Showing 152 results for Type of Study: Research
Morad Nasri, Ali Shojaee,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: The culture of prescribing and drug usage as a strategic commodity, which plays a fundamental role in the economy and health of the family and society, is an important issue that should be addressed by health system policymakers.
Methods: The present study is a cross-sectional prevalence survey of all medical prescriptions of insured persons in a health insurance organization which were accepted and registered in the medical documentation system in the contract pharmacies with health insurance departments in all provinces of the country in the medical records system during 2014 and 2014.
Results: 80% of health insurance expenditures have been consumed by 93.84% in 2014 and 94.88% in 2015 year. An average amount of medicine in 2014, and 2015 years, were respect, 226 and 185 number. In all provinces, 30 to 40 percent of drug costs have been consumed by 30 drugs in each of both years.
Conclusion: Control and monitoring this amount of drug items can optimize 80 percent of pharmaceutical costs in each province and at the level of the health insurance organization. Considering, if each province controls its first 30 medicines, it will lead to optimize about 40% of its pharmaceutical costs.
Azam Sadat Rivandi, Ebrahim Jafari Poyan,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: Monitoring the quality of services in the insurance service purchase can be crucial for improving patients' satisfaction, avoiding unnecessary referral to health centers and Subsequent expenditure, and imposing them on insurance. This study aimed to evaluate the quality of public health clinic services.
Methods: This cross-sectional study was performed in Tehran during 2015, 2016 years. The research population consisted of patients referred to general practitioners in Tehran. A multi-stage cluster method was used for sampling. Overall, 394 samples were obtained from patients referred to general practitioners were included in the study. Researcher-made questionnaire was the data collection method. The questionnaire was prepared based on interviews with experts. The collected data were analyzed statistically using SPSS 22 software.
Results: Based on the results of the research, the quality score of the clinics from 125 to 160 defined in the high range and the importance of quality dimensions from the viewpoint of patients from 131 to 160 were placed in the high range as well. Examining the service quality dimensions indicated, access point (85.5%) and then effectiveness (85.3%) were earned the highest score. Moreover, the effectiveness was earned the highest score in terms of importance. The results showed, a significant relationship between income level and questions of importance. It seems that, quality items are considered different for people according to their income.
Conclusions: Findings of this study indicate that, patients referring to general practitioners high-rated the received services' quality. The results of this evaluation can lead to improvement in the quality of services and reduce the burden on visits for insured persons and also reduce charges imposed on duplicate visits. Besides, it can lead to active purchasing for the health insurance organization.
Hamid Ghasemi Barghi, Babak Aali, Farhad Azimi,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: Identifying the extent of misuse of health services in hospitalization is the first step in implementing health control and restriction programs without damage to the quality of these services. This study was carried out in Valiasr Hospital of Meshkin shahr City with the aim of assessing the rate of admission and unnecessary hospitalization of insured persons and the amount of expenses incurred by this phenomenon to the health insurance organization.
Methods: This cross-sectional study was conducted in July 2016 in Valiasr Hospital in Meskine Shahr. The statistical population in this study was composed of all insured persons covered by the health insurance organization from all the funds referred to the hospital at the time of the study. Overall, 330 samples were selected for sampling in this study. An appropriateness Evaluation Protocol (AEP) was used for data collection.
Results: The results obtained showed that, 56.33% of the insured persons (186 men) and 43.7% of the insured persons were hospitalized (144) were women. From the total of 330 evaluated admissions, 129 cases (39%) were inexpedient, with the highest inexpedient acceptance in the internal ward with 66% and the lowest uncontrolled acceptance was in the surgical ward with a 12% rate. In 2016, the health insurance organization paid 6,133,840,000 Rials for unplanned days of admission in these three parts.
Conclusions: According to the results of this study, the AEP protocol has a good reputation for evaluating of admission and hospitalization days. The health insurance organization and other insurer organizations are essential to reduce and optimize the number of admissions and inexpedient hospitalization days by applying the AEP protocol as a regulatory tool for evaluating hospital admissions documents.
