Keliddar Iman, Mosadeghrad Ali Mohammad, Jafari-Sirizi Mehdi
Tehran University of Medical Sciences, Tehran, Iran.
School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Aug 27;31:47. doi: 10.14196/mjiri.31.47. eCollection 2017.
It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes. The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis. Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles. This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.
由于资源有限而需求无限，为所有需要医疗服务的人提供医疗服务是困难的。因此，必须进行优先级设定和资源分配。本研究旨在批判性地审视卫生部门资源分配的概念，并确定其目的、影响因素、机制和结果。本研究采用了批判性解释性综合方法。使用相关关键词在PubMed、Cochrane和Proquest数据库中进行搜索，以查找1970年至2015年间发表的相关文献。总共审查了161篇已发表的报告并纳入本研究。采用主题内容分析法进行数据分析。卫生服务资源分配是指由于预算限制而限制一些人获得有用或潜在有用的卫生服务。卫生市场和卫生服务的固有特征、资源有限和需求无限使得卫生服务资源分配成为必要。资源分配可在四个层面进行：卫生保健政策制定者、卫生保健管理者、卫生保健提供者和患者。卫生保健资源分配可通过固定预算、福利套餐、支付机制、排队、共付费用和免赔额来实现。本文丰富了我们对卫生服务资源分配及其在各个层面的机制的理解，并通过对卫生服务资源分配进行广泛的概念化，为相关文献做出了贡献。
