Document Type : Original Article
Authors
1 Health Economics, Health Management and Economics Reseach Centre, Isfahan Unversity of Medical Sciences, Isfahan, Iran
2 Lecturer, Midwife, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Lecturer, Midwife, Shahid Sadoughi University of Medical Sciences And Health Services, Yazd, Iran.
4 Lecturer, Midwife, Reproductive Health Research Center, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran.
Abstract
Introduction: Effective use of human resources is considered as a key factor in the efficiency of
health systems. Accessibility to affordable services for individuals according to their needs is also
regarded as a sign of equitable health care system. Providing health services, particularly
reproductive health, for women as a vulnerable population is one of the main priorities for health
policy makers. Gynecologists and midwives are well-trained and have some common skills to
provide women with reproductive health services. The aim of this study was to undertake a costservice analysis of these services from efficiency perspective.
Methods: This study was performed in three phases. The educational curricula of midwifery and
gynecology were first reviewed and compared. Then, a 20-item questionnaire was designed and
its validity and reliability were confirmed. Finally, the questionnaire was used to collect data
from 261 randomly selected women in reproductive age who were visited by gynecologists or
midwives in their offices. The collected data was analyzed by SPSS.
Results: Overall, 14 common services which could be provided by both gynecologists and
midwives were identified. Mean age of patients was 28 years and 65% of them were covered by
health insurance services. Genital infection and pregnancy care were the most common causes
why women referred to gynecologists or midwives. While the most common reason for choosing
gynecologists was their confidence in their skills, it was the affordable fee for selecting midwifes.
Midwifery patients had shorter waiting time, longer visit length and lower payment rates in all 14
services.
Conclusion: The results of this study showed that spending specialists' time for common cases
with longer waiting time and higher payment rate could be considered as an important source of
inefficiency in reproductive health services. Therefore, development of an effective referral
system from midwives to gynecologists and providing insurance coverage for midwifery services
could improve the efficiency of reproductive health services and save more than 250 million
dollars annually for the country.
Keywords
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