رویکردهای تامین مالی در اورژانس‌های پیش‌بیمارستانی و بیمارستانی در ایران در سال 1395
محورهای موضوعی : -مدارک پزشکیعلی جمال محمدی 1 , سیدجمال الدین طبیبی 2 , لیلا ریاحی 3 , محمود محمودی مجدآبادی فراهانی 4
1 - دانشجوی دکتری مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - استاد، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
3 - استادیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
4 - استاد، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: مراقبت اورژانس, تامین مالی, اورژانس بیمارستانی, اورژانس پیش‌بیمارستانی,
چکیده مقاله :
مقدمه: جامعه متعهد است که حداقل خدمات درمانی با اولویت خدمات اورژانس را برای تمام افراد فراهم نماید که تحقق بخشیدن به این حق عمو‌می‌بستگی به مکانیزم‌های تامین کننده خدمات برای تمام افراد دارد، بدون آنکه در این راستا به توانایی فرد در پرداخت هزینه‌ها یا عدم پرداخت حق بیمه‌ها از سوی آنان توجهی نماید. هدف از این پژوهش تعیین عوامل مرتبط با تامین مالی در اورژانس‌های پیش‌بیمارستانی و بیمارستانی در ایران به منظور بهبود ارائه خدمات به افراد جامعه می‌باشد. روش پژوهش: پژوهش حاضر براساس ماهیت، اکتشافی، توصیفی و تطبیقی و از دیدگاه طبقه‌بندی، برمبنای هدف، مروری، کاربردی و تحلیلی می‌باشد. کشورهای توسعه یافته در قسمت‌های مختلف دنیا برمبنای دارا بودن الگوهای قابل قبول ارائه خدمت و در دسترس بودن اطلاعات، شباهت‌های نظام‌های بهداشتی و درمانی براساس منطقه جغرافیایی، میزان توسعه یافتگی شاخص‌های بهداشتی و درمانی، نظام پرداخت و نحوه تأمین مالی و ارتباطات مالی سازمان‌های درگیر در اورژانس‌های پیش‌بیمارستانی و بیمارستانی، نوع اورژانس‌های پیش‌بیمارستانی و بیمارستانی موجود و استراتژی‌های بهداشت و درمان در این حوزه انتخاب شدند. یافته‌ها: یافته‌ها بیانگر آن است که در بسیاری از کشورها؛ کمبود منابع مالی در اورژانس‌های پیش‌بیمارستانی و بیمارستانی یک مانع مهم برای ارائه خدمات در این حوزه است. تامین مالی اورژانس از وضعیت مطلوب تعریف شده، فاصله زیادی دارد (متوسط رو به پایین). در بین معیارها، معیار بودجه (32/69 درصد) و پوشش بیمه‌ای (31/47 درصد) بیشترین فاصله را با وضعیت مطلوب دارد. فرایندهای کلیدی و پشتیبان در تامین مالی به طور مناسب طراحی نشده‌اند. امتیاز کسب شده در معیار خط مشی و استراتژی (37/85 درصد) نشان‌دهنده آن است که خط مشی و استراتژی به طور دقیق بر مبنای مفاهیم تامین مالی در اورژانس‌های پیش‌بیمارستانی و بیمارستانی تدوین نشده است. نتیجه‌گیری: به منظور تامین انتظارات بیماران نیازمند مراقبت اورژانس، نیاز به اصلاح خدمات اورژانس داریم و این اقدام نیازمند سازماندهی مجدد اورژانس‌های پیش‌بیمارستانی و بیمارستانی و ارتقاء اورژانس با بکارگیری رویکرهایی موثر بر بهبود تامین منابع مالی در اورژانس‌های پیش‌بیمارستانی و بیمارستانی در کشور ایران در قالب الگویی یکپارچه و در قالب تغییر نوع نگاه به برنامه‌ریزی و مدیریت مالی در اورژانس با هدف زیست‌پذیر بودن خدمات است که با نمود بارز آن پای نهادن به الگوی مشارکت‌جویانه، اجتماع‌محور، شهروندمدار، همگرا و هم‌افزا در زمینه رویکردهای مختلف مدیریت مطلوب مالی اورژانس، سرمایه اجتماعی و پوشش بیمه‌ای مناسب خدمات اورژانس است.
