According to Khabaronline news agency, quoting from the public relations of the Executive Vice President, Mohammad Jaafar Ghaem Panah In the meeting of per capita allocation and integration of payments to 64 referral system networks with the presence of the officials of the Ministry of Health, Treatment and Medical Education, Program and Budget Organization, Health Insurance Organization, Social Security Organization and other related institutions, referring to the importance of the health sector in the programs of the 14th government, he said: People’s health is one of the main duties of the government, along with education, and the government should use all its capacities to promote the health of the society and the fair access of the people to medical services.
Referring to the global experiences in the implementation of the family doctor system and the referral system, he stated: The scientific and operational experience of many countries shows that the establishment of the family doctor and referral system is one of the most effective solutions to improve people’s health, control costs and increase the productivity of health system resources.
Stating that the limitation of financial resources has always been one of the serious challenges of the country’s health system, Qaim Panah clarified: In addition to the issue of resource limitation, we must also raise this fundamental question: Are the available resources being spent correctly and optimally? The fact is that in parts of the health system, we are faced with induction services, prescribing unnecessary drugs, and unnecessary referrals to specialized and super-specialized levels, which impose significant costs on the people and the insurance system.
Emphasizing the need to strengthen preventive services, the executive vice president added: an important part of cardiovascular diseases, diabetes and blood pressure can be prevented or controlled by lifestyle modification, proper nutrition, physical activity, screening and timely diagnosis. The cost of prevention is much lower than the cost of treating advanced diseases, and if we can prioritize people’s health by establishing a family doctor, we will avoid incurring heavy treatment costs in the future.
He continued: The main goal of the family doctor system is that each person is covered by a specific doctor, his health status is continuously monitored and the services he needs are provided at the appropriate level. In such a system, the family doctor does not just wait for the patient’s visit, but plays an active role in maintaining the health of the society by identifying people at risk, following up the health status and implementing preventive programs.
Pointing to the successful experience of the country’s health network in providing preventive services and primary health care, Ghaem Panah said: We have valuable experience in the field of health network in the country and we must use this capacity. With the correct implementation of this model, the health status of the covered population can be continuously monitored and services such as blood pressure control, diabetes, common cancer screening and periodical care can be provided in a systematic way.
Proposing to create an independent account for healthcare networks
Referring to the limited financial resources of the government and accumulated debts in the health sector, the executive vice president emphasized the need to review the way resources are allocated and said: Considering the financial conditions of the country, it is not possible to solve the problems of the health system simply by increasing the credits. We must manage the available resources in the correct way and create a mechanism so that each service provider receives resources according to its responsibility and performance.
Referring to the studies conducted on the resources of the Ministry of Health, basic insurances, supplementary insurances and people’s payments, he added: Our proposal is to create independent accounts for health and treatment networks and the share of each provider of health resources, according to the covered population and expected services, should be deposited into these accounts.
Ghaem Panah explained: The Ministry of Health should determine its share of the resources needed by the networks, and the insurance organizations should deposit their per capita share into each network’s account based on the number of people assigned to the family doctor and the defined service package. In this way, instead of circulating in multiple and centralized routes, the financial resources are provided to a unit that is directly responsible for providing services to the people.
Emphasizing that the payment of resources should be done a priori and according to the covered population, he stated: If a network has a covered population of 100,000 people, it should receive per capita according to the number of people assigned to the family doctor. By increasing population coverage and network performance, allocated resources will also increase. This method can encourage networks to attract more people and provide better quality services.
performance-based pay; A solution to increase productivity
Referring to the legal capacities in the 7th Development Plan and regulations related to operational budgeting and performance-based payment, Ghaem Panah said: “The Ministry of Health is one of the institutions that has the experience and proper infrastructure to implement this system.” A clear example is the efficient payment in the medical system, which is based on the amount and type of services provided.
He added: We must follow the same logic in healthcare networks. This means that the resources should be paid according to the actual services, the covered population and the level of health goals. In such a situation, doctors, nurses and other network employees can also benefit from their effective performance and have more motivation to provide optimal services.
Emphasizing the regulatory role of insurances, the executive vice president stated: instead of payments based solely on the number of referrals and services, insurance organizations should put the strategic purchase of health services on the agenda and monitor the implementation of defined service packages. The payment of resources should be proportional to the services that are actually provided, and in this way, monitoring and evaluating the performance of networks is of fundamental importance.
Phased implementation of the project in 64 healthcare networks
Pointing to the proposal to implement this model in 64 health and treatment networks as the starting point of the plan, Qaim Panah said: Our specific proposal is to start the implementation of this model from the networks that have been selected to start work, and by providing resources and creating suitable implementation mechanisms, we will provide the basis for its gradual expansion to other networks.
He added: We should not allow the lack of human resources or administrative problems to become an obstacle to the implementation of this program. In some networks, we are facing a shortage of doctors and nurses, and we must act to provide the required manpower, issue the necessary licenses, and create appropriate incentives. If the resources are provided to the networks in a timely manner and according to the performance, the possibility of attracting and retaining expert forces will also increase.
The necessity of strengthening the first level of services and organizing referrals to higher levels
Emphasizing the need to strengthen the first and second level of health services, the executive vice president said: per capita resources should be allocated in such a way as to guarantee the provision of basic services and primary care in the networks. In the second level, services must be provided based on certain criteria and under the supervision of insurance companies in order to prevent the creation of unnecessary services and conflict of interests.
He added: Regarding third level services, decisions should be made according to the power and capacity of each network. Networks that have the ability to strategically purchase specialized and inpatient services can sign contracts with reference hospitals and manage resources related to these services.
Pointing to the necessity of reducing unnecessary visits to specialized and super-specialized centers, Qaim Panah stated: The patient should not travel long distances and pay extra costs to receive services that can be provided at a closer level and in the network of his residence. Using capabilities such as telemedicine and creating effective communication between different levels of service delivery can play an effective role in reducing costs and facilitating people’s access.
In the end, he emphasized that the ultimate goal of all the proposed reforms is to increase people’s satisfaction and protect the health of society, and said: “The duty of the government is to serve the people, and no service is higher than protecting people’s health.” We should try to spend the country’s resources on prevention, continuous care and improving the health of the society, instead of spending on the treatment of preventable diseases and unnecessary expenses.
At the end of this meeting, the issue of creating an independent account for health and treatment networks, determining the ID of the executive body, gradually allocating resources based on the population attributed to the family doctor, and developing an executive mechanism in cooperation with the Ministry of Health, the Program and Budget Organization, and the Ministry of Economic Affairs and Finance were discussed. It was also emphasized on the necessity of starting the implementation of the plan in selected networks and determining the schedule for its expansion.
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