Financial Transactions for the Family Home Health Care Center,

• Enquiry article
• Open Access
• Published: 12 April 2018

The fiscal transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study

BMC Wellness Services Enquiry volume 18, Article number:282 (2018) Cite this article

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Abstract

Background

Customs-oriented nursing intendance is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian customs for nearly two decades. Resource direction, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions betwixt CNCSCs and their clients.

Methods

This study has a qualitative pattern and was conducted on a full of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and straight observations and were analyzed using conventional qualitative content analysis.

Results

The assay of the data led to the extraction of three main categories, including the flaunted atmosphere due to straight fiscal transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction.

Determination

To increment affordability and satisfaction and expand private community-based nursing.

Services, appropriate financial policies should exist designed and applied that can pb to transparent and elementary financial transactions with the clients by style of indirect budgetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and exist toll-constructive for the clients, insurance companies and the health arrangement.

Peer Review reports

Background

In line with the WHO objectives for Primary Health Care (PHC) [1, ii] and the Comprehensive Health.

Activeness Plan 2013–2020 [3], health policies have been established to create a rest between unlike levels of prevention and to provide community-based services [4].In some countries, some bones changes in wellness system policies have made family unit and customs-based services abound to the level that they now account for half of all the health services provided to the public, and the corporeality of health services provided by hospitals is at present equal to the amount of services given past the community [5].

The activities of Counseling and Nursing Care Service Centers (CNCSCs) in Iran tin exist considered a logical step in promoting nurses' professional role in the community [6].These individual centers are allowed to offer different nursing services to individuals, families and the community; still, the majority of their services are currently offered at homes. Community-based nursing intendance has a longer history in countries such as the U.s.a. and Canada, where these centers are supported by the local health systems and have a major share in the delivery of wellness services [7,8,nine]. In developing countries the role of nurses in community-based healthcare provision is cryptic [10,eleven,12] and nursing intendance is mostly restricted to hospitals [13,fourteen,fifteen].

Community-based wellness services offer several advantages, such every bit saving in costs [16, 17]. A major challenge for wellness system managers is to improve the quality of healthcare at the aforementioned time every bit reducing its costs [18]. The costs of providing wellness intendance are always increasing [19] and the need to increment the budget allocated to the health sector and design efficient input-output evaluation mechanisms for improving the efficiency of health financing [twenty] are more than evident than ever. Performing cost-benefits and toll-effectiveness analyses and adjusting reimbursement policies can advance the process of expanding community-based health service provision [21, 22].

Peculiarly in developing countries, health systems are faced with the serious challenge of resources management [23] and healthcare delivery [24, 25]. At nowadays, the privatization of health care services might exist a step also far in assisting the health arrangement to face its challenges [26]; withal, this step is beingness taken in developing countries without a clear and coherent strategy [27].

Mod approaches to health care have identified three main goals for an platonic wellness care system, which include quality comeback, accountability and fair financial contribution to health care services [28, 29]. From the clients' perspective, the most important attributes of proficient wellness care services are their piece of cake accessibility, cost-effectiveness, affordability and high quality [30]. In improver, health intendance organizations and community-based health care centers demand to take an adequate level of income in order to be able to continue providing their services.

Financial profit is naturally a priority of private nursing services, fifty-fifty with the governmental support offered to these centers in developed countries, financing the services was a primary concern [7, 31]. Few studies have examined the economic aspect of community-based nursing intendance [22]. Identifying the challenges in the financial management of nursing services tin help policymakers and CNCSC managers blueprint advisable strategies for expanding customs-based nursing services.

Having a payment schedule and providing cost-constructive services are important for service providers, clients and other stakeholders in whatever financial affair. In addition to the price of the bolt or services, how and when the costs are calculated and paid and what documentations are needed for these financial transactions is also key. In other words, the mean of financial transaction means how to calculate the cost of services, how and when should to pay and which documentation is required.

In spite of well-nigh 2 decades of activity, the services provided past CNCSCs are not well-organized and are faced with great financial issues. The present study was conducted to explore the fiscal transaction between CNCSCs and their clients and the challenges in their management and the contributing factors.

Methods

The present qualitative study was conducted using the content assay method. The main participants included CNCSC managers, but the data obtained fabricated the researchers recruit physicians and clients besides. Sampling connected until information saturation was accomplished with 28participants and complementary interviews were conducted with two other family members(Tabular array ane).The inclusion criterion was to have at least one twelvemonth of work experience(in the by or the present) for having sufficient feel in a CNCSC and the exclusion criterion was unwillingness to participate in the study.

