Document Type : Original Article
Authors
1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
2 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
3 Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Abstract
BACKGROUND: In the 21st century, with the epidemiological and demographic transition and
the changing nature of diseases and the increase in the burden of chronic diseases, the need to
strengthen primary health care and the development of the family medical program as a strategy is
felt significantly.
AIM: The purpose of this study is to compare the model of implementation of family physician
program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran.
MATERIALS AND METHODS: This is a comparative study that examines the model of family
physician implementation in selected countries. Data for each country were gathered from the
valid databases, were compared according to the comparative table, and analyzed by a framework
approach. In order to assure the validity of data, the researchers referred to the websites of the
selected nations’ Ministry of Health and also cross‑checked the findings with reports published by
the World Health Organization.
RESULTS: In this study, we used the Control Knobs framework to compare countries’ FPPs because
the framework can demonstrate all necessary features of national health system programs. This
framework includes governance and organization, regulation, financing, payment, and behavior
in each country. The results of this study show that although the principles of FPP in the selected
countries are almost common, they use different methods in FPP implementation.
CONCLUSIONS: As the success of any policy depends on the political, economic, social, and
cultural context of each country, considering these factors and reinforcing each of the control knobs
are critical to the success of the family physician’s policy implementation.
Keywords
1. Arya N, Gibson C, Ponka D, Haq C, Hansel S, Dahlman B, et al.
Family medicine around the world: Overview by region. Family
medicine around the world: overview by region: The Besrour
Papers: A series on the state of family medicine in the world.
Canadian Family Physician 2017;63:436-41.
2. World Health Organization. Health Sector Reform: Issues and
Opportunities.Kathmandu, Nepal: World Health Organization;
2000.
3. Amiri M, Raei M, Chaman R, Nasiri E. Family physician: The
mutual satisfaction of physicians and health care team members.
Razi J Med Sci 2012;18 (92):23‑30.
4. World Health Organization. The World Health Report 2008:
Primary Health Care Now More Than Ever: Introduction and
Overview. Geneva: World Health Organization; 2008.
5. Montegut AJ, Cartwright CA, Schirmer JM, Cummings S. An
international consultation: The development of family medicine
in Vietnam. Fam Med 2004;36:352‑6.
6. Moosa S, Mash B, Derese A, PeersmanW. The views of key leaders
in South Africa on implementation of family medicine: Critical
role in the district health system. BMC Fam Pract 2014;15:125.
7. Mumenah SH, Al‑Raddadi RM. Difficulties faced by family
physicians in primary health care centers in Jeddah, Saudi Arabia.
J Family Community Med 2015;22:145‑51.
8. Szafran O, Torti JM, Kennett SL, Bell NR. Family physicians’
perspectives on interprofessional teamwork: Findings from a
qualitative study. J Interprof Care 2018;32:169‑77.
9. World Health Organization. Health Systems: Principled
Integrated Care. World Health Report. Ch. 7. Geneva: World
Health Organization; 2003.
10. van der Voort CT, van Kasteren G, Chege P, Dinant GJ. What
challenges hamper Kenyan family physicians in pursuing their
family medicine mandate? A qualitative study among family
physicians and their colleagues. BMC Fam Pract 2012;13:32.
11. McWhinney IR, Freeman T. Textbook of Family Medicine. United
States: Oxford University Press; 2009.1‑537.
12. World Health Organization. Everybody’s Business – Strengthening
Health Systems to Improve Health Outcomes: Who’s Framework
for Action. World Health Organization: 2007.
13. Majdzadeh R. Family physician implementation and preventive
medicine; opportunities and challenges. Int J Prev Med
2012;3:665‑9.
14. Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van
Ginneken E. United States of America: Health system review.
Health Syst Transit 2013;15:1‑431.
15. Abyad A, Al‑Baho AK, Unluoglu I, Tarawneh M, Al Hilfy TK.
Development of family medicine in the middle East. Fam Med
2007;39:736‑41.
16. Osman H, Romani M, Hlais S. Family medicine in Arab countries.
Fam Med 2011;43:37‑42.
17. Rouleau K, Bourget M, Chege P, Couturier F, Godoy‑Ruiz P,
Grand’Maison PH, et al. Strengthening primary care through
family medicine around the world collaborating toward
promising practices. Fam Med 2018;50:426‑36.
