ارائه الگوی نظام تأمین مالی سلامت با تأکید بر عوامل ساختاری، زمینه‌ای، ابزاری و محتوایی
محورهای موضوعی : -مدارک پزشکی
پریوش حیدری ارجلو
1
(دانشجوی دکترای مدیریت خدمات بهداشتی و درمانی، واحد شیراز ،دانشگاه آزاد اسلامی، فارس، ایران)
شقایق وحدت
2
(استادیار، گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران)
حسن سلطانی
3
(استادیار، واحد گروه مدیریت، شیراز، دانشگاه آزاد اسلامی، فارس، ایران)
کلید واژه: نظام سلامت, الگو, تأمین مالی,
چکیده مقاله :
مقدمه: توجه ناکافی به بهداشت و درمان به عنوان یک کالای ضروری می‌تواند زیان‌هایی بر سطح سلامت جامعه داشته باشد و منابع عظیمی‌که در این بخش صرف می‌شود به هدر رود. محدودیت منابع مالی، تحریم کشور، کاهش درآمدهای بودجه ای، پایین بودن سهم اعتبارات تخصیصی از بودجه عمومی‌دولت و پایین بودن سهم هزینه‌های بهداشت و درمان از مجموع هزینه‌های ناخالص ملی از عوامل محدودکننده در تأمین مالی هزینه‌های بهداشت و درمان محسوب می‌شود که نیاز است الگویی متناسب با اقتضائات، الزامات، قوانین و فرهنگ کشور ارایه شود. به همین منظور در این مقاله سعی شد عوامل مؤثر و کارکردی بر تحقق نظام تأمین مالی سلامت در کشور شناسایی و در قالب الگویی ارایه شود. روش پژوهش: این تحقیق توصیفی، به روش زمینه‌یابی پیمایشی است و از نظر فرآیند اجرا، به صورت کیفی و کمی می‌باشد. در این تحقیق ابتدا با رویکرد کیفی و توسط مطالعات نظری و کتابخانه ای، الگوی تأمین مالی در نظام سلامت در جهان مورد بررسی قرار گرفت و سپس با ارایه مقایسه و شرح نقاط افتراق و اشتراک، طراحی مدل اولیه انجام شد. سپس با استفاده از نظر خبرگان،محقق نسبت به طراحی مدل اولیه اقدام نمود و در مرحله بعد جهت معتبرسازی مدل ارایه شده نظام سلامت از الگوریتم تحلیل مدل‌ها در روش Smart-PLS-SEM استفاده شد. یافته‌ها: برای بررسی فرضیه‌های تحقیق و بطور کلی آزمون مدل مفهومی پژوهش، چون ابعاد و مؤلفه‌های مؤثر بر تأمین مالی سلامت رتبه‌های یکسانی نداشتند، در نتیجه اولویت‌بندی انجام شد و در بخش عوامل زمینه‌ای، به ترتیب ابعاد نظام بودجه‌ریزی، خدمات سلامت محور، نظام مالیات محوری ، در بخش عوامل ابزاری صندوق بیماری، مشارکت مالی و بیمارستان اجتماعی، در بخش عوامل محتوایی تدوین طرح‌های تأمین مالی و قانون گذاری و در بخش عوامل ساختاری ابعاد ساختار کیفیت خدمات، ساختار ریسک و ساختار مالی قرار گرفتند و سپس تحلیل‌های لازم در سه بخش برازش مدل‌های اندازه‌گیری، برازش مدل ساختاری و برازش کلی مدل انجام گرفت و سپس به بررسی و تفسیر روابط موجود در بخش ساختاری پرداخته شد و در مرحله پایایی نیز برازش کلی الگوی تحقیق بررسی شد. نتیجه‌گیری: نتایج تحقیق نشان می‌دهد ایجاد یک ساز و کار در بخش نظام مالیاتی، نظام بودجه‌ریزی با توجه به تحریم‌های صورت گرفته و ایجاد محدودیت‌ها در سیستم سرمایه‌گذاری در بخش سلامت و شیوع بیماری‌های مزمن و ناگهانی از بیشترین اهمیت و رتبه در ایجاد الگوی نظام تأمین مالی سلامت در کشور برخوردار است.
