Referral System in Rural Iran: Improvement Proposals

Cad Saude Publica. 2018 Mar 5;34(3):e00198516. doi: 10.1590/0102-311X00198516.


Because of insufficient communication between primary health care providers and specialists, which leads to inefficiencies and ineffectiveness in rural population health outcomes, to implement a well-functioning referral system is one of the most important tasks for some countries. Using purposive and snowballing sampling methods, we included health experts, policy-makers, family physicians, clinical specialists, and experts from health insurance organizations in this study according to pre-determined criteria. We recorded all interviews, transcribed and analyzed their content using qualitative methods. We extracted 1,522 individual codes initially. We also collected supplementary data through document review. From reviews and summarizations, four main themes, ten subthemes, and 24 issues emerged from the data. The solutions developed were: care system reform, education system reform, payment system reform, and improves in culture-building and public education. Given the executive experience, the full familiarity, the occupational and geographical diversity of participants, the solutions proposed in this study could positively affect the implementation and improvement of the referral system in Iran. The suggested solutions are complementary to each other and have less interchangeability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Health Personnel
  • Health Policy
  • Health Services Accessibility*
  • Humans
  • Interviews as Topic
  • Iran
  • Primary Health Care
  • Referral and Consultation / organization & administration
  • Referral and Consultation / trends*
  • Rural Health Services / organization & administration*
  • Rural Health Services / trends
  • Rural Population