Authors

  • Fatemeh Sajjadi Department of Community Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran & Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
  • Fereidoun Azizi Department of Endocrine Diseases, Shaheed-Beheshti University of Medical Sciences, Tehran, Iran & Research Institute for Endocrine Sciences, Endocrinology Research Center, Shaheed-Beheshti University of Medical Sciences, Tehran, Iran.
  • Hamid R Baradaran Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
  • Marzieh Nojomi Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
  • Maziar Moradi-Lakeh Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran & Gastro-Intestinal and Liver Disease Research Centre, Iran University of Medical Sciences, Tehran, Iran.
Abstract:

Background: World Health Organization (WHO) defines three goals to assess the performance of a health system: the state of health, fairness in financial contribution and responsiveness. We assessed the responsiveness of health system for patients with diabetes in a defined population cohort in Tehran, Iran. Methods: Total responsiveness and eight domains (prompt attention, dignity, communication, autonomy, confidentiality, choice, basic amenities and discrimination) were assessed in 150 patients with diabetes as a representative sample from the Tehran Glucose and Lipid Study (TLGS) population cohort. We used the WHO questionnaire and methods for analysis of responsiveness. Results: With respect to outpatient services, 67% (n=100) were classified as Good for total responsiveness. The best and the worse performing results were related to information confidentiality (84% good responsiveness) and autonomy (51% good responsiveness), respectively. About 61% chose “communication” as the most important domain of responsiveness it was on the 4th rank of performance. The proportions of poor responsiveness were higher in women, individuals with lower income, lower level of education, and longer history of diabetes. “Discrimination” was considered discrimination as the cause of inappropriate services by 15%, and 29% had limited access to services because of financial unaffordability.  Conclusion: Health system responsiveness is not appropriate for diabetic patients. Improvement of responsiveness needs comprehensive planning to improve attitudes of healthcare providers and system behavior. Activities should be prioritized through considering weaker domains of performance and more important domains from the patients’ perspective.

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Journal title

volume 29  issue 1

pages  1137- 1149

publication date 2015-01

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