Table 1 Participants' demographic characteristics

Total size table

Data collection began with in-depth individual interviews, and the researcher tried to gather complementary information through the ascertainment of the financial transactions made in the centers and their related documents, if possible. The chief interview questions were' Please discuss your experiences of communicating with clients and providing care to them' and 'Please talk over your experiences of establishing a financial human relationship with your clients, the estimated costs of the services, the tariffs and their payment by the clients'(Boosted File 1: interview guides).

Before each interview, the researchers introduced themselves to the interviewees and briefed them on the study objectives and methods and ensured them of the confidentiality of their data and that they would not be used against them. The participants then signed informed written consent forms for participation in the study. The recorded interviews were transcribed verbatim. Data were analyzed using the conventional content analysis, in which pre-existing theories had no identify and where information analysis was based on the meanings that the data conveyed. In this approach to data analysis, the researcher repeatedly peruses the collected data in order to obtain a general understanding of the subject area [32]. The data obtained in the study were analyzed through the post-obit steps: Preparing the information, defining the unit of analysis, developing codes and categories and a sample text, encoding the entire body of text, ensuring consistency in encoding, drawing conclusions from the encoded information, and reporting the findings [33].

The trustworthiness of the data was ensured through different strategies, such equally the allocation of adequate time to the research, holding in-depth interviews, explaining the objectives of the study to the participants in detail and performing a member bank check and a peer review [34].

Results

The findings of the written report led to the extraction of three chief categories, including the flaunted temper due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for price-effective services and client satisfaction. This section explains the principal categories and subcategories (Table 2).

Tabular array 2 Exploring the challenges in the financial transaction between CNCSCs and their clients

Full size table

A. The flaunted temper due to straight financial transaction

This category consisted of two subcategories, including direct unfavorable budgetary exchanges and the complex interaction with private insurance companies.

Directly unfavorable budgetary exchanges

Nigh clients accept to personally pay for CNCSC services without their public insurance plans covering their associated costs. Even when the cost of their desired service is reasonable, they have to pay it entirely out of pocket (OOPE) and equally soon every bit they receive the service; as a result, the whole scenario notwithstanding seems exorbitant, especially compared to physicians' fees or public hospitals' and clinics' fees that are covered by insurance.

"When nosotros refer patients to CNCSCs for continuing their care, many of them or their families come up and complain well-nigh the high straight costs of these services. For example, they pay200,000 IRR for a dr.'s visit, merely have to pay 400,000 IRR for a wound dressing!"(P.x- General Surgeon).

Another reason extracted was that the clients of these services and their families did non understand the importance of nursing care. Their poor understanding of the scientific nature of nursing and customs-based nursing intendance affected their willingness to pay for nursing services. In some cases, due to insufficient family unit income and the costs of multiple illnesses, they were not able to pay boosted fees for nursing intendance services likewise.

"Things such every bit injections are viewed as very simple tasks by virtually people and they pay less attention to the consequences the nurses may face if they don't properly perform them, so, they are often reluctant to pay for these services. Sometimes, they don't even have the coin to pay for them at all" (P.8- CNCSC Managing director).

The complex interaction with private insurance companies

Some private insurance (PI) companies exercise not take the bills issued past CNCSCs or insist on having them separately confirmed past physicians.

"I feel that private insurances do not have nursing equally an contained profession. At CNCSCs, we accuse a fee for wound dressing care and say that the physician should confirm it too, even though wound intendance is a separate nursing duty"(P.22- CNCSC Managing director).

In some cases, PI contracts cover services through the complementary insurance (CI) cards they upshot to the insured person. Through the card, the client tin can receive wellness services costless of charge or pay a pocket-size role of the beak out of pocket (OOP), which is the main advantage of health insurance for clients. Sometimes, however, due to the poor interaction between CNCSCs and PI companies or the delays in reimbursement of the fees past the PIs, CNCSCs prefer to exist paid for the cost of their services straight and therefore bill the clients on the spot. This form of financial transaction is considered arduous and undesirable for the clients.

"I have been using CNCSC services for a long time to care for my elderly and sick parents, simply since the get-go of this year, they (CNCSC) began request me to pay the costs out of pocket and billed me for dissimilar things. It has gotten complicated and takes a lot of fourth dimension to ready the documentation at present. What triggered this was that the PI companies delayed reimbursing the CNCSCs. The financial part became very difficult and I decided to terminate getting services from CNCSCs"(P. 27- Family Member).

