framework and Application. Daneshvar Medicine 2016; 24:39-50 [In Persian]
15. Roberts MJ, Hsiao W, Berman P, Reich MR. Getting Health Reform Right. 1st Edition, Oxford University Press:London, 2004
16. Forsberg E, Axelsson R, Arnetz B. Financial incentives in health care. The impact of performance-based reimbursement. Health Policy 2001; 58:243-62 [DOI:10.1016/S0168-8510(01)00163-4]
17. Sorensen RJ, Grytten J. Service production and contract choice in primary physician services. Health Policy 2003; 66:73-93 [DOI:10.1016/S0168-8510(03)00026-5]
18. Kabir MJ, Heidari A, Honarvar MR, Khatirnamani Z, Badakhshan A, Rafiei N, et al. Eatablishment of an Electronic Referral System in Golestan Province: Opportunities and Threats. Health Based Research 2020; 6:151-167 [In Persian]
19. Kabir M J, Heidari A, Honarvar M R, Khatirnamani Z, Badakhshan A, Rafiei N, et al. Management Challenges of Implementing Electronic Patient Referral System; a Qualitative Study. Health Research Journal 2021; 6:275-286 [In Persian]
20. Kabir M J, Haydari A, Honarvar M R, Khatirnameni Z, Badakhshan A, Rafiei N, et al. Executive Challenges of Electronic Referral System in the Health Centers and Hospitals in Golestan Province, Iran: A Qualitative Study. Journal of School of Public Health and Institute of Public Health Research 2021; 19:157-172 [In Persian]
21. Molavi Vardanjani H, Kamyabi A, Jabbarizadeh A, Haghdoust AA. Methods of General Practitioners Remuneration in the World: A Benchmarking Study. Journal of Medical Council of I.R.I 2013; 30: 379- 389 [In Persian]
22. Charlesworth A, Davies A, Dixon J. Reforming payment for health care in Europe to achieve better value. London: Nuffield Trust London; 2012. Available from: http://www.nuffieldtrust.org.uk/files/2017-01/reforming-payment-for-health-care-in-europe-web-final.pdf (accessed: 2023 12 February)
23. Kim SJ, Han K-T, Kim SJ, Park E-C, Park HK. Impact of a diagnosis-related group payment system on cesarean section in Korea. Health Policy 2016;120: 596-603 [DOI:10.1016/j.healthpol.2016.04.018]
24. Damari B, Hajebi A, Bolhari J, Heidari A. Developing a package for the provision of spiritual services in healthcare centres in Iran, Mental Health. Religion & Culture 2021; 24: 37-51 [In Persian] [DOI:10.1080/13674676.2020.1819219]
25. Etemad K, Heidari A, Panahi MH, Lotfi M, Fallah F, Sadeghi S. Challenges of Access to Data of Ministry of Health from the Perspective of Policy-makers, Producers, and Consumers of Data: A Qualitative Study. Iranian Journal of Epidemiology 2017; 13: 174-182 [In Persian]
26. Damari B, Hajebi A, Bolhari J, Heidari A. Developing a Training Course for Spiritual Counselors in Health Care: Evidence from Iran. Indian Journal of Palliative Care 2018; 24:145-149 [DOI:10.4103/IJPC.IJPC_207_17]
27. OECD/European :union:. "Strengthening primary care systems", in Health at a Glance. OECD Publishing: Paris Europe State of Health in the EU Cycle, 2016 Available from: https://www.oecd-ilibrary.org/docserver/9789264265592-en.pdf?expires=1677401350&id=id&accname=guest& hecksum=AE731C86EC398827234D20EB5CF36753 (accessed: 2023 12 February)
28. World Health Organization. Paying for Performance in Health Care Implications for Health System Performance and Accountability: Implications for Health System Performance and Accountability. OECD Publishing; 2014 Available from: Open University Press: McGraw-Hill, Buckingham, 2014
https://doi.org/10.1787/9789264224568-en [DOI:10.1787/9789264224568-en (accessed: 2023 12 February)]
29. Farahbakhsh M, Zakeri A, Khodaee N. Health information system in the district health center, Tabriz. Journal of School of Public Health and Institute of Public Health Research 2009; 6:1-10 [In Persian]
30. Sigfrid L, Turner C, Crook D, Ray S. Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management. Journal of Public Health 2006;28: 221-5 [DOI:10.1093/pubmed/fdl028]
31. Hong CS, Atlas SJ, Chang Y, Subramanian S, Ashburner JM, Barry MJ, et al. Relationship between patient panel characteristics and primary care physician clinical performance rankings. JAMA 2010; 304:1107-13 [DOI:10.1001/jama.2010.1287]
32. Mehrotra A, Pearson SD, Coltin KL, Kleinman KP, Singer JA, Rabson B, et al. The response of physician groups to P4P incentives. American Journal of Managed Care 2007;13: 249
33. Robson J, Boomla K, Hull SA. Progress in using the electronic health record to improve primary care. British Journal of General Practice 2020; 70: e215-e20 [DOI:10.3399/bjgp20X708281]
34. Bakhtiari A, Takian AH, Sayari AA, Bairami F, Sadeghtabrizi J, Mohammadi A, et al. Design and deployment of health complexes in line with universal health coverage by focusing on the marginalized population in Tabriz, Iran. Teb Tazkiyeh 2017; 25:213-32 [In Persian]
35. Zahiri M, Mohamadi E, Najafpoor ZH, Mobinizadeh MR, Guodarzi Z. Survey of General Practitioners Point of View about Family Physician and Referral System Policies in Urban Areas for 2013. Journal of Healthcare Management 2017;8: 63-73 [In Persian]
36. Financing and Payment Models for Primary Health Care: Six Lessons from JLN Country Implementation Experience. Joint Learning Network for Universal Health Coverage, Results for Development (R4D),2017https://www.jointlearningnetwork.org/wp-content/uploads/2019/11/phc-financing-payment-models-six-lessons.pdf (accessed: 2023 12 February)
37. Babashahy S, Baghbanian A, Manavi S, Sari AA, Olyaee Manesh A, Ronasiyan R. Towards reforming health provider payment methods: evidence from Iran. Health Scope 2017;6: e33575 [In Persian] [DOI:10.5812/jhealthscope.33575]
38. Adomako-Boateng F, Agada-Amade Y, Alcantara AC, Althauser C, Barasa EW, Cashin C, Manatad de Claro V, Abrenica Diaz GS, Dsane-Selby L, Effah SW, Ehsan FZ. Using data analytics to monitor health provider payment systems: a toolkit for countries working toward universal health coverage. 1st Edition, Arlington, VA: Joint Learning Network for Universal Health Coverage (JLN), 2017 Available from: https://www.jointlearningnetwork.org/resources/data-analytics-for-monitoring-provider-payment-toolkit/ (accessed: 2023 12 February)
39. Hanvoravongchai P. Health Financing Reform in Thailand: Toward Universal Coverage under Fiscal Constraints. Washington DC: The World Bank; 2013 Available from: http://hdl.handle.net/10986/13298 (accessed: 2023 12 February)
40. Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton G. International profiles of health care systems. The Commonwealth Fund: London School of Economics and Political Science, 2020 Available from:https://www.researchgate.net/profile/Roosa-Tikkanen/publication/347011106_International_Profiles_of_Health_Care_Systems_2020/links/5fd7897292851c13fe865e6a/International-Profiles-of-Health-Care-Systems-2020.pdf (accessed: 2023 12 February)
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |