جستجوی مقالات مرتبط با کلیدواژه « بیمه روستایی » در نشریات گروه « پزشکی »

  Rural insurance has been designed and implemented in our country to develop social justice. In the health system, identifying its challenges to improve and implement reforms is essential. The present study aimed to assess the quality of rural insurance challenges in Khorasan Razavi Province. This study was conducted with a qualitative approach and a content analysis method in 2015 in Mashhad. Eighteen managers, policy makers, family physicians, and insurers who were selected by targeted sampling until data saturation were reached. After conducting the interviews, data were analyzed through conventional content analysis approach using the MAXQDA software version 10. Data analysis consists of two main themes including: Management challenges of the rural insurance system (Inefficient financial management of credits, non-comprehensive rules, inadequate implementation of guidelines, and deficiencies in the health information management system), and cultural challenges (lack of referral system observance and inappropriate cultural context). Each category contained several subcategories. Inefficient financial management of credits, lack of comprehensive guidelines, lack of information management and inappropriate cultural context of providers are essential challenges of rural insurance challenges in Mashhad. Since the rural insurance system plays a key role in the success of family physician policy and the development of social justice, it is necessary to use the results of this study to solve the problems and challenges of rural insurance

Monitoring and evaluation of family physicians′ performance are applied to identify strengths, design and implement improving projects, and also to determine the performance indices. The present study aimed to assess the process, tool and results of seasonal monitoring of family physicians performance in northern provinces of Iran.
This cross-sectional study was conducted in the second half of 2012. Study population and samples were all the 47 district health networks in Golestan, Mazandaran and Gilan provinces. Data-collecting instrument was a researcher-made questionnaire consisting of 3 parts and 32 questions and the data were collected through interviews and observation of documents. Data were analyzed by SPSS17.
From 47 cities studied, 36 cities (77%) underwent seasonal monitoring during four seasons of 2011 and the first and second seasons of 2012. 43 cities (92%) underwent seasonal monitoring by a team from headquarter units. 28 cities (60%) used Excel software for the calculation of seasonal results. Monitoring checklists for 32 cities (68%) were exactly the same as national guidelines while the other 15 cities used different checklists. None of the cities analyzed and interpreted the seasonal performance scores of family physicians in terms of their personal characteristics. Feed back of patient refer to second health service level, laboratory, radiology, average cost and drug list were not performed in all the cities.
The monitoring process and instrument of family physicians′ performance were not complete in all the cities and need to be reviewed and improved.

The members of local Organizations in rural regions of Iran can have an effective role in the improvement of health programs due to their resources and logistical influence. Favorable collaboration of them needs sufficienet familiarity and information about the objectives and principles of health programs. This study was Performed to asses the level of familiarity in members of local organizations about the Family Physician (FP) Program and Rural Insurance in Northen Provinces of Iran. This Cross-Sectional Study was Performed in the Second half of the year 2012. % 25 of health Centers doing FP Program in three Provinces of Golestan, Mazandaran, Gillan (totally 139 Centers out of 552 units). In each selected center, available members of dispute resolation council, village coucil, health council, village magor, school manager and native teacher were enrolled in the research. A researcher- made questinnaire which its validity and reliability were Confirmed was used for data gathering. Data analysis was Performed by SPSS17 with Significant level of P<0.05. 521 (84.7%) individuals (out of 601 members of local organizations) were male. The age range was 19-81 years. Mean and standard deviation of participants age was 45±9.7 years. 47.1% of persons had academic education level. Out of total score 27, mean and SD of the familiarity in village magor was 12.4±4, in health council’s members 11.6±3.7, in village council’s members 11.4±4.1, in school managers 10.6±3.3. in dispute resolation council’s members 10.5±5.1 and in native teachers was 8.8±4.9. There were significant relationships between the level of familiarity and being participated in trustees council of the health center, sex and the work type of local organization (p<0.05). There were no signification relationships between the level of familiarity, education, the prevince of living and the marriage status (p>0.05). This Study Showed that the level of familiarity of members of local organizations in rural regions of Iran is not sufficient and interventional Programs must be Planned and Performed for improvement.

