Document Type : Original Article
Authors
Department of Health Services Management, Science and Research branch, Islamic Azad University, Tehran, Iran
Abstract
Background: Strengthening primary health care services for the elderly is vital. In this regard, adequate and sustainable financing is necessary for primary health care. Therefore, the present study aimed to investigate the methods of financing primary health care for the elderly in Iran in 2021.
Methods: This is a mixed method cross-sectional study carried out in 2021 with a combination of quantitative and qualitative data. The sample size was estimated to be 254 subjects. Sampling was done in a stratified manner. The studied variables were the result of a comparative study and interview. In this study, to measure the construct validity, exploratory and confirmatory factor analysis method was used. Data were analyzed using SPSS-21 and AMOS-24 software.
Results: The results of exploratory factor analysis showed that all variables had factor loadings above 0.3. The results of the second-order confirmatory factor analysis showed that all the items of primary health care financing for the elderly were approved. These items include the allocation of GDP to cover part of the costs of old age care, tax collection, social insurance coverage for the disabled and retired, allocation of subsidies to vulnerable groups, private and supplementary insurances, transfer of employee insurance premiums to medical funds to cover the health and medical expenses in old age, the use of municipal and governorate budgets, and incentive policies. The results showed that the use of municipal and governorate budgets and incentive policies had the highest (0.726) and the lowest (0.531) standard coefficients, respectively.
Conclusion: The findings of the study show that the construct validity of the designed model has a good level. Using this model by managers, policymakers, and health planners can improve the financing of primary health care services for the elderly and thus meet their health needs.
Highlights
Samin Nobakht (Google Scholar)
Leila Riahi (Google Scholar)
Keywords
- Padayachey U, Ramlall S, Chipps J. Depression in older adults: prevalence and risk factors in a primary health care sample. South African family practice. 2017;59(2):61-6. doi: 1080/20786190.2016.1272250.
- Borba AKdOT, Arruda IKG, Marques APdO, Leal MCC, Diniz AdS. Knowledge and attitude about diabetes self-care of older adults in primary health care. Cien Saude Colet. 2019;24:125-36. doi: 1590/1413-81232018241.35052016. PMID: 30698247.
- Shokry AAE, Adel MR, Rashad AE-sA. Educational program to improve quality of life among elderly regarding oral health. Future Dental Journal. 2018;4(2):211-5. doi: 1016/j.fdj.2018.07.002.
- Wang L, Guruge S, Montana G. Older immigrants’ access to primary health care in Canada: A scoping review. Can J Aging. 2019;38(2):193-209. doi: 1017/S0714980818000648. PMID: 30777582.
- Gholipour Z, Farahani MMMA, Riahi L, Hajinabi K. Active ageing management in Iran: Designing a model. Asia Pacific Journal of Health Management. 2020;15(2):61-70. doi: 24083/apjhm.v15i2.359.
- Safdari R, Shams Abadi AR, Pahlevany Nejad S. Improve health of the elderly people with M-health and technology. Iranian Journal of Ageing. 2018;13(3):288-99. doi:32598/sija.13.3.288.
- Kalantari AR, Mehrolhassani MH, Shati M, Dehnavieh R. Health service delivery models for elderly people: A systematic review. Med J Islam Repub Iran. 2021;35:21. doi: 47176/mjiri.35.21. PMID: 34169033. PMCID: PMC8214038.
- Emami S-A, Motevalian SA, Momeni M, Karimi H. The epidemiology of geriatric burns in Iran: A national burn registry-based study. Burns. 2016;42(5):1128-32. doi: 1016/j.burns.2016.03.011. PMID: 27126815.
- Amini R, Chee KH, Sen K, Ingman SR. Elder care in Iran: a case with a unique demographic profile. J Aging Soc Policy. 2021;33(6):611-25. doi: 1080/08959420.2020.1722896. PMID: 31992153.
- Gholipour Z, Mahmoodi Majd Abadi Farahani M, Riahi L, Hajinabi K. Factors Affecting in Providing Active Aging Services in Iran. Journal of healthcare management. 2019;10(2):61-72.
- Banerjee D. The impact of Covid‐19 pandemic on elderly mental health. Int J Geriatr Psychiatry. 2020;35(12):1466. doi: 1002/gps.5320. PMID: 32364283. PMCID: PMC7267435.
- Miller KL, Baraldi CA. Geriatric gynecology: promoting health and avoiding harm Am J Obstet Gynecol. 2012;207(5):355-67. doi: 1016/j.ajog.2012.04.014. PMID: 22607665.
- Kostopoulos P, Kyritsis AI, Ricard V, Deriaz M, Konstantas D. Enhance daily live and health of elderly people. Procedia computer science. 2018;130:967-72. doi: 1016/j.procs.2018.04.097.
- Onay O, Aydin C. The distribution of geriatric problems in otolaryngology and their alteration from young adults. Niger J Clin Pract. 2021;24(5):640-. doi: 4103/njcp.njcp_509_19. PMID: 34018971.
- Hosseinzadeh M, Koohpayehzadeh J, Ghafour MY, Ahmed AM, Asghari P, Souri A, et al. An elderly health monitoring system based on biological and behavioral indicators in internet of things. Journal of Ambient Intelligence and Humanized Computing. 2020:1-11. doi: 1007/s12652-020-02579-7.