B. Instability in determining tariffs for nursing services

This category consisted of three subcategories, including inadequate attention to CNCSC services, the demand to bargain with the CNCSCs and clients to prepare a price, and a lacking environment of competence.

Inadequate attention to CNCSC services

Poor toll-setting for nursing services are another important barrier to constructive financial transaction with the clients. Most of the participants said that the prices of nearly care services they offered in the centers were either still non stock-still or were non upward-to-engagement. For instance, although preventive education and counseling have been defined equally the main function of these centers, they lack a clear pricing and are non very cost-beneficial and there has been very little public involvement in these forms of assistance. The sole recipients of pedagogy and counseling are the patients or their family unit members, who are eager to learn more nearly self-care and the steps of referring their patient to a physician or hospital.

"Nosotros offer advice and assistance to our patients and do all of this aslope our other care services …" (P. 4 and P6- CNCSC Nurses).

The need to bargain with the CNCSCs and clients to fix a price

By not setting or updating the prices, CNCSC managers have to constantly negotiate with their clients to reach an understanding almost the price of the requested services or else may have to use prices set by other clinics or healthcare providers.

A lacking surround of competence

Inadequate supervision by the health system, inadequate familiarity with CNCSCs and financial problems are some of the challenges faced past these centers. Moreover, some hospital nurses have the liberty of providing home care to patients without having the required certificates.

"Sometimes, the infirmary nurses institute a sure human relationship with their patients and their family that may atomic number 82 to non-regulated dwelling house nursing care and so we lose some of our clients" (P. 17- CNCSC Manager).

Some healthcare clinics also provide home care in spite of the legal constraints. Some people may fifty-fifty exist receiving nursing services by non-professionals and unlicensed health providers, as the clients sometimes prefer inexpensive admitting depression-quality services over costly but high-quality professional person nursing services.

"Say, a patient comes to our center for urethral catheterization and asks most its costs. I hold a degree, and my response is, 600.000 IRR. A non-professional health worker may suggest 350.000 IRR for the same job. Patients practise not notice that the worker who suggests 350.000 has no expertise in performing catheterization. Unfortunately, the patients ofttimes go to lay health workers who ask 350.000 for the chore. So, you end upwardly seeing the patient refer to our center with a astringent urinary tract infection and many other issues" (P. vi- CNCSC Manager).

Meanwhile, many of the services provided by CNCSCs accept get more than accessible at lower prices in public hospitals and clinics.

C: The employ of benefit strategies for toll-effective services and client satisfaction

This category consisted of three subcategories, including regulating fiscal transactions with the families, expediency trying to expand organizational relationships, and trying to rationalize the costs of service for the clients.

Regulating financial transactions with the families

Patients or elders who need care are often in a poor physical and mental condition and cannot properly participate in the controlling regarding their ain intendance. To create transparency in the contracts, direction and monitoring of care services and to have financial subject area in the calculation of prices and their payment, CNCSC managers prefer to have their professional human relationship and financial transactions with one of the family members throughout the process of service commitment.

"Even if this older person or patient has children and they are willing to participate in the intendance and payment process, we draw up our contract with only one of them"(P. 7- CNCSC Manager).

Meanwhile, CNCSCs prohibit financial transaction between the CNCSC nurses and the patients or their families.

"One of the caregivers I sent to someone's habitation was taking money from the family. I got very upset, just the family unit said he was doing a really skilful job. I said information technology isn't acceptable for us that they go any money from y'all considering they may develop a habit of it. And so, I dismissed that caregiver, later on all"(P. 12- CNCSC Managing director).

Expediency trying to expand organizational relationships

Some private and semi-individual organizations such equally banks and municipalities have independent insurance plans for their employees and their families. These organizations are willing to contract with CNCSCs for receiving nursing services, simply tend to propose lower prices. With such contracts, CNCSCs sometimes take to provide services in locations that are far from their main function, and this long commute increases the time spent and the costs of the services and essentially reduces the cost effectiveness of the services. CNCSC are therefore cautious in concluding contracts with these organizations.

"Several bank regime visited our center and agreed to contract with us. They even drafted the contract, only then I idea it may not be price-effective for the states to offer them these services at these prices and then decided not to work with them" (P. 5- CNCSC Manager).

