تاثیر تغییر در مکانیزم پرداخت برعملکرد مراقبتهای درمانی سرپایی مراکز بهداشتی و درمانی روستایی مجری طرح پزشک خانواده در شهرستانهای ساری و جویبار

Background and purpose: From the second half of 2005, family medicine as reform in primary health care sector was introduced for all rural as well as towns with less than 20000 population in order to improve the performance of this system particularly curative care. In this reform both the method of employment and the payment mechanism that could potentially change the performance of family medicine team were changed. In this paper change in the performance of health centers in ambulatory care before and after the implementation of reform in two cities (Mazandran province) is compared. Materials and methods: This investigation includes two case studied in two cities. Data of 30 rural health centers in Sri and 12 in Joybar were gathered. The collected data were based on existing data of Iran’s primary health network information system. A check list was used for data collection. These data were related to one year before the implementation of scheme and three years after the date that the scheme was started. Results: A substantial increase in the number of patients visited by physician had happened that is about 6 times higher than their performance in the same centres before the reform. A change of about two times increase in the provided services of lab and injection and wound dressing unit had also happened. Conclusion: In this study, health care providers of health centres under the same conditions of primary health care delivery behaved differently so that their performance improved about 6 times compared to prior the reform. The changes, with fewer slopes, were seen on other curative care including lab and injection and wound dressing services.