Introduction:Inadequate attention to health care as a necessary commodity can be detrimental to the health of the community and the huge resources spent in this area can be wasted. Limited financial resources, sanctions on the country, reduction of budget revenues, low share of funds allocated from the general government budget and low share of health care costs are among the total gross national expenditures that limit the financing of health care costs. It is necessary to provide a model that fits the requirements, requirements, laws and culture of the country. For this reason, in this article, we tried to identify the effective and functional factors on the realization of the health financing system in the country and present them in the form of a model. Methods:This descriptive research is based on survey research and is qualitative and quantitative in terms of the implementation process. In this research, first with a qualitative approach and by theoretical and library studies, the financing model in the health system in the world is examined. The design of the initial model was done by comparing and describing the differences and commonalities. Then, with the help of experts, the researcher designed the initial model, and in the next step, the model analysis algorithm was used in the Smart-PLS-SEM method to validate the presented model of the health system. Results:In order to study the research hypotheses and the conceptual research model in general, because the dimensions and components affecting health financing did not have the same ranks, as a result, prioritization was done and in the field of field factors, the dimensions of the budgeting system, respectively. Health-oriented services, tax-oriented system, in the instrumental factors section of the disease fund, financial participation and social hospital, in the content factors section, financing and legislation plans were developed and in the structural factors dimensions, service quality structure, risk structure and financial structure were measured. Then, the necessary analyzes were performed in three sections: fit of measurement models, structural model fit and general fit of the model, and then the existing relationships in the structural section were examined and interpreted, and in the reliability stage, the overall fit of the research model was examined. Conclusion:The research results show that creating a mechanism in the tax system, budgeting system according to the sanctions and creating restrictions in the investment system in the health sector and the spread of chronic and sudden diseases of the greatest importance and ranking in creating the model. The country has a health financing system.
1- Savedoff WD, Ferranti D de, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. Lancet, 2012; 380: 924–32.
2- Saadati M , Rezapour R , Derakhshani N , Naghshi M. Comparative Study of Fair Financing in the Health Insurance. Journal of Healthcare Management, 2017; 7(4): 11. [In Persian]
3- Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet, 2015; 386: 274–80.
4- Savedoff W, Ferranti F, Smith A. Transitions in health financing and policies for universal health coverage. http://www.r4d.org/ wp-content/uploads/THF-Summary-Transitions-in-HealthFinancing-and-Policies-for-Universal-Health-Coverage.pdf (accessed Feb 14, 2018).
5- Jowett M, Petro Brunal M, Flores G, Cylus J. Spending targets for health: no magic number. Geneva, World Health Organisation, 2016. http://www.who.int/health_financing/documents/no-magicnumber/en/ (accessed Feb 14, 2018)
6- GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet, 2017; 390: 231–66.
7- Jowett M, Petro Brunal M, Flores G, Cylus J. Spending targets for health: no magic number. Geneva, World Health Organisation, 2016. http://www.who.int/health_financing/documents/no-magicnumber/en/ (accessed Feb 14, 2018).
8- Kelle, U., Prein, G. and Bird, K. Computer-Aided Qualitative Analysis: Theory, Methods and Practice, 1995. London: Sage.
9- Alizadeh Hanjani MH, Fazaeli AA. The situation of justice in financing the health system in Iran. Social Welfare Scientific Research Quarterly, 2005; 5(19 Iranian children and adolescents).
10- Karimi I, Nasiripour A, Maleki M, Mokhtare H. Assessing financing methods and payment system for health service providers in selected countries: designing a model for Iran. Journal of Health Administration, 2006; 8(22):15-24.
11- Kutzing J. Health financing for universal coverage and health system performance: Concepts and implications for policy. Bull World Health Organ, 2013; 91(8): 602.
12- Hsiao W, Siadat B. In search of a common conceptual framework for health systems strengthening; 2009.
13- Kulesher R, Forrestal E. International models of health systems financing. J Hosp Adm; 2014.
14- Mcintyre D, Kutzin J. Health financing country diagnostic: A foundation for national strategy development. Geneva, Switzerland: World Health Organization.
15- Berton MP, Meesen B. Studing the link between institutions and health system performance: A framework and an illustration with the analysis of two performance – based financing schemes in Burundi. Health Policy Plan, 2013; 28(8): 847.
16- Gill A. Healthcare financing: How should Singapore’s ministry of health shift costs from private pockets to the public purse? Lee Kuan Yew School of Public Policy; 2013.
