Presentation of Health Financing System Model with Emphasis on Structural, Contextual, Instrumental and Content Factors

Subject Areas : medical documents

parivash heidari orejlo ¹ (PhD student in Health Services Management, Shiraz Branch, Islamic Azad University, Fars, Iran)
shaghayegh vahdat ² (Assistant Professor, Department of Health Services Management, South Tehran Branch, Islamic Azad University, Tehran, Iran)
hasan soltani ³ (Assistant Professor, Department of Health Services Management, South Tehran Branch, Islamic Azad University, Tehran, Iran)

Received: 2020-03-07 Accepted : 2020-05-30 Published : 2020-05-21

Keywords: Model, health system, Financing,

Abstract :

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.

References:

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