18. Manca DP. Varnhagen S, Brett-MacLean P. Allan M, Szafran O,
Ausford A, et al. Rewards and challenges of family practice:
Web‑based survey using the Delphi method. Canadian Family
Physician 2007;53:277‑86.
19. Glonti K, Struckmann V, Alconada A, Pettigrew LM,
Hernandez‑Santiago V, Minue S, et al. Exploring the training
and scope of practice of GPs in England, Germany and Spain.
Gac Sanit 2019;33:148‑55.
20. Coutinho AJ, Cochrane A, Stelter K, Phillips RL Jr, Peterson LE.
Comparison of Intended scope of practice for family medicine
residents with reported scope of practice among practicing family
physicians. JAMA 2015;314:2364‑72.
21. Roberts M, Hsiao W, Berman P, Reich M. Getting Health Reform
Right: A Guide to Improving Performance and Equity. London:
Oxford University Press; 2008.
22. Manchikanti L, Hirsch JA. Medicare physician payment rules for
2011: A primer for the neurointerventionalist. J Neurointerv Surg 2011;3:399‑402.
23. Centers for Disease Control and Prevention. National Hospital
Ambulatory Medical Care Survey: Emergency Department
Summary Tables. Centers for Disease Control and Prevention,
US DHHS; 2008.
24. Weggemans MM, van Dijk B, van Dooijeweert B, Veenendaal AG,
Ten Cate O. The postgraduate medical education pathway: An
international comparison. GMS J Med Educ 2017;34:Doc63.
25. Smith JC, Medalia C. Health Insurance Coverage in the United
States: 2013: Us Department of Commerce, Economics and
Statistics Administration, Bureau; 2014.
26. Lynott MH, Kooienga SA, Stewart VT. Communication and the
electronic health record training: A comparison of three healthcare
systems. Inform Prim Care 2012;20:7‑12.
27. Cohen HS. On professional power and conflict of interest: State
licensing boards on trial. J Health Polit Policy Law 1980;5:291‑308.
28. Cylus J, Richardson E, Findley L, Longley M, O’Neill C, Steel D.
United Kingdom: Health system review. Health Syst Transit
2015;17:1‑26.
29. Roland M, Guthrie B, Thomé DC. Primary medical care in the
United Kingdom. J Am Board Fam Med 2012;25 Suppl 1:S6‑11.
30. Peckham S, Gousia K. Gp Payment Schemes Review October,
2014; 2014.
31. Adams T, Budden M, Hoare C, Sanderson H. Lessons from the
central Hampshire electronic health record pilot project: Issues
of data protection and consent. BMJ 2004;328:871‑4.
32. Busse R, Riesberg A; World Health Organization. Health Care
Systems in Transition. Germany: WHO Regional Office for
Europe; 2004.
33. Rosemann T, Wensing M, Rueter G, Szecsenyi J. Referrals from
general practice to consultants in Germany: If the GP is the
initiator, patients’ experiences are more positive. BMC Health
Serv Res 2006;6:5.
34. Kamke K. The German health care system and health care reform.
Health Policy 1998;43:171‑94.
35. Li Y, Lee P, Jian W, Kuo C. Electronic health record goes personal
world‑wide. Yearb Med Inform 2009;18:40‑3.
36. Schreyögg J, Kin LM. Health‑care reforms in singapore‑twenty
years of medical savings accounts. CESifo DICE Rep 2004;2:55‑60.
37. Gericke CA. Financing health care in Egypt: Current issues and
options for reform. J Public Health 2006;14:29‑36.
38. Thomas SL. Family medicine specialty in Singapore. J Fam Med
Prim Care 2013;2:135.
39. Chew C, Chee Y. Postgraduate medical education and specialist
training in Singapore. Ann Acad Med Singapore 2005;34:182C‑9C.
40. Ozair FF, Jamshed N, Sharma A, Aggarwal P. Ethical issues in
electronic health records: A general overview. Perspect Clin Res
2015;6:73‑6.
