|Year : 2020 | Volume
| Issue : 3 | Page : 1413-1417
A policy brief on improving the finance of family physician program: An experience from urban areas of Iran
Mozhgan Fardid1, Mehdi Jafari2, Abbas Vosoogh-Moghaddam3
1 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
2 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences; Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
3 Society and Health Policy Group, Secretariat for Supereme Council of Health and Food Security; Leadership and Governance Scientific Group, Health Manager's Development Institute (HMDI), Ministry of Health and Medical Education, Tehran, Iran
|Date of Submission||11-Nov-2019|
|Date of Decision||23-Jan-2020|
|Date of Acceptance||07-Feb-2020|
|Date of Web Publication||26-Mar-2020|
Dr. Abbas Vosoogh-Moghaddam
Society and Health Policy Group, Secretariat for Supereme Council of Health and Food Security, Ministry of Health and Medical Education, Simaye-Iran Street, Phase 5, Shahrak-e-Qods, Tehran
Source of Support: None, Conflict of Interest: None
In the current scenario, financing suffers from problems related to lack of specific line for UFFP, lack of resource pooling, delay in payment to physicians, and conflict of interests among family physician team. As a result, this policy brief was formulated based on the role of FPs in public access to general practitioner (GP) services in the referral system on one hand, followed by the impact of it on health costs reduction on the another hand, and further considering the necessity of financing system audit to find a sustainable resources for this program to be implemented at a national level in the country of Iran.
Keywords: Family physicians, family practice, healthcare financing, health policy, Iran, primary healthcare
|How to cite this article:|
Fardid M, Jafari M, Vosoogh-Moghaddam A. A policy brief on improving the finance of family physician program: An experience from urban areas of Iran. J Family Med Prim Care 2020;9:1413-7
|How to cite this URL:|
Fardid M, Jafari M, Vosoogh-Moghaddam A. A policy brief on improving the finance of family physician program: An experience from urban areas of Iran. J Family Med Prim Care [serial online] 2020 [cited 2020 Jul 3];9:1413-7. Available from: http://www.jfmpc.com/text.asp?2020/9/3/1413/281234
| Introduction|| |
Recently, the health system was rigid to face emerged needs such as life expectancy increase, immigration to cities, public expectations' increase, and private sector extension., In 2005, the “family physician program and referral system” was approved to be implemented in all rural regions and cities of Iran, populated less than 20000 people, by Islamic Consultative Assembly, especially the Department of Health and Cooperation Organization of Management and Planning. Three years later, the urban family physician program (UFFP) has arrived at agenda-setting. Therefore, the UFFP version 01, was announced to be implemented in cities having more than 20000 population (Khuzestan, Sistan-Baluchestan, and Charmahal-o-Bakhtiyari). Due to some problems like insufficient-income for family physicians (FPs), time-wasting for patient reception, and multiple insurance funds, version 02 of “UFFP and referral system” was developed., This program, in line with the announced policies by supreme leader regarding health and according to article 32, article 35, and article 38 of the fifth development plan was implemented as pilot in Fars and Mazandaran. Currently, this program is in progress as a pilot in above mentioned provinces; however, some issues hinder it from its national implementation.,, Learning from previous experiences encourages the use of evidence-based research and limits research misuse (like lobbyists). Therefore, it contributes to evidence-informed policy which assists policymakers to ask fundamental questions about available research evidence, use good information for decision making, and have fact-based outcomes in line with evidence.
Policymakers argue that developing the FPs program in cities is one of the most major challenges of Iran's health system., The establishment of family physician in cities compared with rural regions encounters some problems such as lack of required infrastructures, fragmented network of primary care, powerful private sector with high conflict interests among family physicians, public high freedom in selecting health services, tendency of urban residents to visit a specialist, treatment-centered advertisements by mass media, government enterprise, not participation of all stakeholders and the gap between theory, and practice of family physician program in urban areas of Iran.
Various individuals, groups and organizations affect family physician including: Ministry of Health, Parliament, Planning and Budgeting Organization, Health Insurance Organization, Social Security Organization, Deputy of Health in the Universities of Medical Sciences, Association of Pharmacists, Association of Physicians, Nursing and Midwifery Association, Medical Council, Representatives of Physicians and Public.
| Recommendations|| |
The recommendations for improving family physician financing are presented in [Table 1].
| Policy Implications|| |
Due to the importance of not-to-do as the same as the importance of policy options, it is recommended to:
- Pass laws to hinder money transfer across budget lines and health plans
- Consider the ability to pay in assigning franchise for preventing from access reduction in poor people
- Set a logical limit for referrals, not that bounded by which the access would be denied, not that opened by which the referrals don't seem different from before.
- Take actions so that the share of all participants be attached to the virtual fund
- Take actions so that the detachment of midwives from physician capitation does not lead to their disobedience from their supervisors.
The advantages, disadvantages, cost-effectiveness, and stakeholders' comments about the recommended options using the research team are compared in [Table 2].
| Conclusion|| |
Paying to midwives from FP's capitation has been designed based on pay for performance. Therefore, detachment of midwives shares from FPs capitation may lead to disobedience of midwives from physicians. So it is suggested that the physician signs a satisfaction certificate for the midwife under supervision prior to payment to her. It will not only make the insurance organizations' payment to midwives uniform but also make the midwives observe job standards and respect to FPs. Besides, training the GPs increases their expectations to receive more rewards and as a result the costs will be increased. Therefore, before training GPs specifically, providing high-quality services by physicians must be assured and the relevant proper evaluation criteria should be set for service receivers. [Table 3], presents the requirements, solutions for recommended options for target groups, providers, managers, policymakers, and related organizations.
This study was part of a Ph.D. thesis approved by the ethics committee of Iran University of Medical Sciences and the approval from the ethics committee is obtained on 15-03-2017 (IR.IUMS.REC1395.9221557205).
All policy-makers, managers, FPs, and patients who agreed to participate in the current study, as well as the anonymous reviewers who helped with their suggestions, are appreciated. The authors would also like to thank the research deputy of Iran University of Medical Sciences for supporting this study (grant No: IUMS/SHMIS. REC1395.9221557205).
Financial support and sponsorship
This study is a part of a Ph.D. thesis approved and supported by Iran University of Medical Sciences (Grant No: IUMS/SHMIS_ 1395/9221557205).
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]