Family Payment System

Discussion

The experiences of other countries about Family Physician program shows that it contains a wide range of reforms for organizing the health care services that subsequently, result in considerable reduction in health system costs ( forrest CB).4

Developing and choosing an appropriate payment system at any level of the health system is a critical issue. Payment systems have to be adapted with hierarchy of policy priorities and practical considerations. Selected payment system and applied incentives should be coordinated with goals of health sector and also improve the clinical knowledge, cultural level and ethical principles ( 35). Findings of the study suggested four major concepts about payment system of family physician program:

Although a large number of them believed that the payment system has been emphasized on capitation, some expressed that fee for service system has been used to pay health team members and some experts suggested the performance-based system. It seems that not providing a clear definition of how to pay family physicians in the documents is the main reason of this incompatibility. While, salary is emphasized in the text of Family Physician policy, according to interviewee the payment is based on the number of delivered services that it indicates the fee for service system. According to experts, the main payment system in Family Physician is the capitation but fee for service and bounce were used for limiting the quality reduction and decreasing the reluctance of physicians. No payment system can compensate the complicated and important functions of physicians (39). Hence, many countries that have implemented the Family Physician Payment system use the Mixed Payment that contains salary, per capita and fee for service. The advantages of this system are the motivation of physicians, prevention of unnecessary visits and improving the quality care and diagnosis

(Giuffrida A) Findings of study showed that the defined payment rates are not correct because they were determined regardless of appropriate technical methods and will lead to oppression against members of the health team. Most experts suggested that payments are too low while the load of physician’s workload is greater and, it results in dissatisfaction of them. In addition, midwifes as the main members of health team have many inappropriate tasks and unsatisfying payment leads to their displeasure and finally, as some studies indicated they leave the health team in order to study in a specialized school. (Hossein