17- Karimi I, Nasiripour A, Maleki M, Mokhtare H. Assessing financing methods and payment system for health service providers in selected countries: designing a model for Iran. Journal of Health Administration, 2006; 8(22): 15-24.
18- World Bank. World Bank country and lending groups—World Bank data help desk. https://datahelpdesk.worldbank.org/ knowledgebase/articles/906519-world-bank-country-and-lendinggroups, (accessed Dec 17, 2017).
19- Farahani M, Subramanian SV, Canning D. Effects of state-level public spending on health on the mortality probability in India. Health Econ, 2010; 19: 1361–76.
20- Jensen, K ‘Introduction: The Qualitative Turn’, in K. Jensen and N. Jankowski (eds), A Handbook of Qualitative Methodologies for Mass Communications Research; 1991: 1–12. London: Rout ledge
_||_1- Savedoff WD, Ferranti D de, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. Lancet, 2012; 380: 924–32.
2- Saadati M , Rezapour R , Derakhshani N , Naghshi M. Comparative Study of Fair Financing in the Health Insurance. Journal of Healthcare Management, 2017; 7(4): 11. [In Persian]
3- Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet, 2015; 386: 274–80.
4- Savedoff W, Ferranti F, Smith A. Transitions in health financing and policies for universal health coverage. http://www.r4d.org/ wp-content/uploads/THF-Summary-Transitions-in-HealthFinancing-and-Policies-for-Universal-Health-Coverage.pdf (accessed Feb 14, 2018).
5- Jowett M, Petro Brunal M, Flores G, Cylus J. Spending targets for health: no magic number. Geneva, World Health Organisation, 2016. http://www.who.int/health_financing/documents/no-magicnumber/en/ (accessed Feb 14, 2018)
6- GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet, 2017; 390: 231–66.
7- Jowett M, Petro Brunal M, Flores G, Cylus J. Spending targets for health: no magic number. Geneva, World Health Organisation, 2016. http://www.who.int/health_financing/documents/no-magicnumber/en/ (accessed Feb 14, 2018).
8- Kelle, U., Prein, G. and Bird, K. Computer-Aided Qualitative Analysis: Theory, Methods and Practice, 1995. London: Sage.
9- Alizadeh Hanjani MH, Fazaeli AA. The situation of justice in financing the health system in Iran. Social Welfare Scientific Research Quarterly, 2005; 5(19 Iranian children and adolescents).
10- Karimi I, Nasiripour A, Maleki M, Mokhtare H. Assessing financing methods and payment system for health service providers in selected countries: designing a model for Iran. Journal of Health Administration, 2006; 8(22):15-24.
11- Kutzing J. Health financing for universal coverage and health system performance: Concepts and implications for policy. Bull World Health Organ, 2013; 91(8): 602.
12- Hsiao W, Siadat B. In search of a common conceptual framework for health systems strengthening; 2009.
13- Kulesher R, Forrestal E. International models of health systems financing. J Hosp Adm; 2014.
14- Mcintyre D, Kutzin J. Health financing country diagnostic: A foundation for national strategy development. Geneva, Switzerland: World Health Organization.
15- Berton MP, Meesen B. Studing the link between institutions and health system performance: A framework and an illustration with the analysis of two performance – based financing schemes in Burundi. Health Policy Plan, 2013; 28(8): 847.
16- Gill A. Healthcare financing: How should Singapore’s ministry of health shift costs from private pockets to the public purse? Lee Kuan Yew School of Public Policy; 2013.
17- Karimi I, Nasiripour A, Maleki M, Mokhtare H. Assessing financing methods and payment system for health service providers in selected countries: designing a model for Iran. Journal of Health Administration, 2006; 8(22): 15-24.
18- World Bank. World Bank country and lending groups—World Bank data help desk. https://datahelpdesk.worldbank.org/ knowledgebase/articles/906519-world-bank-country-and-lendinggroups, (accessed Dec 17, 2017).
19- Farahani M, Subramanian SV, Canning D. Effects of state-level public spending on health on the mortality probability in India. Health Econ, 2010; 19: 1361–76.
20- Jensen, K ‘Introduction: The Qualitative Turn’, in K. Jensen and N. Jankowski (eds), A Handbook of Qualitative Methodologies for Mass Communications Research; 1991: 1–12. London: Rout ledge