Introduction
roviding optimal rehabilitation services to the disabled has always been an essential concern of the health system in any country [1]. The results show that despite the fundamental differences in the organization, finance, and provision of health services in different countries, all countries have faced almost the same challenges [2]. One of the challenges in rehabilitating the disabled in Iran is trusteeship [3]. The Ministry of Health, Treatment, and Education is responsible for health care and has established the General Department of Rehabilitation since 2014. Also, the Red Crescent Organization provides rehabilitation services independently through its rehabilitation centers. Since 1980, with the Supreme Council of the Islamic Revolution’s approval, providing rehabilitation services to the disabled was transferred to the Welfare Organization [4]. However, for the first time in the general health policies announced by the Supreme Leader in 2014, serious attention was paid to the issue of rehabilitation services, and the Ministry of Health, Treatment and Medical Education was appointed as the custodian of organizing rehabilitation services and trusteeship of the health system in all dimensions. 
Financing is also consistently one of the most critical challenges, especially in low- and middle-income countries, because it affects the health system’s other functions performance [5]. Another leading issue in the country’s rehabilitation system is the lack of specialized personnel in different regions. Also, the number of specialized centers for the disabled is not enough [6]. Therefore, considering our country’s political and economic conditions and the increasing number of disabled people, the continuation of the current trend does not meet the growing needs of the disabled, and creating a coordinated and coherent system to provide rehabilitation services to the disabled is vital.
A review on the rehabilitation department performance for the disabled in Iran showed that the system for providing rehabilitation services for the disabled in our country has a non-integrated structure. In general, it faces various challenges such as disruption of primary rehabilitation services, abandoned identification and screening system, unequal access, multiple trusteeships, rehabilitation system deficiencies, rehabilitation anonymity, unbalanced funding in rehabilitation, and incomplete rehabilitation system [5]. Considering the mentioned challenges and countries’ desire to create an integrated system and the lack of similar research in Iran, this study was conducted to comparatively study rehabilitation services for the disabled.
Materials and Methods 
The current study is a comparative study conducted in 2020. The keywords such as healthcare system, rehabilitation, disability, stewardship, financing, resource production, and delivery services were surfed in the library studies. On the website of Rehabilitation Organizations, domestic databases such as IranMedex, IranDoc, and the foreign databases such as Science Direct, Medline, PubMed, Elsevier, and Google Scholar, as well as The World Health Organization website, reference books, published official reports, and related Persian and English articles from 1990 to 2020 were reviewed. After evaluating the preliminary search results, similar and unrelated articles were removed among 149 research articles and annual reports, and then the inclusion criteria were applied. Finally, 45 articles and reports were selected, and the full texts were studied. The required data related to Iran were collected using the reference organizations’ published documents related to the research topic by referring to each organization’s site.
In this study, four dimensions of the health systems performance based on the 2000 report of the World Health Organization were used to determine the framework for the division of rehabilitation systems and countries’ rehabilitation system in trusteeship dimensions resource production, financing, and service provision.
The model used in this study was Bereday and Hilker model [7]. It includes four stages of description, interpretation, proximity, and comparison. Health systems were first subdivided according to a geographical area as an entry criterion, and at least one country was selected from each continent of America, Europe, Asia, and Africa. Then, to compare countries among the health system’s functional models, the World Health Organization model (2000) was selected. In the next stage, the search for helpful content following the research objectives in the four dimensions of rehabilitation services’ functions to the disabled was performed. According to the model, in the first place, the factors affecting the formation of each of these systems of providing rehabilitation services to the disabled in selected countries were collected and translated into fluent Persian, and the various components considered in this study were identified, reviewed, and analyzed. The information about each country was then arranged in Tables 1, 2, 3 and 4. The similarities and differences of each element of rehabilitation systems between all studied countries were determined and compared, and practical suggestions for Iran were presented.
In this study, the purposive sampling method was used, and the sample size was equal to the entire study population (including systems for providing rehabilitation services to the disabled in selected countries and the information available in them). The statistical population included rehabilitation systems globally, and the research examples were Iran, China, Turkey, India, the USA, Mexico, Germany, England, and South Africa.
