Analysis of the interviews resulted in the extraction of 6 main themes and 24 sub-themes (Table 1).
Table 1
The possibility of using Traditional medicine in the implementation of quaternary prevention from the perspective of experts at the Traditional Medicine Faculty of Kerman University of Medical Sciences
No
|
Main category
|
Sub-category
|
1
|
Necessity of services
|
Provide safety of services
|
Delivery of prescriptions to patients with the assurance of the correct provision of herbal medicines
|
Provide logical, scientific and correct services
|
2
|
Patient benefits
|
Patient need for tests, treatments, processes
|
Prevent excessive delivery of services and avoid patient harm
|
Prevent excessive delivery of services to end-stage patients
|
Prevent excessive delivery of services to elderly
|
Patient demand
|
Service effectiveness
|
Use of clinical epidemiology
|
3
|
Complications
|
Complications and explanation of the advantages and disadvantages of providing Traditional medicine services (cupping, consumption of medicinal plants, massage therapy, etc.)
|
4
|
Prevention
|
Measures to prevent disease relapse and lifestyle modification
|
5
|
Rules and regulations
|
Deal with non-physician health care providers
|
Generalization and weak implementation of rules and regulations
|
Measures to deal with non-physicians in the field of Traditional medicine
|
6
|
Financial burden
|
Patient cost
|
Provide cheaper alternative services
|
Costs imposed on the health system
|
To help improve and enhance the level of society’s health, reduce unnecessary visits to medical centers and emergencies, increase public awareness about logical health services and prevent injury to patients, we need to rationalize the provision of Traditional medicine services along with conventional medicine. In this study six main themes including the necessity of service, patient benefit, complications, prevention, rules and regulations, and financial burden along with 24 sub-themes were derived from the data.
1. Necessity of service:
In many parts of the world, policymakers, health professionals, and people are still challenged with issues such as safety, effectiveness, quality, availability, preservation, and use of Traditional medicine. They must make decisions based on the quaternary prevention concepts regarding the best treatment with minimal side effects. Traditional medicine is still widely used in many countries and its use is increasing rapidly in other countries. At the same time, interest in Traditional medicine has grown among the medical community.
Provide safety of the services
Despite the effects of Traditional medicine on health care, little is known about the safety of Traditional medicine. Many physicians believe that this medicine at best is not approved and is unsafe or harmful at worst. The interviewees acknowledged that:
"One of the conditions that the World Health Organization has set for countries to practice their Traditional medicine is safety, which is cost-effectiveness, and so on. The logic behind Traditional medicine is its health-centeredness." (P: 1)
"WHO accepts six of our books and says that without a clinical trial, you can easily prescribe them because they have been prescribed for more than 1000 years and no specific issue has been reported... Another issue is that patient who comes for visiting frequently, or at shorter intervals because it is safer and we do not want to make a mistake in the treatment ". (P: 4)
"Look, it may have fewer side effects than modern medicine surgeries, but it's not safe. It is not as invasive as surgery... I think its risk is moderate; I mean it can have side effects, especially in leech therapy or cupping." (P: 5)
Delivery of prescriptions to patients with the assurance of correct provision of herbal medicines
Preparing medicines prescribed by a Traditional medicine specialist is generally a difficult task because firstly, there are only a few centers that provide medicinal plants, and secondly, there is a big difference between the existing centers in terms of the quality of manufacturing, preparing, keeping and prescribing them. The task of preparing a drug, which is sometimes a combination of several other drugs, takes a lot of time if done by a specialist, and if it is left to the patient, there is a possibility of many and even dangerous mistakes, which negatively influence the desired effect. Interviewees stated that:
"Look at the drugs we prescribe here. To make sure people get them from a safe place, we have a Traditional medicine pharmacy in our health center. Our pharmacy is under the supervision of the Food and Drug Administration, so everything that is presented is passed through our filter." (P: 3)
".... If patients get their medicine from outside the center, they may be harmed. We have no control over those suppliers. Usually, the pharmacies of the health center are under the supervision of a specialist. He is in charge of the medicines that we supply here. The medicine is not given to the patient by mistake. One of the problems is that we do not have a standardized delivery system. To solve the problems, different solutions have been predicted. For instance, the centers should have their herbal medicine supplier or the Traditional health centers should be able to produce medicinal drugs on their responsibility." (P: 5)
Provide logical, scientific and correct services
