Journal of

---

Background: Payment method is one of the most important control knobs in the health system. All organizations that mobilize funds for health sector must be decided: who should be paid? Why this money should be paid to them? And how much should be paid? So the main purpose of this study is to identify different methods of paying to the doctors in referral system of selected countries, and ultimately providing some suggestions for Iranian social security organizations- direct medical service provision.
Materials & Methods: This was a comparative study designed in 2008. First we studied theoretical issues and analyzed them within the framework of the current situation. Then we conducted a comparative study to find some solutions for it. Then we validated selected suggestions using by Delphi technique.
Results: Most selected countries use a combination of methods to pay to the physicians. Usually for employed physicians in insurance organizations, salary makes a large part of doctor`s income. In countries where GPs play the role of gatekeeper, the per capita payment method has a special room. In American Health Maintenance Organizations (HMOs), based on employment or contractual relationship, they pay physicians by one of three methods: "Per Capita", "Salary Monthly" or "Prepayment". In addition to Salaries (if any employment relationship), specialists usually receive some fees for their Services widely.
Conclusion: Bonus payment in exchange for quality indicators is considered as a recently developed payment method for both GPs and specialists, but due to wide infrastructures, it needs accurate designing and plenty of arrangements.

---

Abstract Background: Family physician plan is a form of health care delivery system which its correct implementation results in health promotion. Being aware of family physicians’ viewpoints towards their occupation would play an important role in its better implementation. The present study aims to to investigate family physicians` attitude who are working in health centers affiliated with Tehran University of Medical Sciences towards their profession. Materials and Methods: This qualitative study was conducted in 2011. In order to reach information saturation , the data were collected by performing two singular interviews and four focus group discussions among all 33 physicians working at health care centers of Tehran University of Medical Sciences. Eventually, data were analyzed using conceptual framework method. Results: Data analysis indicated three general concepts. The first issue is the factors that encourage physicians to choose family physician profession and continue doing it (including economical, cultural and environmental factors and work conditions). The second one is the study challenges (including preparation to implement the plan, work conditions and professional limits) and the final one is the reforms needed for its correct and proper implementation ( in policy making and administrative level). Conclusion: Regarding the issue that economical, cultural and environmental factors and work atmosphere have the main role in motivating family physicians, the most important challenges the plan confronts are also related to these factors and major and minor reforms are needed to overcome these challenges. Moreover preparing society’s culture would surely result in better implementation of the plan.

---

Background: The Family Physician Program, one of the most important efforts of the Iran health system to establish a referral system, was developed and implemented in several provinces, but it faced challenges due to several reasons that prevented the program's progress. So This study was conducted to analyze the family physician program to identify the causes and challenges of the program failure.
Materials & Methods: This retrospective study of policy analysis is a qualitative study with Purposive sampling. Semi-open interviews and document analysis were used for data collection. Data analysis was performed through thematic analysis in the policy triangle framework using MAXQDA software.
Results: According to the study framework, the challenges of the Family Physician Program in the context are conflict of interest, dependency of plans to oneself, instability in management and plans, insufficient attention to culture, resources, and infrastructure. In terms of content include disproportionate executive approach, Lack of localization, selection of inappropriate tools, insufficient transparency, and ambiguity in goals, tasks, and responsibilities; The challenges of the process were examined based on the policy cycle.
Conclusion: The implementation of the family physician program is influenced by cultural, social, political, managerial, and economic factors. As the Ministry of Health officials has re-introduced this crucial program, reviewing the content and methods of program implementation seems necessary.

---

Introduction: The present study qualitatively investigated the main components that should be considered for the implementation of the referral system in Bojnord city.
Methods: In this study, data were collected through doing interviews with experts, and finally, the importance of all the extracted components was evaluated using a researcher-made questionnaire. Also, the exploratory factor analysis method was used to classify the components in main sets. Kolmogorov-Smirnov, one-sample t-test, performed in Excel and SPSS software, was used for statistical analysis.
Results: The most frequent noted components by the experts included "empowerment (knowledge, skill, psychological) of human resources involved in the referral system", "paying attention to the motivation of human resources involved in the referral system", and "developing suitable processes for the referral system and re-engineering the processes to meet the conditions". Finally, the main requirements in the referral system of Bojnord city were divided into three categories included organizational and management, manpower, and technology-based requirements.
Conclusion: Briefly, some components may lead to improvement of the referral system, which can be categorized into organizational and management, manpower, and technology-based requirements. Detailed planning to improve the referral system can lead to the improvement of the health system.