Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
Iran-Helal Institute of Applied Science and Technology, Tehran, Iran.
Disabil Rehabil. 2022 Jul;44(14):3679-3685. doi: 10.1080/09638288.2021.1878563. Epub 2021 Feb 4.
To investigate physiotherapists', academics', and relevant decision- and policy-makers' experiences regarding the impacts of the Health Transformation Plan (HTP) on the physiotherapy sector in Iran.
This qualitative study was conducted using in-depth semi-structured interviews. The participants were selected using both purposive and snowball sampling strategies with maximum diversity. The sampling procedure continued until data saturation was achieved. The collected data were analyzed using thematic content analysis in accordance with Braun and Clarke's methodology.
The findings showed that the physiotherapy sector has faced several challenges after the implementation of HTP in five control knobs: (1) financing (a decline in the government budget and insufficient health insurance coverage), (2) payment (delayed payments and setting a tight ceiling for reimbursements), (3) behaviors (a decrease in the motivation of physiotherapists, the tendency toward misbehaviors such as absenteeism and providers' unwillingness to cooperate with insurance companies), (4) organization (difficulty in clinical education and ignoring the preventive effects of physiotherapy interventions), and (5) regulation (absence of stakeholders in political processes and inconsistency of upstream documents).
HTP has posed various challenges on the physiotherapy sector in Iran. Promoting the policymakers' awareness and aligning the health reforms such as HTP with the current upstream documents would diminish the existing challenges.IMPLICATIONS FOR REHABILITATIONMore government budgets and better insurance coverage are needed to strengthen the physiotherapy sector.Timely payment and modification of limitations for reimbursements of physiotherapy services are recommended.It is recommended to adopt strategies to increase the motivation of physiotherapists and reduce the risk of professional misconduct in the physiotherapy sector.Problems in clinical physiotherapy training should be addressed by policy-makers, and the preventive effects of physiotherapy interventions deserve more attention.Enhanced participation of physiotherapy stakeholders in relevant legislative processes is recommended to improve their services.
调查理疗师、学者以及相关决策者在伊朗，关于健康转型计划（HTP）对理疗部门的影响的经验。
本定性研究采用深入的半结构化访谈进行。参与者通过有目的和滚雪球抽样策略选择，具有最大的多样性。抽样程序继续进行，直到达到数据饱和。根据 Braun 和 Clarke 的方法，使用主题内容分析法分析收集的数据。
研究结果表明，理疗部门在 HTP 实施后，在五个控制旋钮方面面临着若干挑战：（1）融资（政府预算减少和医疗保险覆盖不足）；（2）支付（延迟支付和报销设置严格上限）；（3）行为（理疗师的积极性下降，存在旷工等不当行为的倾向以及提供者不愿意与保险公司合作）；（4）组织（临床教育困难和忽视理疗干预的预防效果）；（5）监管（利益相关者在政治进程中的缺席和上游文件的不一致）。
HTP 对伊朗的理疗部门提出了各种挑战。提高决策者的认识，并使 HTP 等卫生改革与当前的上游文件保持一致，将减少现有的挑战。
需要更多的政府预算和更好的保险覆盖来加强理疗部门。建议及时支付并修改理疗服务报销的限制。建议采取措施提高理疗师的积极性，减少理疗部门的职业不当行为风险。政策制定者应解决临床理疗培训中的问题，并更加关注理疗干预的预防效果。建议增加理疗利益相关者在相关立法过程中的参与度，以改善其服务。
