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Systematic Relationship Analysis of Health Insurance Integration Benefits in Iran
Majid Akbari, Khalil Alimohamadzadeh, Ali Maher, Seyed Mojtaba Hosseini, Mohammadkarim Bahadori,
Volume 2, Issue 4 (12-2019)
Abstract

Introduction: Given the importance of health as a valuable asset and achieving universal health coverage, Enjoyment the benefits of health insurance are essential to achieving health for all. So identifying and analyzing the benefits of integrating health insurance funds can be an effective step in this regard. This study aimed to analyze the Systematic Relationship of Health Insurance Integration Benefits in Iran.

Methods: This descriptive study was conducted on 68 health insurance experts in two stages of systematic identification and analysis of the benefits of health insurance integration in Iran. Data collection tool was a 40-item Likert-type questionnaire in the Delphi phase and a paired comparisons questionnaire in the systematic analysis stage. Delphi phase analysis was performed using SPSS software and one-sample t-test and factor weighting were performed using FUZZY DEMATEL technique using MATLAB software.

Results: In total, 40 benefits were identified for integration of health insurance in Iran, and 29 benefits were accepted through Delphi phase. The results of Systematic Relationship Analysis also showed that the component of Stewardship with coordinates (1.31 and 1.31) as the most influential component and the component of operational processes with coordinates (0.959 and -0.959) as the most influential component.

Conclusion: Considering the importance of the Stewardship component, cost control and improving the efficiency of the health system in the current conditions of the country can be considered through the implementation of infrastructure reforms in the Stewardship. Also, achieving service-based benefits, general population coverage, financing, and operational processes can be achieved through medium-term and
long-term plans.


Barriers of Efficient and effectiveness participation of Donors in healthcare system, a Qualitative Study
Narges Asadi Janati, Khalil Alimohammadzade, Seyd Mojtaba Hosseini, Ali Maher, Mohammadkarim Bahadori,
Volume 3, Issue 1 (4-2020)
Abstract

Introduction: Donors participation in the health sector is one of the sources of financing in the healthcare system. According to rising costs of the healthcare system in recent years and consequently increase in out of pockets of people, more attention has been paid to the charitable donations. In order to maintain and increase good support and participation in the health system, the need to identify and remove the barriers they face is essential for Efficient and effectiveness participation.
Methods: the present study according to purpose is applied, Descriptive research in terms of data collection and In terms of type of research data is qualitative. Required data were collected through semi-structured interviews with 41 health experts and beneficiaries using snowball sampling method.Conventional Content analysis was used to analyze the data.
Results: Surveying and categorizing the interviews showed that Efficient and effectiveness participation of Donors in the healthcare system involves four main barriers: Lack of legal mechanisms, Lack of proper and continuous communication with the beneficiary, barriers in the field of management and effective allocation of resources, Lack of awareness of Donors from needs and barriers of the healthcare system and 18 subtheme.
Conclusion: By recognizing and solving these barriers, it has channeled the funds and contributions of the Donors towards the needs of the healthcare system with maximum effectiveness. Can be enhanced by strengthening institutions, structures and processes, Developing facilitator laws, Correct and constant communication with beneficiary and identifying priorities and needs and transferring them to the beneficiaries of health, can be facilitated and encouraged maximum donation.
Keywords: Healthcare Financing, Donors, Barriers,Conventional Content Analysis.

 


Factors Affecting the Service Packages of Supplementary Health Insurance, a Qualitative Study
Shadi Hajikhani, Somayeh Hessam, Irvan Masoudi Asl, Ali Maher,
Volume 5, Issue 2 (8-2022)
Abstract
Introduction: Basic and supplementary insurances play an important role in achieving universal health coverage. In developing countries, complementary insurances have many structural and organizational problems and inadequacies. The present study was conducted with the aim of investigating the factors affecting the service packages of supplementary medical insurance.
Methods: The current research is of a qualitative type with a framework analysis method that was carried out in 1400. 11 experts of the insurance organization and experts in the health system were selected as the research samples by the purposeful sampling method. MAXQDA software was used for data analysis.
Results: The dimensions of the complementary insurance model of treatment in Iran based on the analysis of the opinions of experts and experts in Iran include five main dimensions: "laws and regulations, coverage of services, strengthening and creating a competitive market, developing standards for the use of services and treatment guidelines; Development of complementary insurances.
Conclusion: Based on the findings, efforts to develop a comprehensive package of complementary treatment services in the country in order to increase people's access should be considered by policy makers and the financial capacity to manage and finance universal health coverage should be increased. It is expected that with the scientific development of supplementary medical insurance, it will contribute greatly to universal health coverage in the country.
 