Results
Rehabilitation in Iran was the Welfare Organization’s responsibility, while in the United Kingdom, Germany, and the United States, the Ministry of Health was responsible. In South Africa, the Ministry of Social Development and the Ministry of Health, in China the Ministry of Health and the Ministry of Citizenship, in Turkey the Ministry of Family and Social Policy and the Ministry of Health jointly and in Mexico, the Social Security Institute were responsible for rehabilitating the disabled. The results also showed the trusteeship structure in China, Mexico, South Africa, India, and Turkey. In the United States and Germany, it was decentralized. In Britain, it was mixed, and in Iran, it was often centralized (Table 1). 


In Iran, rehabilitation graduates study in training centers affiliated with the universities of the Ministry of Health. In other countries, such as the United States, Germany, the United Kingdom, Mexico, Turkey, and South Africa, the required human resources were trained through the Ministry of Education, and in India, in addition to universities, the National Rehabilitation Council provided training to rehabilitation specialists. Iran, India, and Mexico lacked a national rehabilitation data management system (Table 2). 


In Iran, as in other countries, the cost of rehabilitation services for the disabled was provided from the general budget, out-of-pocket payments, and a tiny portion through health insurance. In Germany, financing was mainly based on insurance funds such as the accident fund and the disability fund, and the rest was financed through social health insurance, although out-of-pocket payments averaged 13% rather than 9% of the population covered by private insurance. In the United States, financing was managed by private entities operating in a free market economy. Private insurance was purchased as basic insurance and was paid for people with disabilities in need through government health insurance (Medicare and Medicaid insurance systems). 
The system improved out-of-pocket payments to 11%. In the UK, government funding was provided through public taxes and accumulation in a single fund at the Ministry of Health, and although out-of-pocket payments for the general public accounted for 3%, rehabilitation services for the disabled were free, and 11.5% of the population was covered by private insurance. In China, besides paying subsidies from the general budget, especially to the poor, disabled, government insurance and out-of-pocket payments were the source of funding. In India, as in China, public funding and out-of-pocket payments were the funding mechanism, and a significant portion was funded through Non-Governmental Organizations (NGOs). In South Africa, the national health insurance system was in place, and people with disabilities, like everyone else, had health savings accounts, and health disaster insurance was provided for high costs. In addition to public insurance, there was private insurance. In Turkey, besides public government resources, social security insurance covered the disabled rehabilitation costs. In Mexico, government insurance and out-of-pocket payments were the funding sources. People with disabilities in Iran, Mexico, the United States, India, and South Africa needed direct payments in the rehabilitation sector, while in the United Kingdom and Germany, they were paid for free or with a minimum payment (Table 3). 


All countries studied had the necessary structure to provide rehabilitation services, such as providing rehabilitation services in governmental and non-governmental hospitals and rehabilitation centers. In all studied countries, the package of public health services and rehabilitation was defined, but its coverage was not comprehensive in all regions of these countries. All of these countries had access to primary health care. 
In Iran, there were three ways to provide rehabilitation services. The first method is institutional rehabilitation through hospitals and private medical rehabilitation clinics. The second method is extra-institutional rehabilitation through mobile home visiting teams. Finally, community-based rehabilitation provided essential rehabilitation services in collaboration with health care networks and the local community. Similar methods were available in Turkey, China, and Mexico. In all countries, besides hospitals, private centers provided services. In the UK, in addition to hospitals, services were purchased by local units and were provided. Of course, most hospitals and clinics were owned by the government, and most specialists were government employees. In India, there were mostly active non-governmental and charitable rehabilitation centers. In Mexico, most national government rehabilitation agencies provided services, and in South Africa, primary rehabilitation was provided through the primary health care system (Table 4). 


This study aimed to review and compare the systems of providing rehabilitation services for the disabled in the four dimensions of tutoring, human resources, financing, and service provision. These factors are essential in forming an integrated rehabilitation system. Different institutions and staff providing rehabilitation services perform various tasks in the rehabilitation process, and their effective communication and coordination with each other are necessary to achieve a desirable rehabilitation system [8].
