title: A Survey on Clients' Opinions in Isfahan's Public Hospitals About Effective Factors in the Fulfillment of Referral System.
abstract: BACKGROUND
  Cutting back on the staff and equipment and also reduction of costs and devices, balanced distribution of resources for optimal use and prevention of unreasonable costs for patients are some advantages of the fulfillment of referral system process. Accordingly the purpose of the present study is to determine factors affecting the fulfillment of referral system process from the viewpoints of clients of Isfahan's public hospitals so that health system could benefit its advantages.
  
  
  METHODS
  The research is a descriptive-analytic survey and the population consisted of clients referring to public hospitals of Isfahan Province. Hospitals conforming to health network in cities of Falavarjan, ShahinShahr, Shahreza, Naein and some public hospitals of Isfahan city were selected for study. Cluster sampling was applied and at the end 400 subjects were selected by simple random sampling.
  
  
  RESULTS
  Results showed that awareness and satisfaction in urban communities and motivation in rural are of higher levels. Regarding insurance status, those covered by Social Security have the most referrals to all levels and those covered by Health Service Insurance have more referral to the first level. The mean score of awareness of clients about referral system among the hospitals investigated shows a significant difference (p-value≤0.05).
  
  
  CONCLUSIONS
  Results indicate that from the viewpoints of urban clients, the rate of the awareness of and satisfaction with the way of offering health services at primary levels and from that of rural clients motivation affect the fulfillment of referral system process. Therefore improvement of these factors could make the system more efficient.
authors.affiliation: Health Management and Economic Research Center. Isfahan University of Medical Sciences , Isfahan, Iran.
authors.forename: Asadollah
authors.initials: A
authors.lastname: Shams
authors.forename: Hassan
authors.initials: H
authors.lastname: Ashrafi-rizzi
authors.forename: Saeed
authors.initials: S
authors.lastname: Afrough
authors.forename: Marzieh
authors.initials: M
authors.lastname: Javadi
authors.forename: Amin
authors.initials: A
authors.lastname: Shams
keywords: awareness; motivation; referral system; satisfaction; teaching hospital