Student of Ph.D. by Research, Hospital Administration Research Center, Sari Branch, Islamic Azad University, Sari, Iran.
Associated Professor of Hospital Administration Research Center, Sari Branch, Islamic Azad University, Sari, Iran.
Ethiop J Health Sci. 2021 Jul;31(4):885-896. doi: 10.4314/ejhs.v31i4.24.
Countries rely on out-of-pocket spending to different degrees and employ varying techniques. This study aimed at designing an out-of-pocket payment model of patients admitted to the Iran health system.
This study was a combined qualitative and quantitative study. The statistical population of the qualitative section was 30 experts who were purposefully selected and continued by snowball method until data saturation, and in the quantitative section were 212 managers of the Ministry of Health. The questionnaire was designed based on qualitative analysis. Content validity was confirmed based on expert opinion and structural validity using exploratory factor analysis and confirmatory factor analysis. Reliability was confirmed using CRONBACH's alpha coefficient and composite reliability. For model adequacy, KMO index and Bartlett test were used, and for model fit, CFI and IFI fitness index were used.
Based on the results of 6 main themes, 20 Concept and 120 sub-themes of out of pocket payment of hospitalized patients were extracted. The value of chi-square was 4599.861, the degree of freedom was 2421 and the result of their ratio was 1.899 in the model, which was an acceptable value. CFI and IFI fitness indicators are acceptable. The SRMR index was 0.1153, which indicates the adequacy of the model.
The findings showed that the main dimensions of out of pocket payment of hospitalized patients include causal factors, underlying factors, intervening factors, pivotal categories, strategies and consequences. Therefore, the use of a paradigm model to pay attention to all the effective dimensions in reducing the payment of hospitalized patients is recommended.
各国在不同程度上依赖自费支出，并采用不同的技术。本研究旨在为伊朗卫生系统收治的患者设计自费支付模式。
本研究是一项定性和定量相结合的研究。定性部分的统计人群是 30 名专家，他们是通过雪球法有目的地选择的，并持续到数据饱和，定量部分是卫生部的 212 名管理人员。该问卷是基于定性分析设计的。内容效度是根据专家意见和结构效度来确认的，使用探索性因子分析和验证性因子分析。可靠性是通过 Cronbach 的 alpha 系数和综合可靠性来确认的。为了评估模型的充分性，使用了 KMO 指数和巴特利特检验，为了评估模型拟合度，使用了 CFI 和 IFI 拟合指数。
根据 6 个主要主题、20 个概念和 120 个住院患者自费支付的子主题的结果，提取了 20 个概念和 120 个子主题。模型中卡方值为 4599.861，自由度为 2421，其比值为 1.899，是一个可接受的值。CFI 和 IFI 拟合指标是可以接受的。SRMR 指数为 0.1153，表明模型充分。
研究结果表明，住院患者自费支付的主要维度包括因果因素、潜在因素、干预因素、关键类别、策略和后果。因此，建议使用范式模型来关注所有有效维度，以减少住院患者的支付。