41. Thomas SL, Family medicine specialty in Singapore. Journal of family
medicine and primary care, 2013. 2 (2): p. 135
42. Yaman H, Güneş ED. Family practice in Turkey: Observations
from a pilot implementation. Scand J Prim Health Care
2016;34:81‑2.
43. Yildirim HH, Yildirim T. Healthcare financing reform in Turkey:
Context and salient features. J Eur SocPolicy 2011;21:178‑93.
44. World Health Organization. Health Care Systems in Transition:
Turkey. Copenhagen: WHO Regional Office for Europe; 1996.
45. Ökem ZG, Çakar M. What have health care reforms achieved in
Turkey? An appraisal of the “health transformation programme”.
Health Policy 2015;119:1153‑63.
46. Günes ED, Yaman H. Transition to family practice in Turkey.
J Contin Educ Health Prof 2008;28:106‑12.
47. Akbulut Y, Sarp N, Ugurluoglu E. Reform of the health care
system in Turkey: A review of universal health insurance. World
Hosp Health Serv 2007;43:13‑6.
48. Akinci F, Mollahaliloğlu S, Gürsöz H, Oğücü F. Assessment of
the Turkish health care system reforms: A stakeholder analysis.
Health Policy 2012;107:21‑30.
49. Dogac A, Yuksel M, Avci A, Ceyhan B, Hülür U, Eryilmaz Z, et al.
Electronic health record interoperability as realized in the Turkish
health information system. Methods Inf Med 2011;50:140‑9.
50. Lie DA, Boker JR, Lenahan PM, Dow E, Scherger JE. An
international physician education program to support the
recent introduction of family medicine in Egypt. Fam Med
2004;36:739‑46.
51. Abdelaziz A, Kassab SE, Abdelnasser A, Hosny S. Medical
education in Egypt: Historical background, current status, and
challenges. Health Prof Educ 2018;4:236‑44.
52. el‑Henawy A. Current situation, progress and prospects of health
for all in Egypt. East Mediterr Health J 2000;6:816‑21.
53. Eldin AS, Saad D, Samie GA. Evaluation of electronic health
records adoption in Egypt. Int J Eng Res Appl 2013;3:1131‑4.
54. Davari M, Haycox A, Walley T. Health care financing in Iran; is
privatization a good solution? Iran J Public Health 2012;41:14‑23.
55. Raeisee P, Motlagh M, Kabir M. Evaluation of the performance
of referral system in family physician program in Iran University
of Medical Sciences: 2009. Hakim Res J 2010;13:19‑25.
56. DehnaviehR, Kalantari AR, Jafari Sirizi M. Urban family physician
plan in Iran: Challenges of implementation in Kerman. Med J
Islam Repub Iran 2015;29:303.
57. Farzandipour M, Sadoughi F, Ahmadi M, Karimi I. Designing a
confidentiality principles model of electronic health record for
Iran 2007. J Health Adm 2008;11:33‑46.
58. Shiyani M, Rashidian A, Mohammadi A. A study of the challenges
of family physician implementation in Iran health system. Hakim
Research Journal 2016;18:264‑74.
59. Haq C, Ventres W, Hunt V, Mull D, Thompson R, Rivo M, et al.
Family practice development around the world. Fam Pract
1996;13:351‑6.
60. Hilless M, Healy J, World Health Organization. Health Care
Systems in Transition: Australia. Copenhagen: WHO Regional
Office for Europe; 2001.
61. Ayuso‑Raya MC, Escobar‑Rabadán F, López‑Torres‑Hidalgo J,
Montoya‑Fernández J, Téllez‑Lapeira JM, Campa‑Valera F.
Predictors for choosing the specialty of Family Medicine from
undergraduate knowledge and attitudes. Sao Paulo Med J
2016;134:306‑14.
62. Alkhenizan A, Shaw C. Impact of accreditation on the quality of
healthcare services: A systematic review of the literature. Ann
Saudi Med 2011;31:407‑16.
63. World Health Organization. Health System Profile – Egypt.
Regional Health Systems Observatory. Geneva, Switzerland:
World Health Organization; 2006.
64. Starfield B, editor. Is Strong Primary Care Good for Health
Outcomes. The Future of Primary Care: Papers for a Symposium
Held on 13th September 1995. Office of Health Economics: 1996.