The scientific, logical, and correct provision of Traditional medicine can be effective in preventing its misuse and misunderstanding. Given that there is still no absolute method for treating diseases, it is necessary for all groups involved in health and wellbeing to work together away from prejudice to improve patient health and wellbeing. The interviewees in this regard stated:
"The Traditional medicine of each country is completely different because it is native to a certain region. The Traditional medicine services of each country should be integrated with the health system of that country and we should achieve integrative medicine. Integrative medicine states that patients should be viewed as a whole, and we should use everything we have such as Traditional medicine, nutrition, conventional medicine, etc, and see which one of these can benefit the patient. The only way is that a Traditional medicine specialist and a conventional medicine physician would be linked to each other. We should be coordinated and work as a team." (P: 6)
"They should hold series of training and workshops in this field, and in fact, explain these levels of service delivery, so that physicians would get familiarized with it and get a better mentality about it. When they enter a phase, at least they have some information about it. It can lead to good and constructive interdisciplinary interaction." (P: 3)
"One way is the existence of Traditional health centers. Because these centers are under the supervision of s Traditional medicine specialist and these are, in fact, all the facilities that a person can ask for. Another thing that we do not have in the country right now is to enter the hospitals. Entering the hospital is a good thing, and we should participate in new medical consultations ... Another issue is the tariff. We have problems with insurance when it comes to tariffs" (P: 5).
"To provide services, we need to prepare an academic context for it. Then, there must be a high level of political commitment at various political levels. Emphasis should be placed on safety and education and being educated and research-oriented. Services should have a scientific basis. We have the same objectives as the WHO; I mean, most of it is knowledge and being safe." (P: 1)
2. Patient benefit
In quaternary prevention, any harm to the patient should be prevented. Treatment is acceptable if it does not cause any harm to the patient and the patient benefits from it the most. Using the recommendations of Traditional medicine, healthy eating habits and a healthy lifestyle are taught to people for their benefit. Health is everyone's right and no one should be sick. By providing correct, timely, and accurate services scientifically, we can improve people's health.
Patient need for tests, treatments, and processes
The more time a physician spends on taking a patient history, and the more he or she determines the treatment based on the patient’s needs and participation, the better treatment choices will be available for him/her. The basis of diagnosis in Traditional medicine is the diagnosis of temperament. Auxiliary tools in the diagnosis of Traditional medicine include pulse, face color, skin color, tongue, and body temperature. Ultrasound, MRI, and other assisting devices are sometimes used, but this does not mean that Traditional medicine diagnosis cannot be made without them. Diagnostic aids, whether laboratory or para-clinical, play a role in assisting diagnosis in Traditional medicine. The interviewees acknowledged that:
"In fact, it may be said that quaternary prevention wants to make the treatment effective. What is important in quaternary prevention is to know which patient benefits from what kind of treatment. In what way can this patient benefits the most seems to be very important in the quaternary prevention." (P: 1)
"Usually, the patients who come here have already received all the services offered by conventional medicine. They usually have the test results with them. But, if there is a test that patient needs to do, we will refer him. It is according to patient indications and clinical examinations that we decide whether we need these tests or not." (P: 3)
"The use of tests is very important in our diagnosis." (P: 4)
"It is not necessary for everyone. We refer the patient for a test if there is an indication for it even in conventional medicine. I do not impose any costs on the patient until I feel that it is necessary ... In the case of radiation, we should also consider the harm that comes with it along with other things. It is all about cost, time, money, transportation, and the stress that comes with it. That's why I do not prescribe any test until it is necessary." (P: 6)
Prevent excessive delivery of services and avoid patient harm
Health professionals can play an important role in reducing the harm of Traditional medicine treatments to patients. Providing and promoting people’s health in the community is a goal that has been set for many years by senior managers of the health system to provide services in the furthest parts of the country. Health officials are required to use Traditional medicine and make the right decision by considering sufficient and accurate information. The physician is the servant of nature, and sometimes without the physician’s intervention, people can be helped to live a healthy life by using the six essential principles of Traditional medicine. In this regard, the interviewees stated:
"We try to avoid patient harm in the training that we provide to our assistants so that the harm and complications would be minimal. Well, if our patient does not need any intervention, we try to prevent any intervention for him either in prescribing herbal medicines or in providing services such as medical practices." (P: 3)
"Most of our work is preventive and lifestyle improvement. I mean, what has always happened during these years is that we have tried not to provide services that there is no indication for them ... During these years, this has been internalized in people because from the very beginning we tried not to provide unnecessary services." (P: 4)
"We have an interesting term that says the physician is the servant of nature. Well, it means that the physician must fully assess the condition of the body, patient history, recent clinical tests, and patient condition. It is often believed that the immune system of the body is intelligent and can solve many problems on its own. The physician’s only job is to recognize this process and help it. Traditional medicine believes that sometimes, not intervening is the best intervention that the physician can do." (P: 6)
Prevent excessive delivery of services to end-stage patients
Physicians are responsible for patients. So, where they feel they cannot do anything, they should refer the patient. They should also have a scientific exchange with their colleagues. Cancer patients who are treated with conventional medicine often turn to Traditional medicine specialists to reduce the complications of the disease and its treatments, to create opportunities for a better quality of life, and to find a complete cure. The respondents in this regard stated:
"We do not tell our patients that we can do everything for them, or do not use conventional medicine anymore. When a patient comes to us, we always emphasize that he must be in touch with his specialist and should not stop taking his drugs. We emphasize that the patient should keep in touch with his oncologist. If we prescribe a drug, we make sure that the drug has no contra interactions with the patient’s medications, and we tell the patient to inform his oncologist." (P: 3)
"We have a problem in modern medicine, which is the term end-stage. We say this because we think the patient is done, and there is nothing that can be done about it. But in Traditional medicine, we say we are the caretaker of nature. The physician is the caretaker of nature. We help the intelligent system that is the body to control the illness. Yes, you see the patient has cancer and constipation. By treating constipation and controlling the pain, we can help improve the quality of life of the patient and help him better spend the rest of his life. Surely, the better he lives, the longer he can live." (P: 12)
"At the end stage, Traditional medicine cannot do much. The end-stage patients have their conventional treatments, and we do not change those treatments, because there is a person who is under the supervision of a specialist and has some risk factors. The first thing we do for an end-stage patient is to modify the patient’s lifestyle. The medicine that the patient is taking, which is often the chemotherapy medicine, may have many contra interactions with the drugs that we offer. So we consider the drugs and their contra interactions. In any actions that we do for the patient, we are very careful, and modifying the lifestyle is at the top of our action." (P: 5)
"Desperate Patients come to us. We can affect their quality of life. ... We tell them if there is a particular person they want to go out with. I mean, we pay so much attention to their mental state." (P: 9)
"Every end-stage patient has a routine treatment; a palliative care. We ask them if there is something that we can do to increase their quality of life because, for the end-stage patient and the health system, the important thing is the quality of life. It means that they should live well as long as they are alive. We ask if there is a service that they think can help their quality of life, and we provide whatever they seek." (P: 1)
"We pay attention to the food arrangement and the work related to the lifestyle whatever it may be. We try to increase the patient's quality of life. The rest is not up to us, because we are not allowed to intervene with patient’s treatment." (P: 6)
Prevent excessive delivery of services to elderly
Most referrals to Traditional medicine are related to middle-aged and elderly people. These people come to receive Traditional medicine services along with the services received from conventional medicine. Joint pain, back pain, and digestive problems are among the most common problems in the elderly referring to Traditional medicine centers. In this regard, the participants stated:
"Traditional medicine offers a series of measures to elderly people. These measures are aimed at improving the quality of life. Well, we aim to explain the six necessary principles to these patients. If we want to prescribe something, we will make sure that it is more related to nutrition." (P: 3)
"In Traditional medicine, the temperament and physical condition are very important. For the elderly patients, increasing the strength is considered as the first step, and then, it is all about lifestyle and six principles. Then, if needed, we go for medicine or other things." (P: 11)