Introduction: The community is committed to providing at least the first-come, first-served care services for all individuals, that the realization of this public right depends on the mechanisms that provide the service to everyone, without, however, the ability of the individual to pay or not Pay attention to their premiums. The purpose of this study was to determine the factors related to financing in pre-hospital and hospital emergency rooms in Iran in order to improve the provision of services to community members. Methods: The present research is descriptive and comparative. Developed countries in different parts of the world based on the similarities of health systems based on geographical area, the level of development of health and medical indicators, payment system and financing method were selected. The data on the financing process in pre-hospital and hospital emergency rooms of the countries under study were collected and then, based on the adaptive tables, effective factors on the financing of pre-hospital and hospital emergencies in the countries studied in the areas of financial resources management, budget, payment system Service providers and insurance coverage were extracted. Results: Findings indicate that in many countries, lack of funding in pre-hospital and hospital emergency rooms is an important barrier to providing services in this area, and this may be due to several factors: lack of adequate funding, inadequate funding, The pay system is not transparent to service providers and the inability to manage financial resources. Emergency financing is well defined, there is a lot of distance. Key and backup processes are not properly designed to fund, and there is no specific framework for identifying and deploying financing processes to implement policy and strategy in pre-hospital and hospital emergency situations. Conclusion: The need to reform the emergency services by reorganizing the emergency and improving the emergency by applying effective approaches to improving the financing of emergency funds in the form of an integrated model and in the form of a change in the type of look at planning and financial management in the emergency department with a view to the viability of services that With a clear indication of the partnership-driven, community-based, citizen-oriented, converging and synergistic approach to different types of emergency management, social capital and appropriate insurance coverage for emergency services.
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2- Vand Rajab Pour M. Comparative Study of Public Health Insurance System in Selected Countries and Providing a Suitable Model for Iran. Islamic Azad University, Research Center; 1999. [Persian]
3- Barony, M. A Comparative Study of the Methods of Providing Financial Insurance Funding in Selected Countries and Providing a Model for Iran. Faculty of Management and Information, University of Iran; 2004. [Persian]
4- VanRooyen MJ, Thomas TL, Clem KJ. International emergency medical services: Assessment of developing prehospital systems abroad. J Emerg Med, 1999; 17(4): 691-6.
5- Cobelas C, Cooper C, Ell M, Haw thorn G, Kennedy M, Leach V, Quality Management and Emergency Service enhancement Programe, Department of Emergency Medicine, Australia; 2001.
6- American College of Emergency Physicians Report, Emergency Department Operations Management, U.S.A; 2004.
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9- Analysis of The Status of Emergency Departments in The Hospitals of The Country and The Proposal for Interventions (Development of The Emergency Department's Emergency Policies Improvement Document of The National Institute of Health Research Hospital), Tehran University of Medical Sciences (And The Treatment Officer, Center for Medical Accident and Emergency Management); 2013. [Persian]
10- Bahadori M, Mir Hashemi S, Panahi F, Tofighi S. Surveying the Structure, Process and Activities of The Emergency Department in Baqiyatallah University of Medical Sciences Hospitals; 2007. [Persian]
11- Asadi F. Improve the Performance of Emergency Services of Hospitals With The Approach of Quality Management System. Tehran; 2003. [Persian]
12- VanRooyen MJ, Thomas TL, Clem KJ. International emergency medical services: Assessment of developing prehospital systems abroad. J Emerg Med, 1999; 17(4): 691-6.
13- Siddiqui AA, Zafar H, Bashir SH. An audit of head trauma care and mortality. J Coll Physicians Surg Pak, 2004; 14(3): 173-7.
14- Adnet F, Lapostolle F. International EMS systems: France Resuscitation, 2004; 63(1): 7-9.
15- Papaspyrou E, Setzis D, Grosomanidis V, Manikis D, Boutlis D, Ressos C. International EMS systems: Greece. Resuscitation, 2004; 63(3): 255-9.
16- Pozner CN, Zane R, Nelson SJ and Levine M. International EMS systems: The United States: Past, present, and future. Resuscitation, 2004; 60(3): 239-44.
17- Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low-and middle-income countries: Recommendations for action. Bull World Health Organ, 2005; 83(8): 626-31.
18- Safdari R., Ghazi Saeedi M, Goodini A, Monajemi F. A Comparative Study of The Mechanism for Paying Medical Insurance in The United States and Australia and Iran, Journal of Research in Medicine and Tropical Medicine; 2010. [Persian]
19- Office of the Supreme Leader, General Health Policy; 1394. [Persian]
20- Wilm Quentin, Natalie Baier, Micka el Bech, David Bernstein, Thomas Cowling, Terri Jackson, Johan van Manen, Andreas Rudkjøbing, Alexander Geissler , Organization and Payment of Emergency Care Services in Selected Countries; 2016.