65. Marchildon GP. Health Systems in Transition. Canada: University
of Toronto Press; 2013.
66. Dong L, Keshavjee K. Why is information governance important
for electronic healthcare systems? A Canadian experience. J Adv
Hum Soc Sci 2016;2:250‑60.
67. Health Council of Canada. Primary Health Care: A Background
Paper to Accompany Health Care Renewal in Canada:
Accelerating Change. Health Council of Canada; 2005.
68. Osborn R, Schoen C. The Commonwealth Fund 2013 International
Health Policy Survey In Eleven Countries. Common Fund; 2013.
69. Harman LB, Flite CA, Bond K. Electronic health records: Privacy,
confidentiality, and security. Virtual Mentor 2012;14:712‑9.
70. World Health Organization. The World Health Report 2000:
Health Systems: Improving Performance. World Health
Organization; 2000.
71. Wagstaff A, van Doorslaer E, Calonge S, Christiansen T, Gerfin M, Gottschalk P, et al. Equity in the finance of health care: Some
international comparisons. J Health Econ 1992;11:361‑87.
72. Ekman B. Community‑based health insurance in low‑income
countries: A systematic review of the evidence. Health Policy
Plan 2004;19:249‑70.
73. Gold SB, Park BJ. Effective Payment for Primary Care. An
Annotated Bibliography. Draft Report Distributed at Starfield
Summit; 2016.
74. Van HerckP, De SmedtD, AnnemansL, RemmenR, RosenthalMB,
Sermeus W. Systematic review: Effects, design choices, and
context of pay‑for‑performance in health care. BMC Health Serv
Res 2010;10:247.
75. Cashin C, Chi YL, Smith PC, Borowitz M, Thomson S. Paying
For Performance in Health Care: Implications For Health
System Performance and Accountability. UK: McGraw‑Hill
Education (UK); 2014.
76. Srivastava D, Mueller M, Hewlett E. Better Ways to Pay for Health
Care: OECD; 2016.
77. Fujisawa R, Lafortune G. The Remuneration of General
Practitioners and Specialists in 14 OECD Countries; 2008.
78. Kok L, Lammers M, Tempelman C, Bénard H. Remuneration of
Medical Specialists: An International Comparison. SEO Economic
Research; 2012.
79. Behzadifar M, Behzadifar M, Heidarvand S, Gorji HA,
Aryankhesal A, Moghadam ST, et al. The challenges of the family
physician policy in Iran: A systematic review and meta‑synthesis
of qualitative researches Family practice 2018.35:652-60.
80. Larson PR, Chege P, Dahlman B, Gibson C, Evensen A,
Colon‑GonzalezMC, et al. Current status of family medicine faculty
development in sub‑Saharan Africa. Fam Med 2017;49:193‑202.
Family medicine around the world: Overview by region. Family
medicine around the world: overview by region: The Besrour
Papers: A series on the state of family medicine in the world.
Canadian Family Physician 2017;63:436-41.
2. World Health Organization. Health Sector Reform: Issues and
Opportunities.Kathmandu, Nepal: World Health Organization;
2000.
3. Amiri M, Raei M, Chaman R, Nasiri E. Family physician: The
mutual satisfaction of physicians and health care team members.
Razi J Med Sci 2012;18 (92):23‑30.
4. World Health Organization. The World Health Report 2008:
Primary Health Care Now More Than Ever: Introduction and
Overview. Geneva: World Health Organization; 2008.
5. Montegut AJ, Cartwright CA, Schirmer JM, Cummings S. An
international consultation: The development of family medicine
in Vietnam. Fam Med 2004;36:352‑6.
6. Moosa S, Mash B, Derese A, PeersmanW. The views of key leaders
in South Africa on implementation of family medicine: Critical
role in the district health system. BMC Fam Pract 2014;15:125.
7. Mumenah SH, Al‑Raddadi RM. Difficulties faced by family
physicians in primary health care centers in Jeddah, Saudi Arabia.
J Family Community Med 2015;22:145‑51.
8. Szafran O, Torti JM, Kennett SL, Bell NR. Family physicians’
perspectives on interprofessional teamwork: Findings from a
qualitative study. J Interprof Care 2018;32:169‑77.
