Armaghane Danesh Bimonthly Journal (Dec 2022)
Clarifying the Model of Managed Care for Emerging Respiratory Infectious Diseases in Iran\'s Healthcare System in 2019
Abstract
Background & aim: managed care is an example of modern health care systems whose task is to control the cost of services in a cost-effective manner through managed care organizations. Considering that several factors such as inadequate budget, unnecessary prescriptions and tests, incorrect payment system are observed in Iran. Therefore, the purpose of the present study was to determine and explain the model of managed care for emerging respiratory infectious diseases in Iran's healthcare system. Methods: The present case study and semi-structured interview was conducted on 12 experts and professors in 2019 leading to the development of research model criteria. For emerging respiratory infectious diseases, based on content analysis technique, these factors and indicators are categorized. Considering that the purpose of this research is an exploratory combination of the sequential type and the tooling model, designing and editing the model based on the criteria of the model design. The collected data were analyzed using statistical tests of generalized linear models, Hotelling's t and Bonferroni's post-test. Results: Based on the conducted interviews and review of previous researches, Factors affecting the managed care pattern for emerging respiratory infectious diseases were identified and divided into five separate dimensions and placed into 13 categories based on axial coding. In this model, 5 main categories of financing, providing resources, information and research, servicing and equipping, as well as government agents were identified as the main categories. Also, the managed care status of emerging respiratory infectious disease (Corona) was ranked first and other diseases were ranked next. The managed care of rural centers was significantly better than urban centers. Conclusion: In general, planning to establish these organizations as a private sector of insurance alongside the treatment sector is inevitable, so a model that could facilitate the traditional system and move towards the new system is essential.