Ali Shojaee, Seyed Mosoud Shajari Pourmosavi, Mohammad Mehdi , Reza Moradi, Sanaz Taghizadeh, Elnaz Kalantari,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: Health system reforms are designed and implemented according to the situational conditions of each country. Recently health reforms have focused on resources and costs in the health sector for governments; they would be as the tools for making the necessary changes and improvements. Governments have designed and implemented health reforms step by step to completing the coverage of health services in terms of geographic accessibility, service affordability, and avoiding health impoverishments, catastrophic poverty from the use of health services in recent two decades. Objectives other than completing public coverage, improving quality and the quality of health services and care, and the logical reduction in costs and the optimal use of resources. Objectives other than completing public coverage, improving quality The quality of health services and care has not had a reasonable reduction in costs and the optimal use of resources. Comparing the spending costs of hospitalization in the years before and after the Iranian Healthcare Reforms Plan in 2014 has could show that the efficiency and cost of spending. This study seeks to examine the average cost of each hospitalization case in the years before and after the Iranian Healthcare Reforms Plan to compare the impact of the costs on health insurance funds.
Methods: The present study was a cross sectional study. The population of the study has included the sum of the inpatient bed day of health insurers admitted in hospitals of in 31 provinces over the past 5 years from 2010 to 2015. In this study, survey was being conducted, and accessible data resources in the databases were used for data collecting process and analyzing. The analysis has been conducted by using Excel 2010.
Results: The highest of growth rate of the cost of inpatient bed day of health insurers in the first year of the Iranian Healthcare Reform Plan was Included respectively to the rural fund (88.4%), governmental employees fund (75.2%), self-employed fund (73.17%) and other populations fund (73.10%), and the self-employed fund shown third ranking in growth rate, although growth rate of the cost spending in all funds was more than 73%. In the first year of Iranian Healthcare Reform Plan has shown more inpatient costs growth rate than 73 percent’s for all the Iranian Health Insurance Funds.
Conclusion: The average of total inpatient spending cost has increasing trend in all funds of Iran Health Insurance and if there is not be a serious review of the Reform Plan, the health insurance organization may been faced serious financial problems. Therefore, by reviewing the Reform plan, it is possible to improve the plan as well as to ensure health insurance regarding sustainability of financial resources.
Efat Mohamadi, Taraneh Yousefinezhadi, Ali Hassanzadeh, Mojtaba Atri, Mohammadreza Mobinizadeh, Zahra Goudarzi, Sara Mohamadi, Alireza Olyaeemanesh,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: Implementation of the Health Transformation plan (HTP) has had many effects so far. The analysis of these impacts can help policymakers and planners to continuously improve the health system's ultimate goals. Considering that, health financing is one of the most impressive of health system functions from the HTP, the present study examines the effect of the HTP on supplementary health insurance as part of financial providers in the health system in Iran.
Methods: This is a descriptive study carried out using secondary data in 2017. Data were gathered using information systems of health insurance organizations and the statistical yearbook of central insurance of the country. Data analysis was performed using Excel and SPSS software. To analyze and report these data, descriptive statistics and analytical tests were used.
Results: The effect of the HTP on the share of health care providers has shown that in private financing, the share of households is the highest, and during the period 2002-2004, the average share of households from the total private sector share was 86.5%. During the period of 2002-2003, the share of the domestic government as the public sector was 54% on average. Findings in relation to supplementary health show that the net loss has been ascending and premium rate has been increasing.
Conclusions: The share of households in health expenditures has decreased since the implementation of the HTP, but the average pocket spending in the public and private sector has not decreased by more than 10%. The goal of creating competition and improving the quality of the public sector with the private sector and increasing the incentive for people to go to the public sector has largely been met by changing the frequency of contributions made by the financiers. In the long run, with the continuation of the implementation of the health system reform plan and the elimination of the way in which supplementary health insurers benefit from health subsidies, a high percentage of supplementary health insurance funds in the private sector is consumed, while it is better to adopt measures for the use of this resource in the public sector.