In most selected countries, such as Germany, the United States, Turkey, and South Africa, the Ministry of Health was in charge of rehabilitation, while in Iran, the Welfare Organization was in charge and the Ministry of Health and Medical Education, the Red Crescent, the Martyr Foundation, and Veterans’ affairs and exceptional education played an independent role. Zare stated that the World Health Organization believes that developing countries, including Iran, do not have the desired care status in their health system. In this regard, the guardianship field’s main problems included not paying attention to all factors and stakeholders in policy-making, only paying attention to the formulation of laws and regulations, and not paying attention to the implementation and monitoring of policies [3, 9]. Jahanbin’s study results showed that trusteeship is a missing link in teamwork in Iran’s rehabilitation services [10]. The 2019 report of the World Health Organization also emphasized integrating rehabilitation in the health sector, consistent with this study results [3].
In terms of resource production, in Iran, rehabilitation graduates studied only in educational institutions affiliated with the Ministry of Health and Medical Education universities. Simultaneously, In the United States, Germany, the United Kingdom, Mexico, Turkey, and South Africa, the required human resources training was provided through the Ministry of Education. In India, besides universities, the National Rehabilitation Council was involved [11]. The results show that the recruitment of rehabilitation students in proportion to the dispersion of centers and the prevalence of disability in each region, and the appropriate distribution of human resources by the Ministry of Health and Medical Education based on data obtained from complete information can be more effective. This study results also showed that in Iran, India, and Mexico, there is no complete access to comprehensive national data, but in the United States, Germany, China, South Africa, and Turkey, this platform is provided for planning and policy-making [12]. Therefore, the national rehabilitation data management system for the disabled in Iran needs to be reviewed due to existing shortcomings, and similar solutions in rehabilitation systems of developed countries such as Germany can be helpful. 
In terms of financing, the countries under study have provided essential services to people with disabilities by allocating dedicated financial resources, but only a small number of countries have been fully efficient. Abdi’s study found that rehabilitation financing in Iran was unbalanced, citing a lack of funding to compensate for the cost, a weak insurance system, and the market view of rehabilitation therapists [3]. The social insurance systems in Germany and the national health system in the United Kingdom show a good performance in the community’s financial protection. Therefore, it can be said that the establishment of a social or national insurance system can play an important role in protecting people financially against health costs. The majority of high-income countries rely on taxes (e.g. the United Kingdom), compulsory health insurance (Germany), or voluntary private insurance (the United States) to finance health care [13, 14, 15].
In contrast, low-income countries such as Iran, India, Mexico, and South Africa, relied on public budgets and sometimes small private insurances due to the lack of a tax base [16]. In China and South Africa and paying subsidies from the general budget, especially to the poor, disabled, government insurance and out-of-pocket payments were funding sources [17, 18]. Also, in Mexico, government insurance and out-of-pocket payments are the sources of financing [19].
Iran does not have full coverage of public insurance, and private insurance covered only a part of the population, while Germany had a combination of social and private insurance, and Turkey and Britain had national health services [20]. The type of insurance system in Iran was for the disabled working in the social insurance system, which was in line with many countries globally. The rehabilitation system in Iran requires the combined use of different financing methods to reduce the disabled share in the direct payment. Factors such as sanctions and the prevalence of coronavirus disease have affected the rehabilitation sector’s financing for the disabled. Therefore, according to the results, it is proposed that gross domestic product’s rehabilitation sector be increased. According to the service provider organization, in all countries and hospitals, private centers provided services. In England, local units also provide services [21]. A special feature of rehabilitation centers in India was their charitable nature [22]. In Mexico, most national government rehabilitation agencies provided services [23], and in South Africa, primary rehabilitation was provided through the primary health care system [24]. In Iran, inpatient and outpatient rehabilitation services and oversight of private sector rehabilitation clinics were the Ministry of Health and Medical Education’s responsibility. Rehabilitation services, except in hospitals, were provided entirely through parallel private sector centers and other organizations. In other countries studied, the Ministry of Health and the private sector were often provided these services. 
It is important to note that this study did not cover all aspects of the rehabilitation system, as the dimensions of this issue are vast, and this study confines itself within the framework of the defined objectives.
Discussion and Conclusion
This research proposes the following items as the most effective strategy for the integration of the rehabilitation system for the disabled to create a single instruction by the Ministry of Health of Iran: decentralized structure, attention to training sufficient personnel tailored to the needs of each region, creating data management platforms, utilizing financial resources for insurance and public taxes, providing comprehensive rehabilitation services, and providing special service packages, for particular disabilities. 