One of the duties of family physician is to form health records and recording the provided services. The present study was conducted to evaluate health records in family physician program in Northern Province of Iran. This cross-sectional study was carried out in 2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected through systematic random sampling as the study samples, and recording the performance of all family physicians was evaluated. For data collection, a researcher-made questionnaire was used, the validity and reliability of which were confirmed. Data were analyzed by SPSS18 at p<0.05 as the significant level. Out of the 189 family physicians studied, the profile of patients referred to the second level and the associated results were recorded in referral record forms completely by 43 physicians. Out of 1890 families studied, 1559 were reported with health records, among which 892 were filled out completely. Out of 5869 families studied, 4229 patients were examined at least once by their family physician during the periodic examination; 1919, patients were found with complete records respectively. There was a significant difference between rates record of referral to a specialist registered in the Northern Province of Iran (P=0.001). The quality and quantity of health record formation as well as the records of services provided have not been according to the expectations and appropriate interventions are therefore needed in this regard.

Introduction & Family physicians (FP) are responsible for providing services through the appropriate management of the personnel in the healthcare team. This study evaluated the satisfaction of healthcare personnel from the performance of rural family physicians in the northern provinces of Iran. This cross-sectional study was carried out in winter 2013 and 25% of centers providing rural insurance and family physician program (139 centers) in three provinces of Golestan, Mazandaran and Guilan were selected by systematic random sampling. All healthcare staffs with at least one-year work experience were enrolled by census method. For data collection a researchermade questionnaire was used that validity and reliability of it was confirmed in advance. Data were analyzed using SPSS 17 at p<0.05 as the significant level. From the 561 subjects, 380 (67.7%) were females. The majority of the participants (48%) had a bachelor’s degree. The average level of satisfaction scores from FPs performance were 3.7±1, 3.5±1, 3.7±1, 3.9±1.1 and 3.5±0.9 in the field of health management (of 5 score), external cooperation, health promotion, prevention and health service provision and health care referral, respectively. There was a significant difference between the level of satisfaction of healthcare staffs among the northern provinces of Iran (P=0.006). The satisfaction of healthcare staffs from FPs performance has been slightly higher than the average level, so appropriate interventional programs should be established and implemented to maintain and improve the functional level of the FPs.

Family physicianis (FPs) responsible for the health team have five duty to health management, external cooperation, Health Promotion, Prevention and Health Services and treatment care and referral. This study evaluated viewpoint of managers, supervisors and experts of Northern Provinces of Iran from the level of performance of Family physicians (FPs) in five basic task. This cross-sectional study was performed in winter 2013. The study population includes managers, supervisors and experts at Health Network from the total of 47 cities in 3 provinces of Gilan, Mazandaran and Golestan which were censuses selected. A researcher-made questionnaire was used for data gathering. In this questionnaire, personal characteristics and performance level of FPs from five main task of the Likert scale. Validity and reliability of the questionnaire were approved. From the perspective of 557 managers, supervisors and experts of Staff in the study, the average performance level of FPs, in the field of health management (of 5 score) was 3±0.8, external cooperation 2.7±0.9, Health Promotion 2.8±0.9, Prevention and Health Services 3.2±0.9 and health care and referral 3±0.8. There was a significant relationship between job experience and performance level of FPs (p<0.05). However, there was not a significant difference between sex and provinces studied and performance level of FPs (p>0.05). The results of this study showed that from the perspective of managers, supervisors and experts the performance level of FPs’ was in two task lower moderate and in three task moderate.

To get intersectoral collaborations is one of the strategies considered for the goal of health for all by the year 2000 which has been emphasized in the 21th century again. If the members of local Organizations are more satisfied, they will collaborate in the improvement of health programs more. This study was performed to assess the Satisfaction rate of the members of local organizations about the health services of health units in Rural regions of Northern Provinces of Iran. This Cross-Sectional study was performed in the second half of the year 2012. %25 of health Centers doing FP Program in three Provinces of Golestan, Mazandaran, Gillan (totally 139 Centers out of 552 units). In each selected center, available members of dispute resolution council, village council, health council, village major, school manager and native teacher were enrolled in the research. A researcher- made questionnaire which its validity and reliability were Confirmed was used for data gathering. Data analysis was Performed by SPSS17 with Significant level of P<0.05. Mean of satisfaction level about health home was 4.3± 0.6 about health center was 3.7 ± 0.7 (out of total score 5). The lowest satisfaction level was related to incomplete services provided and high service costs. There were significant relationships between the level of satisfaction in the members of local Organizations about health home in Northern Provinces of Iran (p=0.005). There were no significant relationships between the work type of local organizations and general satisfaction rate of health home and health center (p=0.149 & p=0.893). The results of this study showed that the overall satisfaction level of local organizations about the service provided at the first level was favorable, therefore healthy system must explore this positive potential for improvement of health status.