9. World Health Organization. Health Systems: Principled
Integrated Care. World Health Report. Ch. 7. Geneva: World
Health Organization; 2003.
10. van der Voort CT, van Kasteren G, Chege P, Dinant GJ. What
challenges hamper Kenyan family physicians in pursuing their
family medicine mandate? A qualitative study among family
physicians and their colleagues. BMC Fam Pract 2012;13:32.
11. McWhinney IR, Freeman T. Textbook of Family Medicine. United
States: Oxford University Press; 2009.1‑537.
12. World Health Organization. Everybody’s Business – Strengthening
Health Systems to Improve Health Outcomes: Who’s Framework
for Action. World Health Organization: 2007.
13. Majdzadeh R. Family physician implementation and preventive
medicine; opportunities and challenges. Int J Prev Med
2012;3:665‑9.
14. Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van
Ginneken E. United States of America: Health system review.
Health Syst Transit 2013;15:1‑431.
15. Abyad A, Al‑Baho AK, Unluoglu I, Tarawneh M, Al Hilfy TK.
Development of family medicine in the middle East. Fam Med
2007;39:736‑41.
16. Osman H, Romani M, Hlais S. Family medicine in Arab countries.
Fam Med 2011;43:37‑42.
17. Rouleau K, Bourget M, Chege P, Couturier F, Godoy‑Ruiz P,
Grand’Maison PH, et al. Strengthening primary care through
family medicine around the world collaborating toward
promising practices. Fam Med 2018;50:426‑36.
18. Manca DP. Varnhagen S, Brett-MacLean P. Allan M, Szafran O,
Ausford A, et al. Rewards and challenges of family practice:
Web‑based survey using the Delphi method. Canadian Family
Physician 2007;53:277‑86.
19. Glonti K, Struckmann V, Alconada A, Pettigrew LM,
Hernandez‑Santiago V, Minue S, et al. Exploring the training
and scope of practice of GPs in England, Germany and Spain.
Gac Sanit 2019;33:148‑55.
20. Coutinho AJ, Cochrane A, Stelter K, Phillips RL Jr, Peterson LE.
Comparison of Intended scope of practice for family medicine
residents with reported scope of practice among practicing family
physicians. JAMA 2015;314:2364‑72.
21. Roberts M, Hsiao W, Berman P, Reich M. Getting Health Reform
Right: A Guide to Improving Performance and Equity. London:
Oxford University Press; 2008.
22. Manchikanti L, Hirsch JA. Medicare physician payment rules for
2011: A primer for the neurointerventionalist. J Neurointerv Surg 2011;3:399‑402.
23. Centers for Disease Control and Prevention. National Hospital
Ambulatory Medical Care Survey: Emergency Department
Summary Tables. Centers for Disease Control and Prevention,
US DHHS; 2008.
24. Weggemans MM, van Dijk B, van Dooijeweert B, Veenendaal AG,
Ten Cate O. The postgraduate medical education pathway: An
international comparison. GMS J Med Educ 2017;34:Doc63.
25. Smith JC, Medalia C. Health Insurance Coverage in the United
States: 2013: Us Department of Commerce, Economics and
Statistics Administration, Bureau; 2014.
26. Lynott MH, Kooienga SA, Stewart VT. Communication and the
electronic health record training: A comparison of three healthcare
systems. Inform Prim Care 2012;20:7‑12.
27. Cohen HS. On professional power and conflict of interest: State
licensing boards on trial. J Health Polit Policy Law 1980;5:291‑308.
28. Cylus J, Richardson E, Findley L, Longley M, O’Neill C, Steel D.
United Kingdom: Health system review. Health Syst Transit
2015;17:1‑26.
29. Roland M, Guthrie B, Thomé DC. Primary medical care in the
United Kingdom. J Am Board Fam Med 2012;25 Suppl 1:S6‑11.
30. Peckham S, Gousia K. Gp Payment Schemes Review October,
2014; 2014.
31. Adams T, Budden M, Hoare C, Sanderson H. Lessons from the
central Hampshire electronic health record pilot project: Issues
of data protection and consent. BMJ 2004;328:871‑4.
