The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

BACKGROUND: When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. OBJECTIVES: This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). MATERIALS AND METHODS: This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. RESULTS: Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. CONCLUSIONS: With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model.