Participation of people and local organizations can be achieved by activities of the Board of Trustees and health volunteers. This study was conducted to evaluate the participation rate of local organizations in health centers performing rural insurance and family physician program in the Northern provinces of Iran. This cross-sectional study was conducted during the second half of 2012. Twenty five per cent of health centers performing family physician program in three provinces of Golestan، Mazandaran، and Gillan (139 centers out of 552 ones) were selected randomly from certain clusters of the study. In each selected center، participation rate of local organizations were evaluated. A validity and reliable researcher-made questionnaire was used for data gathering. Data were analyzed in the SPSS-18 with significant level of p<0. 05. Fifty seven health centers out of 139 ones (41%) had established a Board of Trustees. The Board of Trustees establishment was more in the Northern provinces (p=0. 001). In 61 health centers (43. 9%)، health volunteers were employed with a more significant employment rate in the Northern provinces (p=0. 001). The mean request rate of health homes and health centers from local organizations to take part in health problem solving were 2. 7 ± 1. 6 and 1. 7 ± 1. 3 times، respectively. The request rate for providing resources and facilities in performing health interventions were 1. 8 ± 1. 3 and 1. 1 ± 1. 0 times، respectively; and the request rate for participation in formal meetings were 3. 1 ± 1. 7 and 1. 9 ± 1. 3، respectively. The request rates of health homes for providing resources and participation in formal meetings were significantly different in the provinces (p=0. 009 and p=0. 005، respectively). This study showed that a large number of health centers did not follow community participation measurements. Interventional programs should be planned and conducted to improve community participation in health centers.

Background and

Health care system is organized at three levels in order to increase efficacy and effectiveness and create justice and also people availability. Considering the three levels of primary health care، access of people to specialized services through referral system is possible. With regard to the importance of referral system in family physician program، this study was performed to evaluate the function of referral system and network system in Northern provinces of Iran.

This analytic study was performed in autumn and winter of 2012. Twenty five percent of health centers (139 centers from 552) which implement the family physician program and rural insurance coverage by medical universities of Golestan، Mazandaran، Babol and Guilan were randomly selected. In each center، 7-8 patients who were referred to level 2 by their family physician and received necessary services were evaluated. They were at their homes at inquiry time.

From 963 patients who received the level 2 services، 687 cases (71%) were females and 276 (29%) were males. Three hundred and twenty cases (33%) had referral form from health house. Only 299 (31%) persons referred to the centers because of diagnosis of family physician and in 161 (17%) of cases، the family physician had a role to choose a specialist of level 2. For 155 (16. 1%) of cases، the specialists wrote the results of their evaluation in feedback form. Only 149 (15. 5%) of patients returned to their family physicians. Six hundred ninety-seven (79. 6%) of patients did not return to their family physician because of lack of knowledge.

The results of this study showed that many principles for referral system from level 1 to higher levels and vice versa are not considered that require education، reformation and intervention in this field.

The national rural family physicians and insurance plan، as one of the major reforms of the health system implemented since 2005، need to be supplied with the resources and facilities required. In this regard، the present study was carried out to evaluate the quantity of essential resources and requirements provided in family physician program in the northern provinces of Iran.

This cross-sectional study was conducted in the second half of 1391; 25% of centers implementing rural insurance and family physician programs in three provinces of Golestan، Mazandaran and Gilan –a total of 139 centers out of 552 centers performing the program– were selected through systematic random sampling as the study samples. A researcher-made questionnaire was used for data collection، the validity and reliability of which were confirmed. Data were analyzed by tests of chi-square and Kruskal– Wallis.

Out of the 139 centers studied، 48 centers (34. 2%) had public pharmacies، 62 centers (44. 6%) had private pharmacies، among which 72 centers had a total of 279 items of drugs. 133 centers (96%) had injection and dressing room facilities، 84 centers (60%) had oral health unit (30. 2%) and 42 centers (30. 2%) had an active lab unit; 138 centers (99%) were found with at least one normal-operating computer، 135 centers (97%) with at least one oxygen capsule، 131 centers (94 percent) with emergency tralee and at least one intact tracheal tube، 129 centers (93%) with at least one intact four (dry heat)، 92 centers (66%) with a normal ECG. Out of the 188 family physicians working in the study centers، 140 physicians (74%) had separate rooms (clinics)، 165 physicians (88%) had a normal desk، 144 physicians (76%) had a normal otoscope، 71 physicians (38%) had an intact ophthalmoscope and 131 physicians (66%) had a normal-operating computer. There was a significant difference in the levels of some resources and facilities provided in the northern provinces of Iran (p<0. 05).