21- Azami S, Sadegh Tabrizi J, Abdullahi L, Yari Fard K, Kabiri N, Sa'adati M, Vali Zadeh S, Daemi A, Abhari A, Nadimi B. Knowledge and Attitude of Educational Hospital Managers of Tabriz University of Medical Sciences and Ardabil on Accreditation, Ardabil Health Journal of Health; 2014. [Persian]
22- Keshavarz H, Zahiri M. Anvaripour, Presenting the Plan of Coordination of Pre-hospital and Hospital Emergency in Bushehr Province; 2012. [Persian]
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1- Masoumi H, Daneshgari M. Ministry of Health, Medical Education, Pre-hospital Emergency Coverage Plan; 2015. [Persian]
2- Vand Rajab Pour M. Comparative Study of Public Health Insurance System in Selected Countries and Providing a Suitable Model for Iran. Islamic Azad University, Research Center; 1999. [Persian]
3- Barony, M. A Comparative Study of the Methods of Providing Financial Insurance Funding in Selected Countries and Providing a Model for Iran. Faculty of Management and Information, University of Iran; 2004. [Persian]
4- VanRooyen MJ, Thomas TL, Clem KJ. International emergency medical services: Assessment of developing prehospital systems abroad. J Emerg Med, 1999; 17(4): 691-6.
5- Cobelas C, Cooper C, Ell M, Haw thorn G, Kennedy M, Leach V, Quality Management and Emergency Service enhancement Programe, Department of Emergency Medicine, Australia; 2001.
6- American College of Emergency Physicians Report, Emergency Department Operations Management, U.S.A; 2004.
7- Masoumi G, Jalili M, Cian Thier M. Hospital Emergency Department Indicators. Ministry of Health and Medical Education; 2012. [Persian]
8- Karimi I. Nassiripour AA. Maleki M. Mokhtare H. Assessing Financing and Payment Systems for Health Providers in Selected Countries: Providing a Template for Iran. Quarterly Journal of Health Management; 2005. [Persian]
9- Analysis of The Status of Emergency Departments in The Hospitals of The Country and The Proposal for Interventions (Development of The Emergency Department's Emergency Policies Improvement Document of The National Institute of Health Research Hospital), Tehran University of Medical Sciences (And The Treatment Officer, Center for Medical Accident and Emergency Management); 2013. [Persian]
10- Bahadori M, Mir Hashemi S, Panahi F, Tofighi S. Surveying the Structure, Process and Activities of The Emergency Department in Baqiyatallah University of Medical Sciences Hospitals; 2007. [Persian]
11- Asadi F. Improve the Performance of Emergency Services of Hospitals With The Approach of Quality Management System. Tehran; 2003. [Persian]
12- VanRooyen MJ, Thomas TL, Clem KJ. International emergency medical services: Assessment of developing prehospital systems abroad. J Emerg Med, 1999; 17(4): 691-6.
13- Siddiqui AA, Zafar H, Bashir SH. An audit of head trauma care and mortality. J Coll Physicians Surg Pak, 2004; 14(3): 173-7.
14- Adnet F, Lapostolle F. International EMS systems: France Resuscitation, 2004; 63(1): 7-9.
15- Papaspyrou E, Setzis D, Grosomanidis V, Manikis D, Boutlis D, Ressos C. International EMS systems: Greece. Resuscitation, 2004; 63(3): 255-9.
16- Pozner CN, Zane R, Nelson SJ and Levine M. International EMS systems: The United States: Past, present, and future. Resuscitation, 2004; 60(3): 239-44.
17- Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low-and middle-income countries: Recommendations for action. Bull World Health Organ, 2005; 83(8): 626-31.
18- Safdari R., Ghazi Saeedi M, Goodini A, Monajemi F. A Comparative Study of The Mechanism for Paying Medical Insurance in The United States and Australia and Iran, Journal of Research in Medicine and Tropical Medicine; 2010. [Persian]
19- Office of the Supreme Leader, General Health Policy; 1394. [Persian]
20- Wilm Quentin, Natalie Baier, Micka el Bech, David Bernstein, Thomas Cowling, Terri Jackson, Johan van Manen, Andreas Rudkjøbing, Alexander Geissler , Organization and Payment of Emergency Care Services in Selected Countries; 2016.
21- Azami S, Sadegh Tabrizi J, Abdullahi L, Yari Fard K, Kabiri N, Sa'adati M, Vali Zadeh S, Daemi A, Abhari A, Nadimi B. Knowledge and Attitude of Educational Hospital Managers of Tabriz University of Medical Sciences and Ardabil on Accreditation, Ardabil Health Journal of Health; 2014. [Persian]
22- Keshavarz H, Zahiri M. Anvaripour, Presenting the Plan of Coordination of Pre-hospital and Hospital Emergency in Bushehr Province; 2012. [Persian]