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Year : 2013  |  Volume : 1  |  Issue : 1  |  Page : 7-10

Evaluation of insured errors in the referral system of villages and towns populated under twenty thousand in Isfahan, using the failure mode and effects analysis model

1 M. S. Students of Health Care Management, Tehran University of Medical Science, School of Public Health, Tehran, Iran
2 Yazd University of Medical Science, Yazd, Iran
3 Expert of Isfahan Medical Services Insurance Organization, Isfahan, Iran

Correspondence Address:
Elnaz Kalantari
Tehran University of Medical Science, Isfafan
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Source of Support: Health Management and Economic Research Center of Isfahan University of Medical Sciences, Conflict of Interest: None

DOI: 10.4103/2347-9019.122416

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Introduction: The best strategy for implementing rural insurance program in the form of referral system is "Family Physician". Since, there were both background and culture of referral system in the villages, the researchers decided to implement the mentioned program at first in the villages. This study intends to evaluate the insured errors through Failure Mode and Effects Analysis (FMEA) model. Materials and Methods: The present research is applied one, the study type is cross-sectional, and it is an action research (using Delphi technique, nominal group, and brainstorming). The population of the study consisted of the experts in the villages and towns populated under 20,000 employed at Isfahan Medical Services Insurance Organization and also experts of Health Centers in the province and number one townships. Sample size and sampling methods were 17 selective accessible in time and place. The research data was collected through a worksheet which was made according to the identified errors. The validity of FMEA worksheet has been confirmed by the experts and its reliability has been approved because of its wide use by many researchers in the field of health in other countries. The research data was collected through observations, literature review, focus group discussion, and brainstorming for the purpose of scoring the potentials of insured errors in the process of referral system during last year. Findings: The findings of the study revealed that the highest and the lowest risk priority number in order counted for "receiving the services from a noncontracted paraclinic" (25.7%) and "visiting a family physician who does not support the area" (13.94%). Conclusion: As the results indicate, most errors in the referral system are related to the patient (the insured person) and the high percentage of his visits to a higher level healthcare system. So, family physician is to suggest a higher level of health system only in necessity, because in the case of visiting the second and third levels directly, many resources will be wasted.

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