Strengthening the National Council for the Rehabilitation of the Disabled seems to help achieve this goal. Germany and the United Kingdom had a more efficient rehabilitation system than the other selected countries studied. Also, localization should be considered a suitable model, especially in reducing out-of-pocket payments for the disabled. 
In the end, policymakers and planners in this field should take a broader view of reviewing and reforming the structure, laws, and processes to move towards the formation of a system for providing rehabilitation services for the disabled in Iran, and the research result should be used in the development of policies and executive instructions.

Ethical Considerations
Compliance with ethical guidelines
All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization and supervision: Leila Riahi, Mohsen Iravani and Kianoush Abdi; Methodology: Mohsen Iravani, Kianoush Abdi; Data collection: Leila Riahi, Mohsen Iravani, Kianoush Abdi; Investigation, writing – original draft, writing – review & editing, data analysis: All authors. 

Conflict of interest
The authors declared no conflict of interest in this study.


References

1. Davis LJ. The disability studies reader. Milton Park: Taylor & Francis; 2006. https://books.google.com/books?id=
2. Kamali M. An overview of the situation of the disabled in Iran. Advancing the rights of persons with disabilities: A US-Iran Dialogue on law. Policy, and Advocacy. 2011; 15. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.669.637&rep=rep1&type=pdf#page=16
3. World Health Organization. The world health report 2000: Health system: Improving performance. Geneva: World Health Organization; 2000. https://www.who.int/whr/2000/en/whr00_en.pdf
4. Karimi I, Salarian A, Anbari Z. [A comparative study on equity in access to health services in developed countries and designing a model for Iran (Persian)]. Journal of Arak University of Medical Sciences. 2010; 12(4):92-104. http://jams.arakmu.ac.ir/article-1-136-en.pdf
5. Abdi K, Arab M, Rashidian A, Kamali M, Khankeh H, Farahani F. Exploring barriers of the health system to rehabilitation services for people with disabilities in Iran: A qualitative study. Electronic Physician. 2015; 7(7):1476. [DOI:10.19082/1476] [PMID] [PMCID]
6. Ferdosi M, Vatankhah M, Khalesi N, Azar FEF, Ayoobian A. Designing a referral system management model for direct treatment in social security organization. Journal of Military Medicine. 2012; 14(2):129-35. http://militarymedj.ir/article-1-934-en.pdf
7. Karimi M. [Welfare and social security in the sixth development plan (Persian)]. Tehran: Ministry of Cooperatives, Labor and Social Welfare; 2015.
8. Abdi K, Arab M, Khankeh H, Kamali M, Rashidian A, Farahani F. Challenges in providing rehabilitation services for people with disabilities in Iran: A qualitative study. Journal of Advances in Medicine and Medical Research. 2016:1-11. [DOI:10.9734/BJMMR/2016/23337]
9. Organization SW. [Statistical annual report of 2019 (Persian) [Internet]. 2019 [Updated 2019]. Available from: http://www.behzisti.ir
10. Kafshian GZ. [A study of factors affecting the social exclusion of persons with disabilities Rey County (Persian)]. Tehran: University of Tehran; 2013.
11. Adick C. Bereday and Hilker: Origins of the ‘four steps of comparison’model. Comparative Education. 2018; 54(1):35-48. [DOI:10.1080/03050068.2017.1396088]
12. Oliver A, Mossialos E. European health systems reforms: Looking backward to see forward? Journal of Health Politics, Policy and Law. 2005; 30(1-2):7-28. [DOI:10.1215/03616878-30-1-2-7] [PMID]
13. Vogel H, Zdrahal-Urbanek J. Rehabilitation in Germany: New challenges of a structured social security scheme. International Journal of Rehabilitation Research. 2004; 27(2):93-8. [DOI:10.1097/01.mrr.0000128058.46440.d0] [PMID]
14. Salize HJ, Rössler W, Becker T. Mental health care in Germany. European Archives of Psychiatry and Clinical Neuroscience. 2007; 257(2):92-103. [DOI:10.1007/s00406-006-0696-9] [PMID]
15. Rashidian A, Kavosi Z, Majdzadeh R, Pourreza A, Pourmalek F, Arab M. [Assessing health system responsiveness: A household survey in 17^th district of Tehran (Persian)]. Iranian Red Crescent Medical Journal. 2011; 13(5):302. [PMCID] [PMID]
16. Damari B, Vosoogh-Moghaddam A, Delavari A. [How does the ministry of health and medical education of Iran protect the public benefits? Analysis of stewardship function and the way forward (Persian)]. Hakim Research Journal. 2015; 18(2):94-104.
