V Yazdi Feyzabadi , Mh Mehrolhasani, Mr Baneshi, S Mirzaei, N Oroomiei,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Urban family physician program(UFPP), a program for improving equity in access to, financing, and quality of health services, is piloting in two provinces of Fars and Mazandaran, Iran since 2012. This study aimed to examine the association between the implementation of program and financial protection measures.
Methods: This cross-sectional, ecological study was performed on aggregated data of financial protection measures and some independent variables in the above provinces from 2008 to 2015. At first, the Lasso regression model was used for selecting independent variables affecting financial protection indexes. After adjusting the selected independent variables, in separate models, the association between the UFPP and financial protection measures, as outcome variables, was examined using a backward linear regression model.
Results: The percentage of households facing catastrophic health expenditure(CHE) in the years of UFPP implementation was 1.82% higher than the years before implementation(P<0.05). This increase was 1.37% in rural areas. the percentage of medical impoverishment in the two provinces increased by 0.83% during the implementation years than the years before(P<0.05). Finally, no significant relationship was observed between UFPP implementation and the Kakwani index and out of pocket payment(as % of total health expenditure) in the two provinces(P>0.05).
Conclusion: Despite the achievements attained by UFPP in improving physical access to health services, it seems that this program has had no success in improving financial protection measures and equitable health care financing. However, further research is warranted in this regard.
V Kohpeima Jahromi , R Dehnavieh, Mh Mehrolhasani,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Due to lack of proper health system coverage in cities, the urban family physician program began as pilot in two provinces in Iran. Decision on developing the program to other provinces requires a comprehensive assessment. The study aimed to evaluate the program in Iran.
Methods: This cross-sectional study was conducted in 2015 and 2016 in two provinces (Fars and Mazandaran). The data of 141 family physicians working in health centers and 710 patients were collected using a questionnaire. A multi-stage sampling method was used for the samples. Data analysis was performed using descriptive and inferential statistical methods.
Results: 81% of the workload of family physicians in a week was patient visits. Co-payment in second and third levels was a real obstacle for some patients. The majority of the patients could receive their required healthcare facilities in up to 40 minutes. Software programs were infrequently used. Patients were visited by their physicians 5.5 times in a week. The mean duration of each patient visit was less than 10 minutes in 80% of the cases. Referral rate was reported by 14% (Fars= 21.8%, Mazandaran= 4%). 30 out of 45 medical devices were available to family physicians on average.
Conclusion: Although the program has been successful in areas such as access to health services and comprehensiveness of care, there are some challenges in coordination and continuity of care. Therefore, it is suggested that the root causes of these challenges be resolved prior to extending this program to other provinces.