"Elderly patients, who happen to need a lot more, also have financial and mental problems. I have to pay a lot of attention to these issues. But if the medicine is needed, sometimes we have to prescribe it. ... If there is a need for referral, we will refer the patient." (P: 4)
"For the most part, Traditional medicine can help prevent and control chronic diseases. That means we try too hard not to intervene in acute illnesses. But on the contrary, in chronic illnesses like blood pressure, digestive problems, constipation, and things that bother the elderly, there are many referrals. These problems can be treated by lifestyle changes or a couple of drugs." (P: 6)
Patient demand
Sometimes, although there is evidence that some methods are ineffective, patients choose them because of the strong tendency that is rooted in their beliefs. The participants stated that:
"It depends on the ethics. If you want to work professionally, you should not listen to the patient and respond to his demand if the patient is asking for cupping and you know that it is harmful to him. So under any circumstances, you are not morally allowed to listen to him, and you have to justify it." (P: 1)
"This is in people’s culture. They think that if they perform the test, they will be ok. This is the exact opposite of what we say in Traditional medicine because the standard has the size and the test has suffered. In our view, he is a patient, but according to the test, he is a healthy person. In my opinion, some people have no indication, but for some people, we have to do it (with laughter). We resist as much as we can, but sometimes we see that it is no longer useful." (P: 2)
"Our health center has become known as an academic and specialized health center. Fortunately, those who come here have a basic knowledge of Traditional medicine. ... Our clients have the knowledge, and usually, when we prescribe something for them, they receive it very well and trust us." (P: 3)
".... It is not like I do my diagnosis based on the patient’s demand. We are responsible and must be accountable, whether to the patient or our conscience. I do what I recognize, and I don’t listen to patient’s request." (P: 10)
" I do what the law, my conscience, and my knowledge say. Many of my colleagues may prescribe what the patients ask them to write. But I never do that. ... This is my opinion now. In Traditional medicine, this is the case, especially in the cases of cupping and manual measures. We allowed those who wanted the manual measures to have free visits, and we do not do it without a visit. It is because the specialist could see whether the patient has any indication or not." (P: 6)
Service effectiveness
Clients who ask for Traditional medicine services believe that, the effectiveness of this treatment method is much greater than conventional medicine. Normally, people who go to Traditional health centers have already tried conventional medicine, and finally, have developed a tendency towards Traditional medicine. The interviewees in this regard stated that:
"We, at the integrative medicine, say that patient needs a cheap, safe and affordable treatment. This cheap, safe, and effective treatment may not necessarily be in allopathic medicine. For example, at this stage, supplementary medicine can respond to the patient. The quaternary prevention wants to make the treatment effective." (P: 1)
"We can begin with a more limited drug until the physician gets a good understanding of the problem. That's why our visit is a bit longer. Because the physician has to think and see what the problem is. With fewer drugs, we can give more benefits to our patients. I think maybe this is more preferable than new medicine." (P: 2)
"The advice we give is more related to the prevention. We advise patients to prevent some diseases from occurring or delaying them ... We also have a screen test. A screening test is mandatory for some people, even if they do not have any complaints. I do this when I have doubt, and I may ask for a colonoscopy." (P: 6)
Use of clinical epidemiology
To perform quaternary prevention, in addition to moral commitment, the physician must have the necessary skills to use clinical epidemiology and evidence-based practice in his decision to prescribe diagnostic, therapeutic, and preventive measures to prevent patient harm. In this regard, the participants stated:
"We have to be very up-to-date, and this must be done by research. Now, there are lots of problems in Traditional medicine. The method works, but some things prevent the method to be effective. However, in some cases, you can see the result." (P: 8)
"One of the problems that we have is statistics. In the groups where you can see different temperaments. Now, maybe in a certain temperament, certain food is bad and in another temperament is good. The general result that comes from statistics concludes that it does not make sense. Then, this result will be reflected in the literature. But, maybe the initial sampling was not right, or inclusion criteria were wrong." (P: 6)
3. Complications
Quaternary prevention is a moral obligation in which health care providers protect their clients from harm and the costs of unnecessary diagnostic, therapeutic, and preventive measures. Based on the patient's history and indications, the services required by him/her should be determined to prevent him/her from physical and mental harm.