17. Zare H. [Basic health insurance: principles, Structure, Coverage and Regulation (Persian)]. Tehran: Medical Services Insurance Organization Publication; 2006.
18. Jahanbin P, Abdi K, Khanjani MS, Hosseini MA. [Exploring Barriers of teamwork in providing rehabilitation services: A qualitative content analysis (Persian)]. Archives of Rehabilitation. 2019; 20(3):210-21. [DOI:10.32598/rj.20.3.210]
19. Gutiérrez SMB, Mizota T, Rakue Y. Comparison of four health systems: Cuba, China, Japan and the USA, an approach to reality. Southeast Asian Journal of Tropical Medicine and Public Health. 2003; 34(4):937-46. https://www.thaiscience.info/Journals/Article/TMPH/10645271.pdf
20. Tuohy CH. Single payers, multiple systems: the scope and limits of subnational variation under a federal health policy framework. Journal of Health Politics, Policy and Law. 2009; 34(4):453-96. [DOI:10.1215/03616878-2009-011] [PMID]
21. Thomson S, Osborn R, Squires D, Reed SJ. International profiles of health care systems 2011: Australia, Canada, Denmark, England, France, Germany, Iceland, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. 2011. https://www.commonwealthfund.org/
22. World Health Organization. Rehabilitation in health systems: Guide for action [Internet]. 2019 [Updated 2020 November 21]. Available from: https://www.who.int/
23. Segall M. On the concept of a socialist health system: A question of Marxist epistemology. International Journal of Health Services. 1983; 13(2):221-5. [DOI:10.2190/L747-35WT-BPXK-1NDU] [PMID]
24. Mistretta MJ. Differential effects of economic factors on specialist and family physician distribution in Illinois: A County-level analysis. The Journal of Rural Health. 2007; 23(3):215-21. [DOI:10.1111/j.1748-0361.2007.00093.x] [PMID]
25. Mullins CD, Wingate LMT, Edwards HA, Tofade T, Wutoh A. Transitioning from learning healthcare systems to learning health care communities. Journal of Comparative Effectiveness Research. 2018; 7(6):603-14. [DOI:10.2217/cer-2017-0105] [PMID]
26. Vahdat D. [Investigation of electronic health challenges in Iran and propose a framework for the establishment of e-health systems in the country (Persian)]. Tehran: Tarbiat Modares University; 2006.
27. Karimi I, Nasiripour A, Maleki M, Mokhtare H. [Assessing financing methods and payment system for health service providers in selected countries: Designing a model for Iran (Persian)]. Journal of Health Administration. 2006; 8(22):15-24. http://jha.iums.ac.ir/article-1-349-en.html
28. Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. Jama. 2006; 295(17):2027-36. [DOI:10.1001/jama.295.17.2027] [PMID]
29. Dastyar V, Mohammadi A. [Investigating the Empowerment of the Physically-Handicapped People and Its Related Factors: A cross-sectional, analytical study in Kohgiluyeh and Boyer-Ahmad Province (Persian)]. Archives of Rehabilitation. 2019; 19(4):354-69. [DOI:10.32598/rj.19.4.354]
30. Randolph DS, Andresen EM. Disability, gender, and unemployment relationships in the United States from the behavioural risk factor surveillance system. Disability & Society. 2004; 19(4):403-14. [DOI:10.1080/09687590410001689494]
31. Rasoulinezhad SA, Rasoolinejad MS. [A study of referal system in health care delivery system and recommended alternative strategies: KASHAN health care network (Persian)]. Hakim Research Journal. 2002; 4(4):238-42. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=48004
32. Busse R, Blümel M. Germany. Health system review. Health Systems in Transition. 2014; 16(2):1-296. [PMID]