Meghdad Rahati, Iravan Masoudi Asl, Masoud Aboulhallaje, Mehdi Jafari, Hossein Moshiri Tabrizi,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: Because of organizations must to have a clear perspective of continuing profitability to be accepted in the capital market, researchers survey efficiency evaluation of the Iranian Public Hospital, so that select qualified hospitals for admission to the capital market by separating efficient and inefficient hospitals
Methods: It is a descriptive, analytical and retrospective study. Data envelopment analysis technique, CCR model and BCC input-axis, were used to measure efficiency. Data includes input and output of public hospital operations, as the inputs include the number of active beds, the number of physician personnel, the number of non-medical personnel and output include the number of hospital admission, the number of outpatient admissions and the bed occupancy rate. The statistical population consisted of 592 public hospitals. According to available data, 558 hospitals were selected. The DEA Solver Pro and SPSS software were used.
Results: In the CCR model, 123 hospitals were efficient (22%), and in BBC model, 183 Hospitals (33%). The average efficiency of hospitals in the CCR model were 0.66 and in the BCC model were 0.75.
Conclusions: According to the data envelopment analysis model (input-axis) inefficient hospital can achieve efficient unit by changing their inputs. But it seems to make sustainable changes, Macro policies and strategies in the health sector should be changed, which can include the autonomy of hospitals, the integration of efficient and inefficient hospitals, Or the formation of hospital cooperation and accept in the capital market.
Zeynab Farahmanfar, Kamran Hajinabi, Afsoon Aeenparast,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: The performance of employees has an important role in productivity of organizations. The performance of employees is affected by a wide range of individual and organizational factors. Recognition of the effective factors has an important role in improving the performance of employees. The aim of this study was investigating the relationship between provision of welfare facilities and performance of health care network of Rey City.
Methods: This was a cross-sectional study. The study population were employees of Rey health network. All the population were selected for the study. 100 employees were studied. The data collection tool was a researcher made questionnaire. The questionnaire contained three main components: demographic questions, performance investigation questions and welfare facilities question. The questionnaire validity and reliability was tested and confirmed. The data of this study were analyzed using SPSS statistical software.
Results: The results of the current study showed that there is no significant difference in employees’ performance between sexuality, different age groups, education, marriage, employment condition, work experience, and job position. Investigating the relationship between the performance of employees and provision of welfare facilities including health insurance, cultural and sport facilities, transportation facilities, tourism facilities, and welfare benefits showed that there is a significant relationship (P < 0.05).
Conclusions: The results of the study depicted that the performance of employees is not influenced by factors such as population and income level of the participants. However, provision of welfare facilities can be effective on employees’ performance improvement. However, in order to gain the maximum performance of the employees, it is necessary to consider welfare matters so that they work with higher motivation in order to improve the health condition of the community.
Raoufeh Asghari, Amin Hassan Zadeh,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: Skin cancer is one of the most common types of cancers in the United States of America and can be prevented in most cases. Skin cancer significantly affects the quality of life of people and can cause disorder or even death. A review of the aging process of cancer patients, its modeling with physiological age and comparison with normal people is conducted in this paper by using phase-type distributions.
Methods: In this model, it is assumed that the length of any physiological age follows an exponential distribution in a Markov chain environment. In the continuous-time Markov chain, a state is assumed to represent death, and n_x transient states, where x is the patient's age at the time of diagnosis of cancer. Each transient state represents a physiological age and aging is a process of change from a physiological age to the next physiological age to reach the end of the process. There is also an absorbing state that the transition from any state to the absorbing state can take place. In this study, using data of skin cancer patients in the United States, the unknown parameters associated with the aging process were estimated.
Results: The study was conducted on patients with melanoma-related cancer in the United States during the years 1973 to 2014, with aged 60-65 years old. The registered number of melanoma cases was 1,882, of which 1,251 were male (66.5%) and 631 were female (33.5%). A table of parameters for estimating survival probability and related charts for the whole population in the age group and gender is presented.
Conclusions: The fitting results of data modeling are very satisfying. The physiological age parameters were estimated in general that could be useful in estimating the distribution of the phase-type parameters and to calculate the function and the moments. And also the effect of gender on the survival rate of patients was determined which indicates that the survival of males is higher than that of women. On the other hand, the life expectancy of cancer patients has been compared with the entire population of the United States, which was less it was expected.
