The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study
نویسندگان
1 Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
2 Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
4
5 Community Medicine Department, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
doi
چکیده
When a country’s health system is faced with fundamental flaws that require the redesign of financing and servicedelivery, primary healthcare payment systems are often reformed.Objectives: This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urbanfamily physicians in Iran when it comes to providing primary health care (PHC).Materials and Methods: This is a qualitative study using the framework method. Data were collected via digitally audio-recordedsemi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban familyphysician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted usinginductive and deductive methods.Results: Regarding the effects of risk-adjusted capitationonthe primary healthcare setting, five themes with 11 subthemes emerged,including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicatedthat the health system is enjoying some major changes in the primary healthcare setting through the implementation of riskadjustedcapitation payment.Conclusions: With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcarepayment system can lead to useful changes in the health system’s features. However, future research should focus on the developmentof the risk-adjusted capitation model.