- Gao Q, Prina AM, Ma Y, Aceituno D, Mayston R. Inequalities in older age and primary health care utilization in low-and middle-income countries: a systematic review. I Int J Health Serv. 2022;52(1):99-114. doi: 1177/00207314211041234. PMID: 34672829. PMCID: PMC8645300.
- Rahimi H, Kalantari A, Rafiee N, Khosravi S. Social trends affecting the future of Iran's health system: A qualitative study using focus group discussion. Int J Prev Med. 2019;10:115. doi: 4103/ijpvm.IJPVM_322_18. PMID: 31367279. PMCID: PMC6639845.
- Bahador F, Mahfoozpour S, Masoudiasl I, Vahdat S. A Systematic Review of the Management of Preventive Health Care for the Elderly in the World. Iranian Journal of Ageing. 2022;16(4):592-607. doi: 32598/sija.2021.3180.2.
- Pettigrew LM, De Maeseneer J, Anderson M-IP, Essuman A, Kidd MR, Haines A. Primary health care and the Sustainable Development Goals. Lancet. 2015;386(10009):2119-21. doi: 1016/S0140-6736(15)00949-6. PMID: 26638948.
- Amado CAdEF, Dos Santos SP. Challenges for performance assessment and improvement in primary health care: the case of the Portuguese health centres. Health policy. 2009;91(1):43-56. doi: 1016/j.healthpol.2008.11.008. PMID: 19118917.
- Takian A, Doshmangir L, Rashidian A. Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract. 2013;30(5):551-9. doi: 1093/fampra/cmt025. PMID: 23788202.
- Noorihekmat S, Rahimi H, Mehrolhassani MH, Chashmyazdan M, Haghdoost AA, Tabatabaei SVA, et al. Frameworks of performance measurement in public health and primary care system: A scoping review and meta-synthesis. Int J Prev Med. 2020;11. doi:4103/ijpvm.IJPVM_34_19. PMID: 33312474. PMCID: PMC7716605.
- Rahimi H, Haghdoost A, Noorihekmat S. A qualitative study of challenges affecting the primary care system performance: Learning from Iran's experience. Health Sci Rep. 2022;5(2):e568. doi: 1002/hsr2.568. PMID: 35308421. PMCID: PMC8919451.
- Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. Family medicine in Iran: facing the health system challenges. Glob J Health Sci. 2015;7(3):260. doi: 10.5539/gjhs.v7n3p260. PMID: 25948450. PMCID: PMC4802109.
- Rahimi H, Bahmaei J, Shojaei P, Kavosi Z, Khavasi M. Developing a strategy map to improve public hospitals performance with balanced scorecard and DEMATEL approach. Shiraz E Medical Journal. 2018;19(7):e64056. doi: 5812/semj.64056.
- Kraef C, Kallestrup P. After the Astana declaration: is comprehensive primary health care set for success this time? BMJ Glob Health. 2019;4(6):e001871. doi: 1136/bmjgh-2019-001871. PMID: 31799000. PMCID: PMC6861067.
- Rahimi H, Goudarzi R, Noorihekmat S, Haghdoost A, Khodabandeh F. Inequality in households’ access to primary health care (PHC): a case study in Kerman, southeast Iran. BMC Health Serv Res. 2022;22(1):1-11. doi: 1186/s12913-022-08467-4. PMID: 35999541. PMCID: PMC9400231.
- Santos MARd, Salomon VAP, Marins FAS. Analytic network process and balanced scorecard applied to the performance evaluation of public health systems. Pesquisa Operacional. 2015;35:353-61. doi: 1590/0101-7438.2015.035.02.0353.
- Zoghtalab Hassas S, Riahi L, Nazarimanesh L, Tabibi SJ. Review Structure of Health Care Services Services Related to the Elderly People With Emphasis on Financing. Iran J Health Insur. 2021;4(3):231-40.
- Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, et al. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health. 2022;10(5):e715-e72.doi: 1016/S2214-109X(22)00005-5. PMID: 35390342. PMCID: PMC9005653.
- Aregbeshola BS. A tax-based, noncontributory, health-financing system can accelerate progress toward universal health coverage in Nigeria. MEDICC Rev. 2018;20:40-5. doi: 37757/MR2018.V20.N4.9. PMID: 31242171.
- Uzochukwu B, Ughasoro M, Etiaba E, Okwuosa C, Envuladu E, Onwujekwe O. Health care financing in Nigeria: Implications for achieving universal health coverage. Niger J Clin Pract. 2015;18(4):437-44. doi: 4103/1119-3077.154196. PMID: 25966712.
- Duku SKO, van Dullemen CE, Fenenga C. Does health insurance premium exemption policy for older people increase access to health care? Evidence from Ghana. J Aging Soc Policy. 2015;27(4):331-47. doi: 1080/08959420.2015.1056650. PMID: 26161589.
- Edelman A, Marten R, Montenegro H, Sheikh K, Barkley S, Ghaffar A, et al. Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context. Health Policy Plan. 2021;36(7):1163-86. doi: 1093/heapol/czab075. PMID: 34185844. PMCID: PMC8344743.
- Asante A, Price J, Hayen A, Jan S, Wiseman V. Equity in health care financing in low-and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PloS one. 2016;11(4):e0152866. doi: 1371/journal.pone.0152866. PMID: 27064991. PMCID: PMC4827871.
)