Complications and explanation of the advantages and disadvantages of providing Traditional medicine services (cupping, consumption of medicinal plants, massage therapy, etc)
Not all complementary and alternative medicine methods are safe, and many of these treatments and prescribed drugs have dangerous side effects, and some are fatal. According to the indication, each patient should be provided with the services he or she needs, and additional or unnecessary services should be avoided.
"In Traditional medicine, we have some manual actions that should have indications. Certainly, one of the deviations in marketing Traditional medicine is not seeing these indications and providing unnecessary services. Well, this is dangerous, and it is everywhere even, in Traditional medicine. Why? Because one of our problems in our university clinics is that the patient comes in and asks to be cupped, but we say you don’t need it." (P: 1)
"Almost 100% of the times when we perform the manual measures for patients, they must sign a form that states they are aware of possible side effects. Sometimes, we prevent them from doing what they want to do." (P: 2)
"In prescribing herbal medicines or providing services such as manual measures like cupping, we first see whether the patient needs such services or not, and if there is no indication, they will not be prescribed." (P: 3)
4. Prevention
The quaternary prevention is based on the principle of "do not cause any harm first" attributed to Hippocrates. This principle is seen in Traditional medicine, in which the six essential principles are used by Traditional medicine specialists at the first step to improve the lifestyle and reduce therapeutic and pharmacological interventions.
Measures to prevent disease relapse and lifestyle modification
Traditional medicine methods are used along with conventional medicine to treat and restore health to sick people and prevent healthy people from getting sick. To reduce harm to patients, planning should be done to expand the use of Traditional medicine and limit the use of ineffective and harmful methods. In this regard, the interviewees acknowledged:
"Patient-physician relationship in Traditional medicine is very important. ... We recommend it to patients and even to those who are healthy. The logic behind Traditional medicine is to maintain health, prevent disease and reduce the costs of the health system." (P: 1)
"The follow-up is important in Traditional medicine. In Traditional medicine, we have a good follow-up, which means we do not leave the patient alone. In follow-up, lifestyle modification is emphasized, and if necessary, the medicine is changed like conventional medicine. If some actions are needed, they will be taken, and we will monitor the patient until full recovery." (P: 7)
"Our main advice is on lifestyle; all aspects of lifestyle. If these devices are observed in healthy people and even in sick people, whose condition may change due to circumstances, many diseases do not occur in the first place, and if they do occur, they can be solved very easily with lifestyle change. They can be controlled." (P: 6)
5. Rules and regulations
Promoting quaternary prevention can significantly contribute to the greater compliance of the health care system with the constitution. By evaluating the status of Traditional medicine and the attitude of patients and physicians towards its sub-branches, it is possible to develop regulated health care strategies and policies. With these rules and regulations, the side effects of treatments are reduced and their beneficial effects are maximized.
