Designing an Informal Payment Model for Patients Admitted in the Iran Health System: A qualitative Study

Area of Science:

• Health Economics
• Health Services Research
• Public Health Policy

Background:

• Healthcare systems worldwide utilize diverse out-of-pocket (OOP) spending mechanisms.
• Understanding OOP expenditure is crucial for patient financial protection and health system sustainability.
• Iran's health system, like others, faces challenges in managing patient OOP payments.

Purpose of the Study:

• To design and validate a comprehensive out-of-pocket payment model for patients admitted to the Iranian health system.
• To identify the critical factors influencing OOP expenses for hospitalized patients.
• To provide a framework for policy interventions aimed at mitigating patient financial burden.

Main Methods:

• A mixed-methods approach combining qualitative and quantitative research.
• Qualitative phase: 30 experts interviewed using snowball sampling until data saturation.
• Quantitative phase: Survey of 212 Ministry of Health managers; questionnaire validated using exploratory and confirmatory factor analysis, reliability assessed via Cronbach's alpha and composite reliability; model fit evaluated using KMO, Bartlett's test, CFI, and IFI.

Main Results:

• Extraction of 6 main themes, 20 concepts, and 120 sub-themes related to OOP payments for hospitalized patients.
• Statistical analysis confirmed model adequacy: Chi-square/df ratio (1.899), CFI, IFI, and SRMR (0.1153) indicated acceptable model fit.
• The model effectively captures the multifaceted nature of OOP payment determinants.

Conclusions:

• The developed paradigm model highlights causal, underlying, intervening factors, pivotal categories, strategies, and consequences of OOP payments.
• The findings underscore the need for a holistic approach to reduce OOP expenditure for hospitalized patients.
• Implementation of this model is recommended to inform policies and interventions for financial protection of patients in Iran.