@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2015;7(4):225-232

Background
… [1-7] All treatment costs are paid by the complementary insurance. The insurance is a service based on a contract between Martyrs and Veterans Foundation and one of the insurance companies [8, 9]. One of the main objectives of the foundation is to investigate the problems in receiving the health and treatment services by the insured people, to reform the insurance conditions and to enhance the people’s status [9]. … [10-13]
Previous Studies
Non-declared
Aim(s)
The aim of this study was to assess the satisfaction level of the family members of the martyrs receiving Para-clinical services as the complementary insurance.
Research type
This is a cross-sectional study.
Research society, place and time
The family members of the martyrs, including the parents, the spouses, and the children received Para-clinical services (laboratory services, imaging services, injection and wound dressing services, physiotherapy, and services in travel), were studied in Tehran, Iran, in 2015.
Sampling method and number
The sample size was estimated 325 persons by satisfaction ratio 50% and accuracy 0.06. Based on the statistical information of Martyrs and Veterans Foundation, the samples were selected randomly. 325 persons had been received the Para-clinical services.
Used devices&materials
Data was collected using a researcher-made questionnaire. Its reliability was confirmed by Chronbach’s alpha equal to 0.84. The questionnaire assessed satisfaction with the received services, satisfaction with the place providing the services, and satisfaction with the refund process. Likert’s five-scale was used as “very low”, “low”, “moderate”, “high”, and “very high”, to investigate the satisfaction level. Then, the information of the subjects was collected in 2 months. Data was analyzed by SPSS 21 software. Chi-square test was used to investigate the correlation between demographic variables and satisfaction with the services, satisfaction with the place providing the services (local distance), and refund. Multiple-regression test was used to determine the effects of different components on the satisfaction level.
Findings by Text
From 1020 family members of the martyrs, 325 persons (31.9%) were received Para-clinical services. (There were 363 received services totally.) 38 persons (11.7%) were simultaneously received two Para-clinical services in their last visit to the health centers. The most used services were laboratory services (52.9%). And following, the most used services were imaging (25.9%), services in travel (9.1%), injection and wound dressing (7.4%), and physiotherapy (4.7%), in succession. The mean age of the users of the services was 60.73±17.42 years (between 10 and 96 years). 112 participants (34.5%) were illiterate. The education levels of 72 participants (22.1%) were diploma and higher. The spouses of 100 martyrs (30.7%) and the mothers of 90 martyrs (27.7%) had used the services more than other persons, in succession. And following, there were the children of 73 martyrs (22.5%) and the fathers of 62 martyrs (19.1%), in succession. 267 (82.5%) and 57 (17.5%) persons, who used Para-clinical services, were employees and non-employees, respectively (Table 1). The levels of the services received from non-governmental and governmental centers were 55.1% and 44.9%, respectively (Table 2). The levels of satisfaction with the received services were “very low” and “low” in less than 10% of the participants. In addition, the highest frequency was in the satisfaction level “very high”. The satisfaction levels of 76.0%, 91.0%, 88.0%, 70.0%, and 81.1% of the participants were “high”, and “very high” in receiving injection/wound dressing, laboratory, imaging, physiotherapy, and travel services, respectively. In satisfaction with the place providing the services (local distance), the satisfaction levels of 73.1%, 68.2%, 60.7%, 58.8%, and 60.6% of the participants were “high” and “very high” in receiving injection/wound dressing, laboratory, imaging, physiotherapy, and travel services, respectively. In the refund service, 118 persons (36.3%) paid for Para-clinical services, of whom 52 persons (44.1%) had requested to refund. In addition, of the persons who had requested the refund 22 persons (42.3%) were received the refund. In the refund process, “high” and “very high” satisfaction levels with laboratory and imaging services were approximately 35% and 40%, respectively. The satisfaction levels with physiotherapy and travel services were approximately 33% and 17%, respectively. The most motivations to be dissatisfied with the received Para-clinical services were no-refund or long payback, to be out of service, hard local or time access, and bureaucracy. In addition, no-refund or non-completed refund in the travel services were the main factor led to the martyrs’ family dissatisfaction with receiving the complementary insurance services (Table 3). There was a fully significant correlation between satisfaction with the place providing the services (local distance) and the resident place (city/country side; p<0.001). However, there was no significant correlation between other demographic variables and satisfaction with the services, the place providing the services (local distance), and refund (p>0.05). As the predicting factors, the demographic variables had no significant effect on the satisfaction level (p>0.05).
Main comparison to the similar studies
There are few studies investigating the veterans’ satisfaction with the services provided by the complementary insurance, generally or in some cities [14]. … [15] The lowest received Para-clinical service is physiotherapy. The utilization of the physiotherapy services in the studied society was low compared to the frequency of the utilization of the services in other parts of the world (4.9 to 8.8% per year) [16, 17]. The lowest satisfaction with the place providing the services was with the place providing physiotherapy services. And following it, there was the places providing imaging services. Approximately, satisfaction with the local distance is the lowest compared to all other services, in such a case that satisfaction levels with the places providing family doctor, midwifery, medication, injection/wound dressing, laboratory, and imaging services are 67%, 74%, 73%, 78%, 60%, and 49%, respectively [18]. The satisfaction level with the local distance was significantly higher in the cities than the country sides. From the viewpoints of the residents in the country sides, the challenges in receiving the primary health services are being on time to receive the services and continuance of the services [19]. Achieving the health services is the main problem especially for the residents in the country sides [20]. The frequency of utilization of the outpatient services in the citizens is higher than the residents in the country sides [21]. In the rate of utilization general outpatient services, specialized services, and Para-clinical services by the citizens, there is no correlation between the income level and the access rate [22].
Suggestions
Other aspects of providing the services such as the quality of the centers providing Para-clinical services should be investigated.
Limitations
Hard communication with the participants was of the limitations for the present study.
Conclusions
The families of the martyrs, who received Para-clinical services via complementary insurance, are relatively satisfied with the services. Nevertheless, the satisfaction levels with the place providing the services (local distance) and, especially, with the refund processes considerably decrease.
Acknowledgments
Statistics Bureau and Health Deputy of Martyrs and Veterans Foundation are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
All the participants voluntarily participated in the study. All forms were nameless and with no personal information.
Funding Sources
The study was funded by Janbazan Medical and Engineering Research Center.

TABLES and CHARTS

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