Deal with non-physician health care providers
In recent years, laws have been put in place to ban the provision of Traditional medicine by non-physicians and non-specialists. Receiving Traditional medicine services from non-specialists and unreliable people can have many consequences because these people are not familiar with the indications, harms, and therapeutic interactions and do not know the correct and useful way of using Traditional medicine methods in different people. Unnecessary and incorrect provision of services can cause harm to the patient. Therefore, their activities should be prevented, and they should be dealt with decisively by law. The interviewees in this regard stated:
"He was not a doctor, but he was very assertive. He said, why don't you let us work?' I said because of paragraph 4 of the order. Paragraph 4 says that any medical intervention can be supervised by the Ministry of Health. Political commitment is the last level in the implementation of a therapeutic option, and yet it has not been defined in the health system. Without political commitment, it cannot be done at the highest level, and the opposite is true. Anyone who can penetrate those levels can divert the path." (P: 1)
"Our problem is mainly with those who want to get rich too quickly. Someone has received limited training and taken a workshop for 4 hours or 8 hours, and now, he thinks he can play with people’s life. That’s why I think this should be taken seriously. Well, someone is interested to work in this field, then training workshops should be available for him, but the scope of his action should be specified, and his service should be strongly supervised." (P: 2)
"Currently, there is an office in the deputy director of treatment called the Office of Excellence in Iranian Medicine, and the number of Iranian medicine experts works there as supervisors. There have been cases of unauthorized service delivery and some harm to patients. The centers that provided such services have been closed. There is a decisive legal action, and the deputy director of treatment supervises them." (P: 3)
"In our country, the tragedy is that we do not have regulations for non-physicians. Physicians have regulations, and if they mistreat patients, they will go to court and pay fines. ... My suggestion is that rules and regulations should also be put in place for non-physicians. They should follow the example of countries like China and India, where they too have complementary medicine, and non-physicians are being monitored." (P: 5)
"Non-physicians are by no means legally allowed to visit, prescribe and treat patients, they are not allowed at all unless they are under the supervision of physicians ... But supervision is the responsibility of deputy of treatment that only has some staffs who just do that." (P: 6)
Generalization and weak implementation of laws and regulations
In the rules and regulations related to the development and use of Traditional medicine, there are general terms related to license and promotion of Traditional medicine. In order to eliminate the executive weaknesses and legal gaps, effective laws and even judicial interventions must be put in place.
"Let’s hold a workshop for everyone and give them a certificate then there will be no supervision after all. However, you see there is the supervision of the deputy of treatment conducts the supervision and condemns some people, and then you see them that go somewhere else and start working again. … There are problems that we always have because the law is not enforced properly." (P: 2)
"I wish it was legal..., the office of Iranian medicine at the deputy of treatment and the university is pursuing this goal ... Some people go to the mosque and visit the people. They do not charge any money for visiting but prescribe expensive drugs and sell them to people. This way that they make many times more money. Unfortunately, their number has increased, and people do not know this issue." (P: 4)
"It's good to be legalized…, making sure that they don't go somewhere else and continue to work. Now, it is all about monitoring laws. When they are found, at least they will be dealt with. Because now, they find them at home, and since there is no supervision, they do nothing to them. They go from this home to the next. I think they should make some policies." (P: 5)
Measures to deal with non-physicians in the field of Traditional medicine
About non-physicians, we face two groups of people. First, the people who have been acquainted with the science of Traditional medicine from their fathers and their knowledge have been passed down from generation to generation. These people are familiar with the indications, drugs, and therapeutic interactions empirically. They also are valuable assets of Traditional medicine and should be used for training and proper use of Traditional medicine methods. A second group is a group of enthusiasts and people with some cross-sectional knowledge who are familiar with only part of Traditional medicine with limited indications. The scope of action should be set for this group of people.