The study findings confirmed that enough facilities and equipments are not provided in a number of centers implementing the program، and effective measures should be taken to supply these items.

The family Practitioner and referral system is one of the main programs of the 4th social and economical development plans in health sector. Client satisfaction is a basic index in payment mechanism and performance monitoring process in family practitioner program. This study aimed to determine factors effective in the satisfaction of insured rural population of Sabzevar University of Medical Sciences. This cross-sectional study was conducted in rural population of Sabzevar in 2011. Data were collected by a valid and reliable questionnaire and were analyzed using independent t-test، ANOVA، Pearson Correlation coefficient and simple linear regression. In the 8 aspects surveyed (care and reverence، safety and welfare، trust and belief in performance، waiting time، usefulness of actions، payment costs، paramedical unit performance and on time accessibility)، the highest and the lowest levels of satisfaction were observed in payment costs، trust and belief in family practitioner performance، respectively. The correlation between sex، age، job، and marital status، and satisfaction rate was not significant. However، the relationship between residence، education، type of center and satisfaction of family practitioner was significant. Based on linear regression model، there was a significant correlation between patient satisfaction with family practitioner، residence، education، and the type of the center rendering services. The results show that higher level of education، place of residence، and delivery from urban health centers may lead to more client satisfaction.

Job satisfaction is one of the most important factors in maintenance of a professional person and the job success, increasing the personal efficiency and the quality of services. On the other hand, it is a tool in the hands of managers in order to maintain the staff in their jobs. The aim of this descriptive study was to investigate the satisfaction of physicians and midwives participating in the family physician scheme with the plan.

The study population was made up of 221 physicians and 144 midwifes. The tool was an author made questionnaire certified by experts as a standard, valid and reliable scale via content validity measurements through a pilot study.

The average satisfaction of physicians and midwives was 44.34% while the highest satisfaction was 65% with the location of services and the lowest was 30.6% with the financial issues. In relation to the financial affairs, physicians were more dissatisfied than midwives, so satisfactions were increased by the increase in the amount of salaries.

Over 4 years of implementation of family physician plan, the physicians and midwives satisfaction was shown to be still low. It is necessary to consider re-programming in the scheme in order to increase the amount of payments and create more motivational factors for physicians as well as to reduce working hours for midwives and establish appropriate levels of payments for them.

Assessment of policies and determining their challenges are necessary to improve and reform health systems. Family physician and rural insurance policies have been the second important phase of changes in health services provided in Iranian villages and towns with populations under 20,000. This study aimed to identify the challenges of implementing these policies in Kerman Province, Iran. This qualitative study was carried out in 2010 through semi-structured focus group discussions and document reviews. Purposive sampling was used to select 10 policy executives from Kerman University of Medical Sciences and Medical Insurance Organization and family physicians. Data from the focus groups and document reviews was analyzed by content analysis. The challenges were categorized into seven main groups including improper motivation initiatives, inadequate educational effectiveness, poor comprehensiveness in instructions and arrangements, deficient per capita resources, low efficacy of health information management systems, lack of a suitable referral chain, and inadequate cultural infrastructure. The success of every policy depends on periodical assessments of its implementation challenges. Considering the expansion of family physician policy in larger urban areas, more attention should be paid by the national and local authorities to eliminate the identified barriers and constraints.

National program of family physician (FP) and rural assurance was started in rural and urban area with populations less than 20,000 people in 2005 according to 91st act of 4th development program. This survey was performed to evaluate knowledge of people having rural assurance about facilities they can take benefit, principles, and conditions of this assurance in FP program in northern provinces of Iran. This cross-sectional (descriptive - analytic) study was performed in autumn 2008 in rural and urban areas with populations less than 20,000 people at the universities of Golestan, Mazandaran, Babol and Guilan (43 districts). Data were collected by questionnaire and analyzed by Chi-square and Kendall's Test using SPSS. In this study, among 1081 person involved in rural assurance, the level of knowledge for 33 person (3%) with rural assurance was high, for 416 person (38.5%) was medium and for 632 (58.5%) was low. There was a significant relationship between sex, age and education level and level of knowledge. There was no significant relationship between marital status, inhabitancy, job and the provinces (universities in this study) and level of knowledge. In general, the knowledge of people engaged in rural assurance about principles, facilities, and conditions was low. Therefore it is necessary to perform educational programs.