نوع مقاله : مقاله پژوهشی
نویسندگان
1 دانشجوی دکتری تخصصی، مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی درمانی، دانشکده علوم پزشکی، واحد سمنان، دانشگاه آزاد اسلامی، سمنان، ایران
2 دانشیار، مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی درمانی، دانشکده علوم پزشکی، واحد سمنان، دانشگاه آزاد اسلامی، سمنان و مرکز تحقیقات سیاستگذاری اقتصاد سلامت، واحد علوم پزشکی، دانشگاه آزاد اسلامی، تهران، ایران
3 دانشیار، مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی درمانی، دانشکده علوم پزشکی، واحد سمنان، دانشگاه آزاد اسلامی، سمنان، ایران
4 دانشیار، اقتصاد، گروه اقتصاد، دانشکده اقتصاد، واحد سمنان، دانشگاه آزاد اسلامی، سمنان، ایران
چکیده
مقدمه: با توجه به فراوانی بروز و شیوع و ماهیت خاص بیماریهای قلبی- عروقی در کشورمان و تعدد، تنوع، پیچیدگی و گرانقیمت بودن خدمات و تجهیزات تشخیصی و درمانی، امکان القای تقاضا در این دسته از بیماریها بیشتر است. پژوهش حاضر با هدف آزمون رویکرد حداقل مربعات جزیی عوامل مرتبط با تقاضای القایی در بیماریهای قلبی- عروقی و ارایه الگویی از ارتباط این عوامل انجام شد.روش بررسی: این مطالعه از نوع کتابخانهای با مرور 39 مقاله و سپس پیمایشی با نمونه 118 نفره بود. ابتدا به وسیله فن تحلیل محتوای کیفی، فهرستی از عوامل، زیرعاملها و مؤلفههای مرتبط با تقاضای القایی استخراج گردید. سپس با تکمیل پرسشنامه رواسازی شده توسط پزشکان، کارشناسان، کارکنان و مراجعان به بیمارستان قلب شهید چمران اصفهان در سال 1398، با استفاده از فن تحلیل مسیر، مدل برازش و الگوی نهایی با نظر متخصصان معتبرسازی شد.یافتهها: در تحقیق حاضر، 5 عامل اصلی و 18 عامل فرعی و 82 گویه به دست آمد. در برازش مدل اندازهگیری، ضرایب پایایی ترکیبی، روایی متقاطع، همگرا و واگرای نتایج آزمون مطلوب و در برازش مدل ساختاری نیز ضرایب مسیر به جزء در مسیر «بیماران»، مقادیر در سطح اطمینان 95 درصد معنیدار و میانگین ضریب تعیین مدل، 822/0 (قوی) و شاخص تناسب پیشبین به جزء در مورد ویژگیهای خدمات درمانی، بیشتر از 02/0 و از حد قابل قبولی برخوردار بود. نتیجه بررسی برازش کلی، 133/0 گزارش گردید که نشان دهنده مطلوبیت برازش کلی متوسط مدل بود. اعتبار الگوی نهایی ارایه شده با 77 درصد توافق نظر متخصصان، مورد تأیید قرار گرفت.نتیجهگیری: بر اساس نتایج به دست آمده از پژوهش، ضروری است در سطح کلان، سیاست مناسب جهت اصلاح ساختار شبکه و ارجاع و تقویت مدیریت اطلاعات اتخاذ گردد و در سطوح اجرایی نیز نسبت به اصلاح روشهای پرداخت، تغییر تعرفه و فرانشیز و تغییر روشهای بیمهگری و پوششهای آن اقدامات لازم صورت گیرد.
کلیدواژهها
عنوان مقاله [English]
Investigation the Factors Related to Induced Demand for Patients with Cardiovascular Diseases
نویسندگان [English]
- Hamed Asgari 1
- Nader Khalesi 2
- Amir Ashkan Nasiripour 3
- Reza Ziyari 4
1 PhD Student, Health Services Management, Department of Health Services Management, School of Medical Sciences, Semnan Branch, Islamic Azad University, Semnan, Iran
2 Associate Professor, Health Services Management, Department of Health Services Management, School of Medical Sciences, Semnan Branch, Islamic Azad University, Semnan AND Health Economics Policy Research Center, Medical Sciences Branch, Islamic Azad University, Tehran, Iran
3 Associate Professor, Health Services Management, Department of Health Services Management, School of Medical Sciences, Semnan Branch, Islamic Azad University, Semnan, Iran
4 Associate Professor, Economics, Department of Economics, School of Economics, Semnan Branch, Islamic Azad University, Semnan, Iran
چکیده [English]
Introduction: Due to the frequency, prevalence, and specific nature of cardiovascular diseases in our country, and the multiplicity, variety, complexity, and high cost of diagnostic and therapeutic services and equipment, the possibility of inducing demand in this category of diseases is higher. Using the partial least squares approach, this study aimed to test the factors affecting the induced demand in cardiovascular diseases, and provide a model of the relationship between these factors.Methods: This was a library study with a systematic review of 49 articles, and then a survey of 118 people selected via random sampling method. First, a list of factors, sub-factors and components related to induced demand was extracted using qualitative content analysis technique; and then, using analysis technique, the path of the fitting model and the final model were validated by completing a validated questionnaire by physicians, experts, staff, and clients of Shahid Chamran Heart Hospital in Isfahan, Iran, in 2019.Results: In this study, 5 main factors, 18 sub-factors, and 82 items were obtained. In fitting the measurement model, the combined reliability coefficient, cross validity, convergent, and divergent the results of test was acceptable, and in structural fit model, path coefficients were significant, except for “patients” coefficient, at the 95% confidence, the mean model determination coefficient was 0.822 (strong), and the predictive fit index, except for the characteristics of medical services, was greater than 0.02 (acceptable). The result of the overall fit test was 0.133, which indicated the desirability of the overall fit of the model. The validity of the final model was confirmed with 77% agreement of experts.Conclusion: Based on the findings of this study, it is necessary to adopt an appropriate policy at the macro-level to reform the network structure and referral and strengthen information management, and at the executive level, to modify payment methods, change tariffs and franchises for services, and change insurance methods and coverage.
کلیدواژهها [English]
- Induced Demand
- Health Care System
- Patients
- Cardiovascular Diseases
- Insurance
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