Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Burns. 2021 Aug;47(5):1191-1202. doi: 10.1016/j.burns.2020.10.029. Epub 2020 Nov 9.
Victims of burn have particular characteristics such as high vulnerability, expensive treatment, and cost of burn services. Thus, the financing of burn services is crucially important. The purpose of the present work is to recognize the financing challenges in Iranian specialized burn hospitals (SBHs).
In the present qualitative descriptive research, purposive sampling was used for selecting key informants with maximum variation at local, provincial, and national levels. Semi-structured interviews were used for data collection. Interviews were continued as long as the saturation point was achieved at the 21 st interview. We employed conventional content analysis using an inductive data-driven coding process and theme development for the analysis of the transcribed documents by MAXQDA Analytics Pro 2018 (VERBI GmbH Release 18.2.0 Berlin).
We extracted 3 themes and 12 sub-themes, including resource mobilization (the poor burnt victims, unique feature of the single- SBH, high direct and indirect costs, and poor intra-sectoral advocacy), insurance coverage for burn care (incomplete breadth of population coverage, inadequate depth of benefits package and coverage of costs, and reimbursements of burn care) and mechanism of financial resource allocation (unsuitable payment system, less sustainable budgeting, inappropriate tariffing for burning services, top-down budgeting approach, and politicized budget process).
We suggest that health policy-makers in Iran could modify the SBHs financing system by improving resource mobilization, scaling up insurance coverage for burns, and optimizing the allocation of financial resources. Besides, we propose several points for policy entry to address SBHs financial difficulties. These points are serious attention to vulnerable and the poor burn patients, provision of burn care in multi-specialized hospitals, strengthening intra-collaboration, revision of tariffs, and payments for burn services, and preservation and realization of burn budgeting.
烧伤患者具有高度脆弱性、治疗费用昂贵和烧伤服务成本高等特点。因此，烧伤服务的融资至关重要。本研究旨在认识伊朗专科烧伤医院（SBH）融资面临的挑战。
在本定性描述研究中，采用目的抽样法，在地方、省和国家各级选择具有最大差异的关键信息提供者。采用半结构式访谈收集数据。在第 21 次访谈达到饱和点时，继续访谈。我们使用传统的内容分析法，采用归纳式数据驱动的编码过程和主题发展，对 MAXQDA Analytics Pro 2018（VERBI GmbH Release 18.2.0 Berlin）转录文件进行分析。
我们提取了 3 个主题和 12 个子主题，包括资源动员（贫困烧伤患者、单一 SBH 的独特特征、高直接和间接成本以及内部部门间倡导不力）、烧伤护理保险覆盖（人口覆盖范围不完整、福利套餐和成本覆盖深度不足以及烧伤护理报销）和财务资源分配机制（不适当的支付系统、预算可持续性较差、燃烧服务的收费不适当、自上而下的预算方法以及政治化的预算过程）。
我们建议伊朗卫生政策制定者可以通过改善资源动员、扩大烧伤保险覆盖范围以及优化财务资源分配来修改 SBH 融资系统。此外，我们提出了一些政策切入点，以解决 SBH 的财务困难。这些要点是认真关注弱势群体和贫困烧伤患者，在多专科医院提供烧伤护理，加强内部合作，修订费率和烧伤服务的支付，以及保护和实现烧伤预算。