33. Nosratnejad S, Rashidian A, Mehrara M, Sari A, Mahdavi G, Moeini M. [Willingness to pay for social health insurance in Iran (Persian)]. Global Journal Of Health Science. 2014; 6(5):154. [DOI:10.5539/gjhs.v6n5p154] [PMID] [PMCID]
34. Saadati M, Rezapour R, Derakhshani N, Naghshi A. [Comparative study of fair financing in the health insurance (Persian)]. 2017; 7(4): 65-73. https://jhm.srbiau.ac.ir/article_10414.html?lang=en
35. Saltman RB, Figueras J. Analyzing the evidence on European Health Care Reforms: Experience in western European health care systems suggests lessons for reform in the United States, according to a major international comparison by the World Health Organization. Health Affairs. 1998; 17(2):85-108. [DOI:10.1377/hlthaff.17.2.85] [PMID]
36. Nahin RL, Barnes PM, Stussman BJ. Expenditures on complementary health approaches: United States. National Center for Health Statistics. 2016;(95):1-11. [PMID]
37. Boyle S. United Kingdom (England): Health system review. Health Systems in Transition. 2011; 13(1):1-483. [PMID]
38. Gudlavalleti, Venkata S. Challenges in accessing health care for people with disability in the south Asian context: A review. International journal of Environmental Research and Public Health. 2018; 15(11):2366. [DOI:10.3390/ijerph15112366] [PMID] [PMCID]
39. Van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, et al. Paying out-of-pocket for health care in Asia: Catastrophic and poverty impact. Erasmus University, Rotterdam and IPS, Colombo. 2005. https://econpapers.repec.org/paper/esswpaper/id_3a823.htm
40. Spaan E, Mathijssen J, Tromp N, McBain F, Have At, Baltussen R. The impact of health insurance in Africa and Asia: A systematic review. Bulletin of the World Health Organization. 2012; 90:685-92. [DOI:10.2471/BLT.12.102301] [PMID] [PMCID]
41. Sandoval H, Pérez-Neri I, Martínez-Flores F, Valle-Cabrera MGd, Pineda C. Disability in Mexico: A comparative analysis between descriptive models and historical periods using a timeline. Salud Pública de México. 2017; 59:429-36. [DOI:10.21149/8048] [PMID]
42. Ayhan M, Ridvanoğlu S, Akgün U, Gergi̇S, Aktaş C, Gökmen F, et al. An analysis of the labour market based on disability. general directorate of services for persons with disabilities and elderly people [Internet]. 2011 [Updated 2011 November]. Available from: https://www.ailevecalisma.gov.tr/media/42387/an-analysis-of-the-labour-market-based-on-disability.pdf
43. Orszag PR, Emanuel EJ. Health care reform and cost control. The New England Journal of Medicine. 2010; 363(7):601-3. [DOI:10.1056/NEJMp1006571] [PMID]
44. O’Keefe P. People with disabilities in India: From commitments to outcomes. Washington, D.C.: The World Bank; 2009.
45. Guzman JM, Salazar EG. Disability and rehabilitation in Mexico. American Journal of Physical Medicine & Rehabilitation. 2014; 93(1):S36-S8. [DOI:10.1097/PHM.0000000000000019] [PMID]
46. McIntyre D, Gilson L. Putting equity in health back onto the social policy agenda: Experience from South Africa. Social Science & Medicine. 2002; 54(11):1637-56. [DOI:10.1016/S0277-9536(01)00332-X]
47. Karimi S, Ziari NB. [Equity in financial indicators of the health in Iran during the third and fourth development programs (Persian)]. Health Information Management Journal. 2013; 9(7):1113-22.
48. Fathi F, Khezri A, Khanjani M, Abdi K. [Comparison of Responsiveness Status of Rehabilitation Services Organization From the Perspective of Services Recipients (Persian)]. Archives of Rehabilitation. 2019; 20(3):270-85. [DOI:10.32598/rj.20.3.270]
49. Hassan-Zadeh A. [GP referral system designed and defined in terms of health services (Persian)]. Tehran: Ministry of Health and Medical Education; 2003. http://militarymedj.ir/