Hatam Nahid, Joulaei Hassan, Kazemifar Yalda, Askarian Mehrdad
Department of Health Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;
Iran J Med Sci. 2012 Dec;37(4):253-9.
In recent years use of family physicians has been determined as a start point of health system reform to achieve more productive health services. In this study we aimed to assess the cost-efficiency of the implementation of this plan in Fars province, southern Iran.
This cross-sectional descriptive study was done in 2007 in 18 provincial health centers as well as 224 rural health centers in Fars province. Data were collected using forms, statistics, and available evidence and analyzed by expert opinion and ratio techniques, control of process statistics, and multi indicator decision model.
Although in the family physician plan more attention is paid to patients and the level of health training, availability, and equity has improved and the best services are presented, it has not only decreased the costs, but also increased the referrals to pharmacies, laboratories, and radiology clinics and the costs of healthcare.
Although the family physician plan has led to more regular service delivery, it has increased the patients' referral to pharmacies, laboratories, and radiology centers and more referrals to family physicians. It seems that the possibility of setting regularity in health system can be gained in the following years of the family physician program mainly via planning, appropriate management and organizing correct health plans according to need assessments, and continual supervision on activities, which would happen according to current experiences in this plan.
近年来，家庭医生的使用已被确定为卫生系统改革的起点，以实现更高效的卫生服务。在本研究中，我们旨在评估在伊朗南部法尔斯省实施该计划的成本效益。
这项横断面描述性研究于2007年在法尔斯省的18个省级卫生中心以及224个农村卫生中心进行。数据通过表格、统计数据和现有证据收集，并通过专家意见和比率技术、过程统计控制和多指标决策模型进行分析。
尽管在家庭医生计划中更加关注患者，卫生培训、可及性和公平性水平有所提高，并且提供了最佳服务，但该计划不仅没有降低成本，反而增加了药房、实验室和放射科诊所的转诊量以及医疗保健成本。
尽管家庭医生计划使服务提供更加规范，但它增加了患者对药房、实验室和放射科中心的转诊以及对家庭医生的更多转诊。看来，在家庭医生计划实施后的几年里，主要通过规划、适当管理以及根据需求评估制定正确的卫生计划，并对活动进行持续监督，才有可能实现卫生系统的规范化，这将根据该计划目前的经验来进行。
