Background: Electronic referral system (e-Referral system) in Iran was launched to increase access to care and improve interaction. Objectives: The present study aimed to design an appropriate model for evaluating the performance of the e-Referral system in Iran. Methods: This study was conducted in three stages: 1) review of literature related to electronic referral systems, 2) qualitative phase, and 3) quantitative phase. Participants in the qualitative phase included 42 managers, policymakers of the Ministry of Health, medical universities, service providers, and recipients who were purposively selected for this study. Data were analyzed through content analysis. In the quantitative phase, the target group consisted of 604 staff of medical universities implementing the e-Referral system. Data were analyzed using the EQS (version 6. 3) and SPSS (version 20) software. Chi-square test, degree of freedom, the goodness of fit index, root mean square error, adjusted goodness of fit index, and the Friedman test were used to investigate the suitability of the model. Results: Fourteen main themes were identified and classified for the model design Based on the results of the present study. The components of developing rules and regulations, stakeholder advocacy, economic evaluation, and quality of health services had average ratings of 13. 99, 13. 00, and 11. 35, respectively, regarding their role in designing the evaluation model for the e-Referral system in Iran. Conclusion: The results of structural equation modeling showed that the components play an essential role in designing the performance evaluation model of e-Referral in the Iranian health system. This study addressed various aspects affecting the e-Referral and provided the possibility of performance evaluation in the health sector in a principled and systematic format. Health managers and policymakers can use the present study findings to discover the strengths and weaknesses of the e-Referral performance.

Background and Purpose: The electronic referral system was established in Iran with the aim of increasing access to care, improving interaction, and efficient use of resources. The purpose of this study was to determine the effective factors in the establishment and implementation of electronic referral system in Iran. Materials and Methods: The present study was qualitative with a content analysis approach. In order to collect information, in-depth and semi-structured interviews were used. After interviewing 42 people, the information was saturated. The interviews were transcribed and analyzed, and the main topics were quoted, cited and coded. Content analysis method was used and all authors participated in the analysis process to avoid bias and agreement. Results: Four main themes and eleven sub-themes were mentioned as effective themes in the implementation of the electronic referral system by the interviewees including resource management (human resource management, financing and equipment and infrastructure), stewardship (policy-making, inter-sectorial leadership and intra-sectorial governance), advocacy stakeholders (senior officials and policy-makers related to the program, service providers, community), and social commitment (commitment and accountability of service providers). Conclusions: Successful implementation of electronic referral systems requires the development of an operational plan that correctly identifies the factors affecting the establishment and implementation, as well as the cooperation of all responsible organizations which can help improve the establishment and sustainability of the program. It is suggested that managers and officials active in the field of health services use the results of this study in the establishment and implementation of electronic referral system.

Objective: The payment system of specialist physicians has significant effects on the country's health costs and the provision of medical care at a fair, sufficient and high-quality level. This study was conducted to design the payment system's implementation guidelines for providing specialized services in the electronic referral system. Methods: A qualitative study was conducted in 2021. The participants were hospital managers, top managers and experts in charge of health, treatment and development departments of Ministry of Health and Golestan University of Medical Sciences, Health Insurance Organization of Golestan province, specialist physicians and faculty members. Fourteen focus group discussion and six in-depth individual interviews were conducted. The content analysis method was used to analyze the data. Results: The requirements for the establishment of an efficient and effective payment system were classified into 6 main themes (legal, political, managerial, executive, economic, cultural and social) and 32 subcategories. The executive mechanism was classified into 3 main themes (executive structure, executive process and monitoring and evaluation method) and 16 subclasses. Conclusion: The implementation of the designed instruction can lead to increasing the access and benefit of services, improving the quality of providing specialized services, cost management and finally increasing the satisfaction of service providers and receivers.