32. Busse R, Riesberg A; World Health Organization. Health Care
Systems in Transition. Germany: WHO Regional Office for
Europe; 2004.
33. Rosemann T, Wensing M, Rueter G, Szecsenyi J. Referrals from
general practice to consultants in Germany: If the GP is the
initiator, patients’ experiences are more positive. BMC Health
Serv Res 2006;6:5.
34. Kamke K. The German health care system and health care reform.
Health Policy 1998;43:171‑94.
35. Li Y, Lee P, Jian W, Kuo C. Electronic health record goes personal
world‑wide. Yearb Med Inform 2009;18:40‑3.
36. Schreyögg J, Kin LM. Health‑care reforms in singapore‑twenty
years of medical savings accounts. CESifo DICE Rep 2004;2:55‑60.
37. Gericke CA. Financing health care in Egypt: Current issues and
options for reform. J Public Health 2006;14:29‑36.
38. Thomas SL. Family medicine specialty in Singapore. J Fam Med
Prim Care 2013;2:135.
39. Chew C, Chee Y. Postgraduate medical education and specialist
training in Singapore. Ann Acad Med Singapore 2005;34:182C‑9C.
40. Ozair FF, Jamshed N, Sharma A, Aggarwal P. Ethical issues in
electronic health records: A general overview. Perspect Clin Res
2015;6:73‑6.
41. Thomas SL, Family medicine specialty in Singapore. Journal of family
medicine and primary care, 2013. 2 (2): p. 135
42. Yaman H, Güneş ED. Family practice in Turkey: Observations
from a pilot implementation. Scand J Prim Health Care
2016;34:81‑2.
43. Yildirim HH, Yildirim T. Healthcare financing reform in Turkey:
Context and salient features. J Eur SocPolicy 2011;21:178‑93.
44. World Health Organization. Health Care Systems in Transition:
Turkey. Copenhagen: WHO Regional Office for Europe; 1996.
45. Ökem ZG, Çakar M. What have health care reforms achieved in
Turkey? An appraisal of the “health transformation programme”.
Health Policy 2015;119:1153‑63.
46. Günes ED, Yaman H. Transition to family practice in Turkey.
J Contin Educ Health Prof 2008;28:106‑12.
47. Akbulut Y, Sarp N, Ugurluoglu E. Reform of the health care
system in Turkey: A review of universal health insurance. World
Hosp Health Serv 2007;43:13‑6.
48. Akinci F, Mollahaliloğlu S, Gürsöz H, Oğücü F. Assessment of
the Turkish health care system reforms: A stakeholder analysis.
Health Policy 2012;107:21‑30.
49. Dogac A, Yuksel M, Avci A, Ceyhan B, Hülür U, Eryilmaz Z, et al.
Electronic health record interoperability as realized in the Turkish
health information system. Methods Inf Med 2011;50:140‑9.
50. Lie DA, Boker JR, Lenahan PM, Dow E, Scherger JE. An
international physician education program to support the
recent introduction of family medicine in Egypt. Fam Med
2004;36:739‑46.
51. Abdelaziz A, Kassab SE, Abdelnasser A, Hosny S. Medical
education in Egypt: Historical background, current status, and
challenges. Health Prof Educ 2018;4:236‑44.
52. el‑Henawy A. Current situation, progress and prospects of health
for all in Egypt. East Mediterr Health J 2000;6:816‑21.
53. Eldin AS, Saad D, Samie GA. Evaluation of electronic health
records adoption in Egypt. Int J Eng Res Appl 2013;3:1131‑4.
54. Davari M, Haycox A, Walley T. Health care financing in Iran; is
privatization a good solution? Iran J Public Health 2012;41:14‑23.
55. Raeisee P, Motlagh M, Kabir M. Evaluation of the performance
of referral system in family physician program in Iran University
of Medical Sciences: 2009. Hakim Res J 2010;13:19‑25.
56. DehnaviehR, Kalantari AR, Jafari Sirizi M. Urban family physician
plan in Iran: Challenges of implementation in Kerman. Med J
Islam Repub Iran 2015;29:303.
57. Farzandipour M, Sadoughi F, Ahmadi M, Karimi I. Designing a
confidentiality principles model of electronic health record for
Iran 2007. J Health Adm 2008;11:33‑46.
