Executive instruction for the payment mechanism of outpatient services in the electronic referral system in Iran

The payment system of specialist physicians has significant effects on the country's health costs and the provision of medical care at a fair, sufficient and high-quality level. This study was conducted to design the payment system's implementation guidelines for providing specialized services in the electronic referral system.

A qualitative study was conducted in 2021. The participants were hospital managers, top managers and experts in charge of health, treatment and development departments of Ministry of Health and Golestan University of Medical Sciences, Health Insurance Organization of Golestan province, specialist physicians and faculty members. Fourteen focus group discussion and six in-depth individual interviews were conducted. The content analysis method was used to analyze the data.

The requirements for the establishment of an efficient and effective payment system were classified into 6 main themes (legal, political, managerial, executive, economic, cultural and social) and 32 subcategories. The executive mechanism was classified into 3 main themes (executive structure, executive process and monitoring and evaluation method) and 16 subclasses.

The implementation of the designed instruction can lead to increasing the access and benefit of services, improving the quality of providing specialized services, cost management and finally increasing the satisfaction of service providers and receivers.