Author/Authors :
Babashahy، Saeideh نويسنده MSc Student, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences and Expert of Tariff Policy , , Baghbanian، Abdolvahab نويسنده Heath Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran , , Manavi، Saeed نويسنده Ministry of Health and Medical Education, IR
Iran , , Sari ، Ali Akbari نويسنده Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran , , Olyaee Manesh، Alireza نويسنده Health financing System, National Institute for Health Research, Tehran University of Medical Sciences, Iran , , Ronasiyan، Raziyeh نويسنده Ministry of Health and Medical Education, IR
Iran ,
Abstract :
Equity of access to health and provider payment mechanism in
healthcare is a worldwide debated. Healthcare reforms are primarily
designed to improve productivity, economic efficiency and quality of
care; however, an appropriate reimbursement of healthcare providers for
services offered to patients and marinating a robust payment mechanism
are not elucidated yet. The current study aimed to develop a potential
model of provider payment mechanism within and across different levels
of healthcare delivery system in Iran. A three-stage, qualitative
approach was carried out in 2013 to complete the study. In the first
stage, a range of databases were used to extract evidence-informed
literature pertinent to provider payment methods from 1990 to 2015, and
to develop an interview guide. A purposive sample of 15 key healthcare
executives was then selected to explore the provider payment mechanism
in the Iranian healthcare system through semi-structured interviews and
focused group discussions. A preliminary model of provider payment was
developed, which subsequently scrutinized by using experts’ opinions
through Delphi technique. Narrative analysis was used to analyze the
data. A hybrid model of provider payment was developed for various
levels of healthcare provision. The model suggested the adjusted
capitation payment method as the best possible payment method for the
first level of healthcare delivery. A combination of diagnosis-related
group (DRG) and pay-for-performance methods was proposed for the
secondary and tertiary services across the country especially for
in-patient care. Fee-for-service (FFS) payment method suited for
out-patient services than other methods. No single payment method was
emerged as the best predictor to accurately and fairly determine the
providers’ payment, and to serve patients’ needs in all situations. A
range of payment methods are required to be in place to tackle
challenges faced by patients, providers, insurance companies and
policy-makers.