Nonetheless, there take been successful instances of service centers establishing work relationships with some private and semi-private organizations with good financial capacities.

Trying to rationalize the costs of service for the clients

To increase the affordability of CNCSC nursing services, these centers endeavor to make families understand the importance and sensitivity of community-based nursing services. They brief the patients and their families on the benefits of receiving services from these centers, such equally the less commute to healthcare centers and reduced costs forth with the improved quality of services. These explanations demonstrate the superiority of CNCSC nursing services over non-professional and cheaper services.

"Nosotros try to make the family understand their mistakes… That if they spend100.000 IRR less, it may non really exist meliorate for the patient, as they may develop complications and receive a very poor-quality service" (P. fifteen- CNCSC Supervisor).

The complicated procedure of getting reimbursed by complementary insurance companies makes the clients have to ask CNCSCs to help them with getting the appropriate documentation and perchance building an breezy relationship with the physicians to accept their bills confirmed.

"We have the invoices to specialists to confirm, and this is simply possible through informal relationship with the doctors, because information technology is not truly their job" (P. iii and p.22.CNCSC Managers).

Give-and-take

The findings revealed the flaunted temper due to straight financial transaction and instability in determining tariffs for nursing services as factors increasing annoyance, confusion, out-of-pocket payment and customer dissatisfaction. To reduce the negative effect of these factors on the affordability of the services, CNCSC managers usually utilize cost-do good strategies for offer cost-constructive services and increasing client satisfaction.

Public insurance plans do not embrace the costs of CNCSC services. The inadequate insurance coverage for nursing services negatively affects the financial transaction between nursing intendance service providers and clients in CNCSCs, increases OOPs and ultimately reduces the use of community-based nursing services. Clients accept to pay the entire costs of using these services themselves and may have to pay other costs, simultaneously and therefore experience keen fiscal difficulties. The results of other studies as well suggest that the multiplicity of payments for wellness intendance services complicates financial transactions and has negative effects on financial management [35]. The poor insurance coverage offered for nursing services means that fifty-fifty when the services are offered at a fair price, some families notice them expensive and unaffordable, especially given that they may exist able to receive like services at a lower cost in public hospitals and clinics.

The increased (CI) coverage past (PI) companies can be considered an opportunity for individual health care providers such equally CNCSCs. Still, the relationship between CNCSCs and these companies is gradually growing and some of the barriers, such equally not having a clear and customized policy for community-based nursing services, may be resolved. It should be noted that CI helps those of the community who are insured voluntarily (rather than obligatory through their employee) who often are relatively in better fiscal situation and can pay CIs a premium [36, 37]. Therefore unlike in advanced countries [38, 39], depression-income peoples benefit from CNCSC services to a lower degree. Like many other studies [forty, 41], the present study found that the inadequate insurance coverage for nursing services imposes a smashing financial brunt on families and makes them reluctant to seek such services. The heavy costs of healthcare tin limit the clients' access to high-quality and cost-effective healthcare services [19]. Lack of health insurance in developing countries may mean enormous OOPs [42, 43], while countries with better healthcare systems rely less on OOPs [44,45,46]. Nursing centers in these countries have a flourishing market and their policies are such that reimbursement for these services is adequate both by public and individual insurance companies [31].

There are 3 principal healthcare delivery models, including public assistance, health insurance and national health services. The wellness authorities in Iran adopted the Public Assistance model [47] and fund information technology in a pluralistic way through the social security organization [25] and by way of an almanac government wellness budget [44], taxes, social security insurance payments and out-of-pocket payments [26, 46]. In this model, wellness decision-making, planning, resource direction and service commitment fall nether the responsibleness of the government [47]. Consequently, government policies and plans tin can dramatically affect the presence and activities of healthcare delivery centers, including CNCSCs. The negative touch on of policies counteracts and weakens the health management procedure [48].

Like in other developing countries, Iran's health intendance system is faced with complexities in marketing and management [25, 49], such as the overuse of wellness intendance services [26] and bereft funding (41). Such challenges have imposed serious limitations on the efficiency, quality and equity of the healthcare services [26]. The function of health insurance is sub-optimal from the perspective of wellness insurance organizations, health intendance providers and clients [25]. In spite of the meaning increase in public insurance coverage in the recent decade [26] and the wellness transformation program in place [50], Islamic republic of iran's health system has non been successful in reducing OOPs in customs-based health centers significantly [51].

