The Effect of Health Policy and Structure of Health Insurance on Referral System in the Urban Family Physician Program in Iran

The importance of the referral system in the health system is very high so that it is stated that 80 to 90% of the first-level health care clients are diagnosable and treatable. Therefore, Referral system in the health system is very important so that it is mentioned that 80 to 90 percent of patients in the first level of health cares are recognizable and treatable. Therefore, modification of referral system can reduce greatly amount of specialist and supersonic referral of hospitals. The purpose of this paper is to investigate on the Effect of Health Policy and structure of health insurance on referral system in the Urban Family Physician Program in Iran in order to improve and develop the first, second, and third level services of the referral system in Iran.
The present study is a descriptive-correlation research. The policy makings conducted, as well as the status of the insurance system of different countries was extracted through systematic identification of the Urban Family Physician's referral system. Then the effects of these factors on the referral system were identified using a researcher-made questionnaire and statistical analysis of factor analysis and T test. Statistical population was included 400 subjects who were expert on family physicians at the national level. The Data Sufficiency was evaluated by the Kaiser-Meyer-Olkin’s (KMO) test. Reliability of test was calculated and confirmed according to Cronbach's Alpha and Combined Reliability (CR). Also, the validity of the test was calculated and confirmed according to the average variance extracted (AVE).
The effect of proper health insurance structure and transparent financial rules on the referral system of the urban family physician and proper health system’s policy makings were proved through coefficients of 0.860 and 0.804, respectively. In the health policy factor, the most important variable is the question number 9 on supervision of the provision of services at first, second, and third level of referring in which factor loading is 0.774.also, in the insurance structure dimension , the most important variable is the question number 12 on applying restrictions in order to refer patients in the pharmacy clinic having in which factor loading is 0.793.
It can be calculated that proper health insurance structure and proper health system’s policy play important roles for success and improving referral system of urban family physician.