Zhaleh Abdi, Iraj Harirchi, Mahshad Goharimehr, Elham Ahmadnezhad, Rezvaneh Alvandi, Elham Abdalmaleki,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: One of the most important measures to ensure achieving Universal Health Coverage (UHC) is expanding health insurance coverage to all population. Accordingly, the present study was conducted with the aim of investigating the effect of having health insurance on the utilization of outpatient services provided by physicians using the data of the utilization of health services survey (2015).
Methods: This study is a secondary analysis of the utilization of health services survey data that was conducted in two groups of the insured and uninsured to examine the differences between these two groups in outpatient healthcare utilization provided by physicians. The variables were insurance status as an independent variable and the number of physician visit as a dependent variable. This analysis was disaggregated by place of residence and income.
Results: The visit per capita for outpatient services was lower in all uninsured groups. The visit per capita in insured people was almost two times more than that of uninsured individuals, which was 4.25 and 2.61 among insured and uninsured individuals, respectively. Therefore, the lack of basic health insurance decreased the utilization of outpatient services by 50 percent. General physician visits per capita for insured people living in urban and rural areas were 11.2 and 0.35, respectively.
Conclusions: Based on the results of this study, the visit per capita is directly related to the insurance status of the individuals. Therefore, it is necessary to ensure the equity in utilization of outpatient services provided by the physicians among various groups of population.
Ali Akhavan Behbahani, Saeedeh Alidoost, Iravan Masoudi Asl, Maryam Rahbari Bonab,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: The health insurance organizations in Iran are an important part of the health system. However, they are not conscious to many unnecessary costs incurred by providers and recipients, and the health system suffers from a lack of an efficient health insurance system. Therefore, it is essential to assess the performance of insurers and implement appropriate measures. This study aims to investigate the performance of Iranian health insurance organization and present solutions to the challenges.
Methods: This study employed an explanatory sequential mixed method. The quantitative part of the research is a descriptive cross-sectional study and the qualitative section is conducted through qualitative content analysis. Quantitative data were collected by a researcher-made tool and analyzed based on descriptive statistics. For the qualitative section, the focus group discussion method was used for collecting data.
Results: Quantitative results show an increase in the population covered, especially in Self-employed fund, and increase in the number of contracting providers except physicians and dentists. The analysis of indicators related to utilization of health services indicates that the distribution of health facilities varies in different provinces which Sistan and Baluchestan Province has the lowest ranking. Also, financial indicators show that overhead costs and medical expenses of health insurance organization have been rising significantly since 2014. The analysis of qualitative data led to identification of three themes including: factors affecting budget deficit, suggested solutions for health insurance organization and suggested solutions for the health system. Based on the findings, the increasing of tariffs, population covered and benefit packages coverage are the most important factors in increasing costs, which strategic purchasing and revising of basic benefit package can play a significant role in meeting challenges.
Conclusions: In recent years, the population covered by the health insurance organization and the number of contracting providers have risen, and the utilization of health services has increased. On the other hand, the costs of this organization experiencing a significant increase for various reasons. Therefore, it is vital to design and implement appropriate strategies to manage the costs.
Shapour Badiee Aval, Amin Adel, Hosein Ebrahimipour, Akbar Javan Biparva, Elaheh Askarzadeh,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: Since supplementary insurance patients should benefit from the benefits of insurance, they do not receive health subsidies, the behavior of supplementary insurance organizations and their insured may be endangered for supplementary insurance. The purpose of this study was to investigate the change in the behavior of supplementary insurers and insured individuals before and after the implementation of the health system reform in Mashhad University of Medical Sciences hospitals.
Methods: This descriptive study was conducted on a retrospective cross-sectional study in 2012-2017. The population of the study consisted of 2099499 admitted and under-observed patients in 24 public hospitals affiliated to Mashhad University of Medical Sciences. The data were collected by referring to the hospital discharge department and patient information through HIS in each hospital. The accuracy of the data was evaluated. Data analysis was performed using SPSS v16 and EViews v10 software.
Results: The share of supplementary insurance in the year 2012 was about 1, and in the year 2013, Implementation of the health system reform program has reduced the share of supplementary insurance, And by the end of the year 2017, the trend has been declining to 0.2.
Conclusions: It seems that supplementary insurance contracts should be integrated with university hospitals and patients' insurance coverage should be done electronically.