Co-ordinate to the present study, the absence of articulate tariffs and an agreement on CNCSC services confuses the clients nigh the real costs of the services. Other studies have similarly shown that clients may pay different fees for a similar service and some insurance plans exercise not cover the costs of these services and straight payments increase drastically [45]. Due to the underestimations well-nigh the importance of community-based nursing care, most patients and families are reluctant to pay for nursing services. The heavy costs of these services may mean that the patients suffice to lower-quality intendance from breezy service providers. The clients' willingness to pay is an important component of the cost-benefit analysis of wellness services [22, 52]. Nursing has a long history in adult countries and community-based nursing intendance is very extensively offered; people may as well take ample knowledge about the practice of nursing in these countries and might truly capeesh its benefits and thus put their trust in nurses [53]. In developing countries, however, the novelty of community-based nursing services means that more serious attempts are needed to gain a wider public interest. Increasing the variety of nursing services offered can help the public improve perceive the nurses' role and their capabilities and thus change the mental attitude toward nursing services and nurses [54].

The nowadays study showed that public health centers and hospitals in Iran do not collaborate with CNCSCs and accept most no interaction with these centers. Unlike these findings, other studies take shown a good relationship between community-based nursing intendance centers and the good accessibility of their services [31]. As a result, people are rarely informed well-nigh or referred to these centers in Iran. The poor integrity of health organisation programs and the weak interactions between the private and public health sector [55].The lack of economic expertise in health care direction, the poor monitoring of the services and OOPs are other challenges faced with the privatization of health care [25].Improving fiscal direction skills in healthcare managers is therefore as vital every bit it is in nursing managers [38, 56].

The weather condition of care delivery and the fiscal transactions between Iranian CNCSCs and their clients are remarkably similar to home-based nursing practices in Turkey. Most Turkish people cannot use home-based nursing services due to the inadequate insurance coverage offered for these services [57]. In countries such every bit the United States and Canada, still, most nursing centers are supported by comprehensive healthcare plans such every bit Medicare or receive financial back up from the government, and most people, fifty-fifty depression-income groups, can widely benefit from these services [7, 53, 58].

The 3 main stakeholders in a health-related financial transaction are the clients, the service providers (CNCSCs) and the insurance arrangement. Some important points should be taken into account when establishing such financial transaction: 1. The toll of the services should be clear and fair; 2. All the stakeholders should achieve a fair turn a profit by engaging in this transaction, 3. Processing monetary payments should exist carried out with clarity and simplicity, and 4. Every wellness care program must have a systematic design and application. The cost-benefit analysis of health care services should consider the costs and the direct and indirect benefits of these services [59]. Failing to bear a fiscal analysis of programs increases the concluding costs of wellness care services [forty].

In spite of the greater willingness toward indirect payment and the separation of payment from service delivery [xl], the nowadays study showed that the financial transaction between CNCSCs and their client move toward directly payments. The low insurance coverage's, the direct payments with circuitous and depression reimbursements and the heavy out-of-pocket payments for CNCSC services have created serious challenges in the affordability and expansion of these private customs-based nursing care centers (Boosted File 2: FigureS1). Fixing a minimum/maximum time immune for payment sand finding the best methods of payment are necessary for private health intendance delivery direction [60].

CNCSC managers use certain strategies to offer cost-constructive services and increase their clients' satisfaction. They enter agreements with semi-individual organizations with peachy financial resources that request various nursing services and effort to convince the clients near the benefits of receiving CNCSC services and paying their costs and aid them provide advisable documentation for CI reimbursement past PIs. Still, some of their deportment, such as forcing the clients to make directly payments, are cause for client dissatisfaction.

Iran'due south Ministry of Wellness has well understood the challenges and seeks to upwardly-to-date the tariffs of some of CNCSC services and improves the professional interaction betwixt hospitals and these centers. To date, these efforts have not yielded practical results in terms of increasing the insurance coverage for these services and the problems persist, such as direct payments, high OOPs, poor affordability of the services and increased client dissatisfaction and confusion.

The stability and development of private community-based nursing services rely on cooperation between CNCSCs, clients, the health system and insurance organizations. In addition to the wellness arrangement, private community-based service centers such as CNCSCs should as well seek to develop policies and plans that take business relationship of the benefits of the main stakeholders and thus improve the quality of wellness services and decrease their costs to a more than reasonable level. At the aforementioned fourth dimension, CNCSCs must convince health systems and insurance companies that the expansion of their action reduces the wellness system burdens and the costs of public and private insurances.

