设计一个国家框架,防止欺诈在伊朗的卫生系统:一个连续的混合方法研究使用定性分析和德尔菲共识共识
Ali Vafaee Najar1, Elaheh Hooshmand2
1Department of Management sciences and health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
BMJ open
|November 20, 2025
概括
制定了一个新的框架,以打击伊朗的卫生系统欺诈行为,重点关注法律明确性,制裁和技术. 这个经过专家验证的模型旨在提高医疗保健的透明度和问责制.
科学领域:
- 卫生政策和治理卫生政策和治理
- 医疗保健管理的管理
- 医疗道德和预防欺诈行为
背景情况:
- 医疗保健系统中的欺诈和不当行为,包括虚假索赔和非正式支付等做法,侵蚀了效率和公众信任.
- 伊朗的卫生系统面临着治理挑战,需要针对欺诈控制制定有针对性的战略.
研究的目的:
- 设计和验证国家框架,防止和控制伊朗卫生系统中的欺诈和不当行为.
- 解决特定的欺诈行为,如过度计费,不必要的处方和受益人操纵.
主要方法:
- 采用了一种连续的混合方法方法,首先是定性访谈,然后是两轮的德尔菲共识过程.
- 这项研究涉及12名定性阶段的专家和31名德尔菲过程的专家,他们都在健康管理和政策方面有着丰富的经验.
主要成果:
- 框架分析确定了六个战略干预类别:文化,教育,法律,技术,保险相关和结构性.
- 德尔菲进程在优先考虑干预方面达成了高度共识,一致同意法律清晰度,可执行的制裁和电子身份验证.
- 最终框架通过六个战略支柱整合了能力建设,加强监督和现代化基础设施.
结论:
- 为伊朗的医疗系统提出了一个经过验证的,特定于环境的反欺诈框架.
- 该框架提供了切实可行的策略,以提高医疗保健的透明度,问责制和弹性.
- 这种模式有可能指导其他低收入和中等收入国家应对类似的医疗保健治理挑战.
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