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 Table of Contents 
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 1413-1417  

A policy brief on improving the finance of family physician program: An experience from urban areas of Iran


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 Submission11-Nov-2019
Date of Decision23-Jan-2020
Date of Acceptance07-Feb-2020
Date of Web Publication26-Mar-2020

Correspondence Address:
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
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_997_19

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  Abstract 


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 Top


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.[1],[2] 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.[3] 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).[4] 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.[5],[6] 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.[7] Currently, this program is in progress as a pilot in above mentioned provinces; however, some issues hinder it from its national implementation.[8],[9],[10] 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.[11]

Policymakers argue that developing the FPs program in cities is one of the most major challenges of Iran's health system.[4],[12] 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.[13]

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 Top


The recommendations for improving family physician financing are presented in [Table 1].
Table 1: Policy options for the financing of urban family physician

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  Policy Implications Top


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].
Table 2: The advantages vs. disadvantages of policy options

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  Conclusion Top


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[19].
Table 3: The requirements, solutions for recommended options

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Ethical Consideration

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).

Acknowledgment

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.



 
  References Top

1.
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The Executive Protocol of Family Physician Plan and Rural Insurance in 2014. Ministry of Health and Medical Education; 2014.  Back to cited text no. 3
    
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The Pathology of Implementing Family Physician Plan and Referal System in the Cities with More than 20000 Population. Ministry of Health and Medical Education; 2014.  Back to cited text no. 4
    
5.
Jabbari Beyrami H, Doshmangir L, Ahmadi A, Asghari Jafarabadi M, Khedmati Morasae E, Gordeev VS. Impact of rural family physician programme on maternal and child health indicators in Iran: An interrupted time series analysis. BMJ Open2019;9:e021761.  Back to cited text no. 5
    
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The protocol of family physician plan and referal system in the urban areas2011.  Back to cited text no. 6
    
7.
Honarvar B, Lankarani KB, Rostami S, Honarvar F, Akbarzadeh A, Odoomi N, et al. Knowledge and practice of people toward their rights in urban family physician program: A population-based study in Shiraz, Southern Iran. Int J Prev Med2015;6:46.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Rafiei S, Mohebbifar R, Ranjbar M, Akbarirad F. The preferences of general practitioners regarding family physician contract in the underprivileged areas of Iran in using conjoint analysis. Evid Based Health Policy Manag Econ 2019;3:96-104.  Back to cited text no. 8
    
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Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. Family medicine in Iran: Facing the health system challenges. Global J Health Sci2015;7:260-6.  Back to cited text no. 9
    
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Jabbari H, Azami-Aghdash S, Piri R, Naghavi-Behzad M, Sullman MJ, Safiri S. Organizing palliative care in the rural areas of Iran: Are family physician-based approaches suitable? J Pain Res2018;12:17-27.  Back to cited text no. 10
    
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Oxman AD, Lavis JN, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 1: What is evidence-informed policymaking? Health Res Policy Syst2009;7(Suppl 1):S1.  Back to cited text no. 11
    
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Kavosi Z, Keshtkaran A, Hayati R, Ravangard R, Khammarnia M. Household financial contribution to the health system in Shiraz, Iran in 2012. Int J Health Policy Manag2014;3:243-9.  Back to cited text no. 12
    
13.
Khayyati F, Motlagh ME, Kabir MJ, Kazemeini H, gharibi F, Jafari N. The role of family physician in case finding, referral, and insurance coverage in the rural areas. Iran J Public Health2011;40:136-9.  Back to cited text no. 13
    
14.
Ault A. Trump signs 2018 budget, with some big wins for healthcare. Medscape Logo2018.  Back to cited text no. 14
    
15.
AAFP. Federal Budget Deal Brings Wins for Family Medicine. 2018. Available from: https://www.aafp.org/news/government-medicine/20180213federalbudget.html.  Back to cited text no. 15
    
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17.
Durkin P. Medibank ramps up 'virtual hospitals', which cut costs by two-thirds. 2018. Available from: https://www.afr.com/brand/boss/home-hospitals-cutting-private-health- fund-costs-by-twothirds-20181015-h16nzt.  Back to cited text no. 17
    
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AAFP. Family Medicine Specialty. Available from: https://www.aafp.org/about/the-aafp/family-medicine-specialty.html.  Back to cited text no. 18
    
19.
Liu X, Tan A, Towne Jr SD, Hou Z, Mao Z. Awareness of the role of general practitioners in primary care among outpatient populations: Evidence from a cross-sectional survey of tertiary hospitals in China. BMJ Open2018;8:e020605.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
   Abstract
  Introduction
  Recommendations
  Policy Implications
  Conclusion
   References
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