Iranian Center of Excellence in Health Services Management, Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Int J Health Plann Manage. 2019 Jan;34(1):e183-e193. doi: 10.1002/hpm.2631. Epub 2018 Aug 30.
Flat capitations are not necessarily able to compensate health providers equitably due to the variability of resource consumption among different age and sex groups. The aim of this study is to develop a risk adjusted capitation formula as a base for primary health care payment in Health Complexes of Tabriz, in Iran.
This cross-sectional study was conducted in four stages: (1) determining health service package, (2) calculating unit cost of services, (3) estimating service utilization, and (4) calculating age/sex weighted capitation. We calculated unit cost of services with and without building and equipment expenses. Data collection was carried out through a data extraction checklist. Data management and analysis was carried out via Microsoft Excel 2007.
A list of 99 services and their processes were identified and then assigned each to one of 10 categories according to their resource consumption. The lowest and highest unit cost, respectively, belonged to prenatal care and group training by family physicians. The risk adjusted capitation was calculated with and without renting cost of building and equipment, respectively, 347 000 and 332 000 Rials (1 US$ worth 35 000 Iranian Rials).
The development of health risk adjusted capitation could improve equity in payment system and the efficiency of delivering primary health care services. Estimated weights proposed with our study can be adapted then applied in contexts with similar characteristics.
由于不同年龄和性别群体的资源消耗存在差异，固定人头付费不一定能够公平地补偿医疗服务提供者。本研究旨在为伊朗大不里士医疗综合体的初级保健支付制定风险调整的人头付费公式。
这项横断面研究分四个阶段进行：（1）确定卫生服务包，（2）计算服务的单位成本，（3）估计服务利用情况，（4）计算按年龄/性别加权的人头付费。我们计算了有和没有建筑和设备费用的服务单位成本。通过数据提取清单收集数据。通过 Microsoft Excel 2007 进行数据管理和分析。
确定了 99 项服务及其流程，然后根据资源消耗将其分配到 10 个类别中的一个。最低和最高的单位成本分别属于产前护理和家庭医生的小组培训。分别考虑和不考虑租用建筑和设备的成本，计算出的风险调整人头付费为 347000 里亚尔（1 美元相当于 35000 伊朗里亚尔）和 332000 里亚尔。
制定卫生风险调整人头付费可以改善支付制度的公平性和提供初级保健服务的效率。本研究提出的估计权重可以适用于具有类似特征的环境。
