The effective features of access to medical care in Iran

Objective: Access to medical care is recognized as a fundamental requirement in the health system. The purpose of this study was to improve people's access to medical care through determining the features inşuencing the access to medical care and its subcomponents and preparing a proper model for public hospitals in Iran.

Methods: The sample size was 406 patients and 401 experts of Iran's public hospitals chosen by a multistage sampling method, in which the country was divided in to 5 regions of the North, South, Center, West, and East. By giving two shares to each region, two hospitals were chosen from each region, then from each hospital 40 patients and experts were chosen separately. To collect data, the researcher prepared a questionnaire to be used. To evaluate the validity of the questionnaires, expert tips, content validity and the factorial analysis method were utilized and in order to evaluate the reliability of the questionnaire the Cronbach alpha coefficient was used. In this study, the Cronbach alpha coefficient of the questionnaire was calculated to be 0.88 for patients and 0.80 for experts, which was very satisfactory. The data were analyzed by the SPSS software and Lisrel through the factor analysis method.

Results: Based on the responses of 401 patients and 406 experts, the current situation of access to medical care in the public hospitals of Iran has lower than average quality and most of the patients and experts gave a low rating to each of the 5 factors of accessibility in the current situation. In addition, the findings showed that the structure of access to medical care in Iranian public hospitals has a 5-dimensional structure containing individual characteristics, service providing system, social-geographic features, health policy making and management strategies. The relationship among the 5 dimensions was meaningful from 0.13 for the correlation of health policy making with the individual characteristics to 0.40 for the correlation of health policy making with the management strategies.

Conclusions: The findings show that the service providing system had the highest quality and was the most effective factor on having access to medical care structure. It seems that it can be helpful to pay attention to the above factors especially in programming and policy making to improve access to medical care by distributing the standardized number of beds and specialists based on the population of each region, training, organizing, and managing the human resources, and improving the service providing system process.