مقايسه خود- ارجاعي در سه ساختار عرضه خدمات درماني كاشان

Comparative study of self referral in three health care delivery systems in Kashan

Introduction: Health care delivery system and payment type, have a lot of effects on patient referral and for reasons of high therapeutic costs and resource limitations in health care delivery systems and necessity to investigate the ways of improvement efficacy and effectiveness, this study was conducted on three health care delivery systems. Methods: In this descriptive study, 1036 patient covered by Imam Khomeini Committee welfare, rural health insurance and open referral received cares in public and private sectors, randomly selected. For gathering the data relevance to study specific objectives and self= referral investigation in three health care delivery structures, interview and questionnaire were used. Also patients opinions about self referral factors were asked. For data analysis descriptive and analytical statistics were used Results: The study showed that in Imam Khomeini Committee welfare(closed loop referral system) 6.8 % patients were self- referred, in rural health insurance (semi-closed loop referral system) 29. 7% patients were self- referred and in open referral system 75.5 % patients were self- referred. Also in this study 50% patients believe that specialist skills and 42% waste of time are the factors cause self referral. Conclusion: This study indicates needs for review and revise and renew health care delivery systems in Iran.