Fragmentation of payment systems: an in-depth qualitative study of stakeholders' experiences with the neonatal intensive care payment system in Iran.

IF 2.7 3区 经济学 Q1 ECONOMICS
Zakieh Ostad-Ahmadi, Miriam Nkangu, Mahmood Nekoei-Moghadam, Mohammad Heidarzadeh, Reza Goudarzi, Vahid Yazdi-Feyzabadi
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Abstract

Background: Iran's fee-for-service (FFS) payment model in neonatal intensive care units (NICUs) is contentious due to the involvement of multiple stakeholders with differing interests, leading to increased costs, fragmentation, and reduced quality of care. This study explores the experiences and challenges of stakeholders with the NICU payment system and considers alternative payment methods.

Method: A qualitative research approach was used, involving key informant interviews with stakeholders at various levels of the health system. Data were collected between March 2022 to September 2023 using a purposive sampling method with a snowball strategy. The transcribed data were analyzed using an inductive thematic approach in MAXQDA, with themes and sub-themes emerged and assessed by two independent coders. Four trustworthiness criteria were applied to ensure the quality of the results.

Results: The study involved 23 participants with diverse NICU payment backgrounds, identifying issues related to service accessibility, rising costs, neonatologists' income, and service quality. Stakeholders held differing views on the best payment model: health insurance executives favored a prospective payment method, faculty members favored supported modified FFS or per diem, and neonatal specialists expressed concerns about low tariffs and delayed payments.

Conclusion: Iran's NICU payment system is unsatisfactory and requires urgent reform. Although stakeholders disagree on the best approach, reforms must be evidence-based and collaborative, addressing structural and cultural issues within the health system. The identification of an optimal payment system is essential for supporting neonatal care, benefiting newborns, families, society, and the broader health system.

支付系统的分散:对伊朗新生儿重症监护支付系统利益相关者经验的深入定性研究。
背景:伊朗新生儿重症监护病房(NICU)的按服务收费(FFS)支付模式因涉及利益不同的多个利益相关者而备受争议,导致成本增加、分散和护理质量下降。本研究探讨了利益相关者在新生儿重症监护病房支付系统方面的经验和挑战,并考虑了替代支付方法:采用定性研究方法,对医疗系统各层面的利益相关者进行关键信息访谈。数据收集时间为 2022 年 3 月至 2023 年 9 月,采用了滚雪球策略的目的性抽样方法。在 MAXQDA 中使用归纳式主题方法对转录数据进行了分析,形成了主题和子主题,并由两名独立的编码员进行了评估。研究采用了四项可信度标准,以确保研究结果的质量:这项研究涉及 23 位具有不同新生儿重症监护病房支付背景的参与者,确定了与服务可及性、成本上升、新生儿科医生收入和服务质量相关的问题。利益相关者对最佳支付模式持有不同意见:医疗保险管理者倾向于预期支付方法,教职员工倾向于支持修改后的 FFS 或按日支付,而新生儿专家则对低关税和延迟支付表示担忧:结论:伊朗的新生儿重症监护病房支付系统不能令人满意,急需改革。尽管利益相关方对最佳方法存在分歧,但改革必须以证据为基础,并通过合作解决医疗系统内的结构和文化问题。确定最佳支付系统对于支持新生儿护理,造福新生儿、家庭、社会和更广泛的医疗系统至关重要。
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来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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