The effective component of access to hospital care in iran
The hospital care is recognized as a fundamental necessity in the health system, and some people in society are not able to supply health necessities. Moreover, care policies and fundamental method in preparing medical care are not efficient enough; but it is possible to improve access to hospital care through determining the feature and factors influencing the accessibility. The purpose of this research is to improve people access to hospital care through determining the feature influencing the access to hospital care and its subcomponent and preparing a proper model for public hospitals in Iran. This research is the descriptive analytic survey type. The population of the research includes employed hospitalized in different parts of public hospitals. Sample size includes 406 experts of Iran public hospitals, which were chosen by multistep share sampling method in which the country was divided into 5 parts of north, south, centre, west and east and by given two shares to each part. Two hospitals were chosen, then from each hospital experts were chosen. To collect data, questionnaires were used. To evaluate the validity of the experts questionnaire, two methods of content validity and structure validity were utilized. To evaluate the content validity, the expert's judgment was taken into account, to evaluate the structure validity the method of analyzing the exploring agent was used, and to evaluate the questionnaire reliability the alpha coefficient was used. In this survey, the Cronbach alpha coefficient of the questionnaire was 0.80 for expert, which was very satisfactory. After collecting data, they were analyzed by the SPSS software and Lire through the method of factor analysis. Being 401 experts and 406 patients to answer, the current situation of access to hospital care in public hospitals has the quality of lower than average and most of the patients and experts gave low rating to each of the 5 factors of accessibility in the current situation. Also, by analyzing the exploring and confirming factor, the surveys findings showed that the structure of access to hospital care in Iranian public hospitals is a 5-dimensional structure, which contains personal characteristics, the system of giving services, social-geographic, health policy making and management guidelines; moreover the relation between 5-dimension was meaningful form 0.13 for the correlation of health policy making with the factor of personal characteristics, to 0.40 for the correlation of health policy making with the factor of management guidelines accordingly, the factor of personal characteristics, the system of giving services, social-geographic and health policy making have direct relation to each other. Generally, all dimensions were related to each other and the correlation of the 5 dimensions was significant at a level lower than 0.01. Also, according to step-by-step regression the 5 dimensions of access to hospital care defined 95% of change in the level of accessibility in sum, so that the factor 2, i.e. the system of giving services, having R-2=47.7 and high clarification ability, has the highest variance and effective accessibility and factor 3, i.e. social-geographic, having R-2=2.8, has the lowest effect on access to hospital care. The structure of access to hospital care contains 5 factors of personal characteristics, the system of giving services, social-geographic, health policy making and management guidelines, and the factor of the system of giving services with its high clarification ability has the highest effective on access o hospital care. It seems that it can be helpful to pay attention to the above factors, especially the system of giving services in programming and policy making in the area of health to improve access to hospital care.