Mohammadreza Rezaee, Saeid Daei Karimzadeh, Mehdi Fadaei, Akbar Etebarian,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: The Iran Health Insurance Organization (IHIO) was established to develop the Iran Health Insurance Sector. Currently, this organization lacks the adequate funding and faces challenges in providing the required resources due to the imposed unilateral sanctions; therefore, it is necessary that this organization take proper measures within the framework of state policies regarding the resilience economy in order to finance itself and cover more population in accordance with the Iranian operating laws. The objective of the present study was to propose a financing model for the IHIO based on the resilience economy.
Methods: This was a qualitative study based on the Grounded Theory (GT), and the data were collected from framework documents, open and in-depth interviews, and a review of the lectures given by 31 experts. The validity was first examined by the interviewees and then approved by the experienced professors. The reliability was determined to be 73% via process auditing. The data were analyzed through a GT-based methodology and constant comparison over three stages of open, axial, and selective codings.
Results: The examination of the qualitative date revealed that there are many factors in action in the IHIO’s financing process and this organization needs to review and revise its structure and methodology. Taking into consideration the current sanctions and lack of funds, the IHIO should change the following seven components within the framework of notified resilience economy policies: organizational management, financial management, research, structural change, cultural revision, and regulatory procedures.
Conculsions: There has been a remarkable increase in the IHIO’s insured parties recently, and more people have been receiving healthcare services. Thus, it is highly essential to propose a model to change the IHIO’s approach towards commercialization and make it produce more revenues and finance in accordance with the current economic situation in Iran.
Hassan Askarzadeh, Mohammad Jafar Tarokh,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: A significant amount of treatment cost is paid by health insurance organization. Insurance companies, mostly, use certified people to consider documents, but according to the number of documents and the limitation of time and human resource, consider documents carefully is almost impossible and more importantly, some infringements are not identifiable According to only one document but is identifiable by accumulation of documents and intelligent analysis based on data mining. Detection of beneficial referral (self-referral and kickback) that a doctor refers a patient to a specific pharmacy that has benefits for him, is one of these things.
Methods: In this research, data warehouse was prepared by using Tehran health insurance data until 1396 and then after eliminating faulty data, according to network mining methods, actions for detecting anomalistic referrals on the network, data filtering and weighing the edges of the network based on certified people views, were taken. This method was implemented in Knime environment and a short list was presented to health insurance organization’s monitoring department for considering.
Results: In this research, according to the importance of detected interactions during network mining‘s process between doctors and pharmacies, and using visual tools in Knime, 73 doctors were detected that had meaningful relation with 26 pharmacies.
Conclusions: Inspectors of health insurance organization can have a more accurate and more effective examination with spending less time and human resource according to examination patterns based on network mining and visualization.
Farzaneh Maftoon, Batool Mousavi, Mohammadreza Soroush, Kazem Mohammad, Mojgan Sharifan, Fatemeh Naghizadeh Moghari,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: The rate of out of pocket in health services has particular importance in health system. The aim of this study was to assess the rate of out of pocket and also the satisfaction with reimbursement process.
Methods: This study was across- sectional one which was done in 2018. At all 1177 war survivors and their families whom were covered by supplementary insurance were studied and they were selected randomly. In this study the questionnaire which was used in similar previous study, used for collecting data.
Results: At all 1177 veterans, their families and martyrs' families were studied. About 53 percent (622 persons) of them had paid out of pocket for health services during the one year. In reimbursement process the satisfaction of 622 studied persons with the waiting time, providers, service place and repayment process was 33%, 69%, 54% and 39%.respectively. Also the waiting time and situation of cost repayment effected on satisfaction with reimbursement process.
Conclusions: Base on this study results decreasing the rate of out of Pocket Payment and increasing the satisfaction with reimbursement Process are important. For next study it is recommended appropriate project resulted in strategies for improving reimbursement Process.
Masoud Kavosi, Seyed Jamaledin Tabibi, Mahmoud Mahmoudi Majdabadi Farahani, Kamran Hajinabi,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: The boundaries of providing heath care to patients have become so widespread that provide all these services in the form of health insurance at least not economically feasible. In many countries, supplementary insurance is used to provide health care. This research has been conducted to determine the effective factors on organizations supporting the supplementary health insurance system in selected countries and Iran.
