Economic Reform Strategies to Improve the Performance of Surveillance and Infrastructure for Implementation of New Fee for Service Guidelines, 2014: A Qualitative Study

In year 1995, new hospital administration plan system (fee for service) was notified. Under the scheme, a dedicated percentage of specific revenues allocated as a fee for the hospital staff. In the early September 2014, new guidelines as performance-based fee for service plan with the aim to fix the deficiencies in the previous plan was reviewed and implemented in hospitals in Isfahan, Iran. This study aimed to investigate strategies for economic reforms to promote performance monitoring and improve infrastructure for implementation of the new fee for service guidelines in 2014.
In this qualitative study, in-depth interviews were used to collect the data. Eleven samples consisting of middle managers and senior headquarters of university hospitals, and some faculty members and hospital officials were chosen via purposive sampling method. All interviews were recorded and then written on paper. The duration of interviews varied between 30 to 60 minutes. Data analysis in this research was based on content analysis.
In this study, six main themes of strategies for economic reforms to promote performance monitoring and improve infrastructure for implementation of the new fee for service guidelines were obtained including payment system reform, price reform, defined package of services in public hospitals, financial and economic policies, reform and implementation of family physician referral system, and support of the insurers.
Our results define strategies for economic reforms to promote performance monitoring and improve infrastructure for implementation of the new fee for service guidelines. The most notable findings include pay reform, price reform, and financial and economic policies. These findings can help policy makers to consider the proposed revisions with appropriate strategies to monitor and improve the implementation of new fee for service plan.