58. Shiyani M, Rashidian A, Mohammadi A. A study of the challenges
of family physician implementation in Iran health system. Hakim
Research Journal 2016;18:264‑74.
59. Haq C, Ventres W, Hunt V, Mull D, Thompson R, Rivo M, et al.
Family practice development around the world. Fam Pract
1996;13:351‑6.
60. Hilless M, Healy J, World Health Organization. Health Care
Systems in Transition: Australia. Copenhagen: WHO Regional
Office for Europe; 2001.
61. Ayuso‑Raya MC, Escobar‑Rabadán F, López‑Torres‑Hidalgo J,
Montoya‑Fernández J, Téllez‑Lapeira JM, Campa‑Valera F.
Predictors for choosing the specialty of Family Medicine from
undergraduate knowledge and attitudes. Sao Paulo Med J
2016;134:306‑14.
62. Alkhenizan A, Shaw C. Impact of accreditation on the quality of
healthcare services: A systematic review of the literature. Ann
Saudi Med 2011;31:407‑16.
63. World Health Organization. Health System Profile – Egypt.
Regional Health Systems Observatory. Geneva, Switzerland:
World Health Organization; 2006.
64. Starfield B, editor. Is Strong Primary Care Good for Health
Outcomes. The Future of Primary Care: Papers for a Symposium
Held on 13th September 1995. Office of Health Economics: 1996.
65. Marchildon GP. Health Systems in Transition. Canada: University
of Toronto Press; 2013.
66. Dong L, Keshavjee K. Why is information governance important
for electronic healthcare systems? A Canadian experience. J Adv
Hum Soc Sci 2016;2:250‑60.
67. Health Council of Canada. Primary Health Care: A Background
Paper to Accompany Health Care Renewal in Canada:
Accelerating Change. Health Council of Canada; 2005.
68. Osborn R, Schoen C. The Commonwealth Fund 2013 International
Health Policy Survey In Eleven Countries. Common Fund; 2013.
69. Harman LB, Flite CA, Bond K. Electronic health records: Privacy,
confidentiality, and security. Virtual Mentor 2012;14:712‑9.
70. World Health Organization. The World Health Report 2000:
Health Systems: Improving Performance. World Health
Organization; 2000.
71. Wagstaff A, van Doorslaer E, Calonge S, Christiansen T, Gerfin M, Gottschalk P, et al. Equity in the finance of health care: Some
international comparisons. J Health Econ 1992;11:361‑87.
72. Ekman B. Community‑based health insurance in low‑income
countries: A systematic review of the evidence. Health Policy
Plan 2004;19:249‑70.
73. Gold SB, Park BJ. Effective Payment for Primary Care. An
Annotated Bibliography. Draft Report Distributed at Starfield
Summit; 2016.
74. Van HerckP, De SmedtD, AnnemansL, RemmenR, RosenthalMB,
Sermeus W. Systematic review: Effects, design choices, and
context of pay‑for‑performance in health care. BMC Health Serv
Res 2010;10:247.
75. Cashin C, Chi YL, Smith PC, Borowitz M, Thomson S. Paying
For Performance in Health Care: Implications For Health
System Performance and Accountability. UK: McGraw‑Hill
Education (UK); 2014.
76. Srivastava D, Mueller M, Hewlett E. Better Ways to Pay for Health
Care: OECD; 2016.
77. Fujisawa R, Lafortune G. The Remuneration of General
Practitioners and Specialists in 14 OECD Countries; 2008.
78. Kok L, Lammers M, Tempelman C, Bénard H. Remuneration of
Medical Specialists: An International Comparison. SEO Economic
Research; 2012.
79. Behzadifar M, Behzadifar M, Heidarvand S, Gorji HA,
Aryankhesal A, Moghadam ST, et al. The challenges of the family
physician policy in Iran: A systematic review and meta‑synthesis
of qualitative researches Family practice 2018.35:652-60.
80. Larson PR, Chege P, Dahlman B, Gibson C, Evensen A,
Colon‑GonzalezMC, et al. Current status of family medicine faculty
development in sub‑Saharan Africa. Fam Med 2017;49:193‑202.
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