"Different groups are part of the Ministry of Health's programs, particularly the apothecary. I would like to inform you that training for different groups has been defined by the Ministry of Health. But for the general public, we had several meetings with different goals." (P: 1)
"There are some people who are working in the area of folk medicine, which means common medicine. We have to use their experiences, take away those things that are useful, and do research on them, and put aside those things that may be wrong." (P: 12)
"... Everyone is taking courses; courses are being held, and we do not have control over the courses. You cannot stop them because people are interested in them without knowing their limits. They must teach them their limit in this area so that this field can advance. We should have enforcement laws in this area, which we do not have right now." (P: 5)
6. Financial burden
Despite the critical and extreme tendencies towards Traditional medicine, one of the reasons for its expansion is its low cost compared to conventional medical treatments. In quaternary prevention, emphasis is placed on reducing costs while maintaining quality. Traditional medicine, in terms of quality, safety, and effectiveness, helps to achieve the goal of access to health care for all people. Herbal remedies, Traditional therapies, and Traditional healers are the primary and sometimes the only source of health care for millions of people. This type of care is close to where people live and is accessible and affordable for them.
Patient cost
Physicians should always consider how to treat patients without harming them physically, mentally, or financially. However, Traditional medicine treatments are not necessarily cheap. To be fair, it makes sense to have insurance cover for Traditional medicine services. The respondents in this regard stated:
"The logic (emphasis) behind Traditional medicine is to reduce the cost of treatment for the patient." (P: 1)
"Depending on how long the person should take the medicine, it is very different. One should take the treatment for two months, which may be cost about 100 tomans. But usually, the first prescription is at least 30 tomans. However, if it is for particular goals like increasing the strength, only the medicine costs about 15-20 Tomans." (P: 2)
"Unfortunately, Traditional medicine services are not covered by insurance. We have tried very hard to cover it, and these efforts are still going on, but unfortunately, this has not been done yet. Because it is not covered by insurance, the treatment cost is high. When prescribing medicine to a patient, always our concern is that we should only prescribe it until the patient needs this medicine. We are careful not to put financial pressure on the patient, and we try not to prescribe anything unless the patient needs it." (P: 3)
"It's different. Unfortunately, the major problem we have is that we are not yet covered by insurance, so our service usually costs the patient some money." (P: 6)
"Our drugs are not covered by insurance. Well, when it is not insured, its cost is high, and that in itself reduces the number of people who are interested in this method. They say that we are spending money on conventional medicine, what is the point of doing it here again?" (P: 5)
Provide cheaper alternative services
If there are alternative therapies that fit the patients’ indication and financial capacity, they will be used to reduce economic pressure on patients. The interviewees in this regard stated:
"When a patient comes in, we give him a piece of paper and tell him to do this, do not do that, eat this, do not eat that... It depends on the individual. If he cooperates with us, the cost of his treatment will be reduced. (P: 2)
"In Traditional medicine, there are many alternatives. Maybe when we prescribe combined drugs for the patient, its costs are high. However, he may reach the same result with the single drug or the lighter drug. In such cases, it may take a longer time for the patient, but it costs is less." (P: 3)
"It depends on the patient. If the patient can tolerate it, we will choose the less aggressive way. Of course, it is not like coming from the end to the beginning."
Costs imposed on the health system
In addition to reducing the costs for the patient, using Traditional medicine will reduce unnecessary referrals to the health system and prevent unnecessary services. Many of their problems can be controlled if people use the six necessary principles with the opinion of doctors and specialists in this field, and improve their lifestyle. So, the need to perform unnecessary tests and invasive procedures is reduced. Therefore, the costs of the health system will also be reduced. The interviewees believed that:
"The logic behind Traditional medicine is that you should go forward with a preventive approach even in the treatment of disease. Not only in healthy people but also in patients, in Traditional medicine, we first see the main reasons that have caused the disease. Now, you can see which diseases are costing the health system more. If we leave aside the accidents, the rest are all chronic diseases or the so-called non-communicable diseases. (P: 1)
"Now, prevention is one thing, and therapeutic intervention is another thing, which is, in fact, para-clinical interventions that have a financial burden for both the patient and the health system. Often, if prevention is observed, para-clinical interventions may not be needed. There are also many common diseases which are mild to moderate cases do not need treatment at all; only lifestyle changes." (P: 6)