Methods: The present study is a descriptive-analytic, cross-sectional and applied study. The data of this study were collected through a questionnaire by checking texts and field studies. Reliability of the questions was confirmed by experts and limited content validity method. The data were entered into SPSS software version 25 for the purpose of calculating descriptive and inferential statistics. Then, the exploratory factor analysis was confirmed through the AMOS software program.
Results: The present study showed that men with a postgraduate degree and 17 years of service experience have contributed to this research. In this regard, supportive organizations such as the Ministry of Health and Medical Education, and the subsidy targeting organization, have the least impact on supplementary care insurance had.
Conclusions: The results of this research indicate that the Ministry of Health and Medical Education has played a significant role in optimal utilization of supplementary health insurance and improved patient satisfaction as well as improved community health.
Parinaz Doshmangir, Leila Doshmangir,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: Making medical interventions over the actual needs of patients, not only waste existing resources and cause more costs but also threaten people’s health. Identifying, removing and preventing factors affecting unnecessary medical interventions have a main role in its controlling. So, this study aimed to explore factors affecting this phenomenon from the viewpoints of Iranian health system experts.
Methods: To collect data, Focus Group Discussions, semi-structured face to face interviews were conducted. The participants were selected through purposeful sampling. Related documents were also collected. Content analysis (inductive-deductive) was used for data analysis.
Results: Four themes and 16 subthemes were extracted. Making evidence informed policy interventions in payment system, insurance system, tariff system and education system in the country, management of conflict interests, making culture and informing community are the factors that are influential on controlling and decreasing side effects of this phenomenon.
Conclusions: effort to identifying factors influential on unnecessary medical interventions can help establishing accurate supervision and reporting system and cause preventive interventions to reduce more unnecessary costs and inappropriate outcomes resulted from this phenomenon.
Elham Shami, Shirin Nosratnejad, Alireza Pirestani,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: Getting and receiving health care services is called health care utilization. Health system management depends on decisions that are right and conscious, Utilizing knowledge of health services and studies in this area is mandatory for allocating financial resources and health planning. Access has an important role in the utilization and use of health services. One of the most important factors in increasing access to services is the people’s insurance coverage. The aim of this study was determine health care utilization among new insured people of the Iranian health insurance plan after the implementation of Health Care Improvement Plan.
Methods: The present study is a cross-sectional study with a sample size of 400 households from Tabriz with random sampling. The study was conducted using a telephone conversation (retrospective information) questionnaire on the rate of utilization of outpatient and inpatient care services among the Iranian health insurers of Tabriz during one-year period. Data were analyzed using descriptive and analytical statistics and analyzed using STATA 11 and EXCEL software.
Results: The relative frequency of outpatient and inpatient services were 98.49, 98.75%, respectively. Also, access to services in the use of outpatient and inpatient services was 93% and 90%, respectively. Satisfaction rate for outpatient services was 51%. Satisfaction rate for receiving hospital services was 56%.
Conclusions: Health insurance in Iran has led to the benefit of people without health insurance, which is higher in inpatient services. Moving toward universal health coverage can be a better way to cover people uninsured and the community.
Mohammadreza Rezaee, Said Daei-Karimzadeh, Mehdi Fadaei, Akbar Etbarian, Hamid Bahrami,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: The family physician program and the referral system in health insurance of Iranian villagers and nomads were implemented in 2005 by the Iran Health Insurance Organization, after being approved by the Islamic Consultative Assembly. Financial resources and other physical and legal infrastructures as well as human resources are the essential requirements for implementing this program. The present study aimed at examining the factors contributing to the success of this national program in the described areas, considering their ease, accessibility, and role in the success of the family physician program and the referral system in health insurance of Iranian villagers and nomads in 2017.
Methods: In the current study, the variables involved in the physical and legal infrastructures, manpower, and provision of financial resources were first examined using Delphi method according to the experts' opinion including practitioners involved in the rural programs, inspectors, and supervisors of health insurance plan as well as experts and managers of Khuzestan, Isfahan, Lorestan, Ilam, Kermanshah, Chaharmahal va Bakhtiari, and Kohgiluyeh va Boyer-Ahmad provinces selected based on the purposive and chain sampling methods. Student t-test was then used to compare the responses with standard tables.