Limitations

Given the private nature of CNCSC services, they are less obliged to collect and keep their financial documents than formal public wellness organizations. They can even hide their real incomes and expenses. The researcher was not able to admission the CNCSCs' fiscal documents, especially their income forms.

Given the limited number of studies on community-based nursing service centers, hereafter studies are recommended to further explore the other aspects of these centers.

Conclusion

Insufficient public insurance coverage and the lack of admission to an up-to-appointment cost list increment direct payments and atomic number 82 to defoliation and drive away the clients and thus reduce the use of CNCSC services.

To increment the affordability of these services, increment client satisfaction and aggrandize private community-based nursing care, fiscal policies should be designed to enable articulate and elementary financial transactions with the clients through indirect payments, increased insurance coverage and reduced out-of-pocket payments. These policies should be designed with integrity and in a systematic manner and should facilitate cooperation betwixt different sectors of the health system and atomic number 82 to price-constructive services for the clients, insurance companies and the entire health system.

Abbreviations

CI:

Complementary Insurance

CNCSCs:

Counseling and Nursing Care Service Centers

IRR:

Iranian Currency (Rial)

OOPs:

Out-Of-Pocket payments

PI:

Private Insurance

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Acknowledgements

This study is part of a PhD dissertation approved by the Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. The authors would similar to limited their gratitude to deputy research of Tarbiat Modares University and all those who helped in conducting the study, especially the CNCSC managers and staff interviewed.

Funding

This enquiry project was approved and financially supported by deputy research of Tarbiat Modares University in Iran.

Availability of data and materials

The datasets generated and analyzed during the current study are non publicly available as they might compromise the participants' identity but are available from the corresponding author on reasonable asking. The secondary data generated from the raw information is provided in Additional File iii.

Author information

Affiliations

1. Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal Al-Ahmad, P.O. Box 14115-331, Tehran, Iran

   Sefollah Alaei, Fatemeh Alhani & Hassan Navipour

Contributions

SA is the starting time author and contributed to the design and development of the study, data drove, data analysis and the writing of the paper. FA supervised the report and contributed to the blueprint and development of the study and its data analysis and estimation of data, and guided the first author in writing the newspaper. She was besides the administrator of the project. HN is the research advisor for this study and helped in the development of the report and its data analysis also every bit the revision of the paper. All authors have read and approved the manuscript final version.

Corresponding author

Correspondence to Fatemeh Alhani.

Ethics declarations

Ethics approval and consent to participate

This inquiry project was canonical (ID: 52/8199) by the Ethics Committee of the Medical Scientific discipline..

Sciences, Tarbiat Modares University, where the work was undertaken. Earlier each interview, the participants were introduced to the interviewers and then briefed on the study objectives and methods and ensured of the confidentiality of the data and of their not being used against them. The participants then gave their written consents for participation in the report.

Consent for publication

Not applicative.

Competing interests

The authors take no conflicts of involvement to declare.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Boosted files

Additional file 1:

Interview guides of CNCSCs financial transaction with clients. Brief description of the data: Interview guides that developed specifically and used in research process in enquiry entitled: "The financial transaction between Counseling and Nursing Care Service Centers (CNCSCs) and their clients: A qualitative report" (DOCX 15 kb)

Additional file ii:

Effigy S1. Influencing factors on CNCSCs financial transaction with clients. Brief description of the data: This file Designed for better clarify constructive factors on CNCSCs financial transaction with clients and strategies that to be applied with CNCSCs managers. (DOCX 34 kb)

Additional file 3:

Raw data of CNCSCs financial transaction with clients. Brief description of the data: Raw data which gathered in research process about CNCSCs fiscal transaction with clients (DOCX 23 kb)

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Open Access This article is distributed under the terms of the Creative Eatables Attribution four.0 International License (http://creativecommons.org/licenses/past/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Artistic Eatables license, and indicate if changes were fabricated. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Alaei, S., Alhani, F. & Navipour, H. The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative written report. BMC Health Serv Res 18, 282 (2018). https://doi.org/10.1186/s12913-018-2934-z

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• Received: 25 February 2017

• Accepted: 12 February 2018

• Published: 12 Apr 2018

• DOI : https://doi.org/x.1186/s12913-018-2934-z

Keywords

• Counseling and nursing care service centers (CNCSCs)
• Qualitative inquiry
• Financial transaction with the clients
• Financial management

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