Assessment of Referral System in Rural Family Medicine Program Based on the Comprehensive Care Criterion

In the current study, the referral system in family medicine program was assessed based on the criterion of comprehensive health care services on data from 17 health centers in Gorgan city, Iran.
First, the indices of referral system failure and family medicine characteristics for comprehensive care were introduced. Then, the regression correlation between referral failure and explanatory variables of comprehensive care in a panel data model with error-correction framework was considered, using monthly records of the Gorgan health centers from 2011 to 2012. Based on the employed model, the difference between coefficients in a monthly (long-run) and less than a month (short-run) trends was detectable.
In the monthly trend, 10% increase in the number of family physicians reduced referral failure by 4.3%. On the contrary, the effect of 10% increase in the number of nurses and midwives, and similarly medical laboratory services on the failure of the program was negligible, 0.2%, and 1.5%, respectively. The weight coefficient of physicians in monthly trend was more than other factors, 51%.
The difference between family medicine program and health network development program can be described in the comprehensive care prompted by family physicians and the associated team services. This difference indicated the priority of family medicine program over the health network services. The lower effects of physicians’ assistants, compared with family physician services, on the improvement of referral system could be considered as the difficulties of health system development in Iran.