Results: In the provision of financial resources, physical and legal infrastructure and manpower after several years of implementating the program were approved by the indices such as the timely allocation of funds and provision of service packages, the determination of the actual per capita and the payment of services per capita, approval of referral system law and upstream laws, the payment of franchises at levels 2 and 3, and the number of specialists in the villages, their appropriate distribution on the basis of population density and the expansion of health centers based on this density, appropriate training, and long-term contracts, which create a sense of usefulness and ease of using services in insures and has a significant relationship with changing the family physician program and the success of the project.
Conclusions: After several years of implementing rural family physician program, the project has a relatively appropriate performance in terms of financing and other infrastructures. However, the referral system is still not implemented properly and feedbacks from specialized physicians are not sent to family physicians.
Mahdi Shahraki,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: The increasing variety and costs of health services, the high share of out of pocket, and the quantity and quality of services covered by basic insurances increased the demand for supplemental health insurance. Considering the importance and necessity of supplementary health insurance, its demand growth and its impact on improving the quality of life, the present study amed at investigating the demand of supplementary health insurance in the urban household of Iran.
Methods: The present descriptive-analytical and applied study with cross sectional design was conducted in 2016 employing the probit econometric model with sample selection and maximum likelihood method. The sample size was 18,809 urban households in Iran's provinces selected via the three-stage sampling method on a systematically randomized basis by the Statistical Center of Iran. Data were extracted from the cost-income questionnaire of urban households and the coefficients of the model were estimated with Stata 14 software.
Results: The results showed that the increase in age, education, the level of literacy, and the marital status of the head of the household increased the probability of demanding for the supplementary health insurance by 0.6%, 0.17%, 6.6%, and 5.3%, respectively. Also, the number of family supporters, having a child under seven years old, and owning a private house increased this probability by 16%, 3.7%, and 0.85%, respectively. The increase in health and medical expenses, as well as income and educational expenditures had a negligible positive effect, while the squared index of the age and education of the head of the household had a negative impact on the demand for supplementary health insurance.
Conclusions: Marital status, age, education level of the head of the household, the number of family supporters, increased health costs per capita, increased education expenditures and the per capita income had a positive impact on the demand for supplementary health insurance by households. Among these variables, the number of family supporters, marital status, and the age of the head of the household had the highest impact and per capita income and education expenditures of the family members had the lowest effect on the demand for supplementary health insurance. Also, the demand for supplementary health insurance by Iranian urban households was a quadratic concave function of the age and education level of the head of the household. Thus, it is recommended to identify and classify households based on the factors affecting their demand and determine the appropriate conditions for the health services coverage corresponding to each class of household. It is particularly necessary to support the elderly in the treatment costs.
Neda Shojaeizadeh, Mahmoud Keyvanara, Leila Safaeian, Saeed Karimi,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: Irrational use and prescribing of medications is a major problem in healthcare systems worldwide. The factors affecting prescribing and use of drugs can be assessed in educational, management, supervision and financial areas. Present study was designed to investigate the role of financial incentives in this field.
Methods: This qualitative study was conducted using a semi-structured interview in 2016. Participants included those who were well-informed and experienced in the field of rational use of drug. Sampling was done in a targeted way and 16 people were interviewed. Interviews were evaluated after the implementation of the theme analysis method.
Results: In this qualitative study, four main themes and 12 sub themes were obtained. The main topics were: 1. Financial incentives for physicians (including: motivation for attracting more patients, earning more money, health insurance organizations' liabilities, community expectations of physicians' financial position, physician financial problems, and shifting physician's role from factor to performer), 2. Financial incentives for pharmacies (including: pharmacies' economic problems, health insurance organizations' liabilities, earning more money through over-the-counter sales of all medications, patient insistence and pharmacists' security), 3. Financial incentives for patients (including: self-medication and community poverty) and 4. Financial incentives for pharmaceutical companies (including: earning more profit by selling a particular brand).
Conclusions: Financial motivators are among the important intervening factors in irrational use and prescribing of medications. Providing appropriate financial solutions by policy makers and improving economic situation of the community can help the quality of medical services and improve status of prescribing and usage of medications.