Relationship Between Dental Insurance Coverage and Oral Health
Medhi Farhadi, Seyed Mojtaba Hosseini, Ali Maher,
Volume 6, Issue 1 (Spring 2023)
Abstract
Introduction: Due to the very weak coverage of basic treatment in the dental insurance sector, such services are considered as luxury services for people and the indicators of oral and dental health in Iran are not very favorable. With regard to the supplementary excess treatment coverage by commercial insurances, in this research, the factors affecting the use of dental services were investigated.
Methods: The research method was descriptive, analytical and cross-sectional, the statistical population of the present study included patients referred to Tehran clinics in 2022. The sample size in this study was equal to 383 people who were selected by cluster sampling method. The information was collected through a questionnaire and the data were analyzed at the level of descriptive and inferential statistics, one population and binomial t-tests and Friedman’s test.
Results: There is a relationship between insurance coverage of dental services and oral health of people (P=0.000; t=23.99). There is a relationship between the amount of patients' out-of-pocket payments for dental services and oral health status (P=0.000; t=16.117). The amount of insurance payment for dental services has an effect on the amount of use of dental services (P=0.000; t=29.73). The demographic characteristics of the insured (DMFT index, age, gender, education level, marital status) have an effect on the use of dental services (P=0.000; t=33.04).
Conclusion: Due to the relationship between insurance coverage, payment amount, age and education level of people with oral and dental health, the officials and practitioners of oral and dental health should consider appropriate decision and policy regarding this matter.

Analysis of Factors Affecting the Optimal Management of Hospitals: A Qualitative Study
Nasim Nabipour Jafarabad, Ali Maher, Amin Ghasem Begloo, Ali Fakhr-Movahedi,
Volume 6, Issue 4 (Winter 2024)
Abstract
Introduction: The rapid growth of technology, demographic changes, increasing patients’ demand, and changes in the nature of diseases, increased competition among hospitals and healthcare providers, and constraints in budget allocation necessitate adopting a novel approach to the management of medical centers based on international standards.
Methods: This qualitative study was conducted in two stages by a content analysis approach in the year 2022 in teaching hospitals affiliated with the Islamic Azad University nationwide. The statistical population in the first stage included all studies addressing various aspects of the factors affecting the optimal management of hospitals. In the second stage, it included 10 executive managers of hospitals purposively selected as experts until reaching data saturation. The validity and reliability of the interviews were confirmed using the Lincoln and Guba methods. The data analysis method involved a comprehensive review of studies to identify factors affecting the optimal management of hospitals and a contractual content analysis to identify, analyze, and report themes.
Results: In the first stage, a comprehensive review of studies was conducted, encompassing a total of 96 research papers, including 36 in Persian and 60 in English. Following the examination of the titles and abstracts of these research papers and aligning them with the predefined inclusion and exclusion criteria, a total of 18 studies were selected for final analysis, comprising 11 in Persian and 7 in English. After identifying the factors affecting the optimal management of hospitals, three main dimensions were extracted, including strategic planning (12 components), reengineering (8 components), and supply chain engineering (14 components) for the optimal management of hospitals affiliated with the Islamic Azad University using the content analysis method.
Conclusion: Managers should implement each of the identified components of strategic planning, reengineering, and supply chain engineering for the optimal management of hospitals in line with the hospitals’ structure. By examining the excellence and efficiency of hospitals over time, as well as evaluating the trends of each of them, they should take steps towards adopting reform policies and their experiences should be utilized in other hospitals.

Induced Demand of Providers of Diagnostic and Therapeutic Services in the World; Scoping Review
Azamsadat Rivandi, Khalil Alimohammadzadeh, Sara Emamgholipour Sefiddashti, Ali Maher, Amin Ghasem Begloo,
Volume 7, Issue 1 (Spring 2024)
Abstract
Introduction: Induced demand is a major challenge for financing health promotion. Experts have highlighted the important role of health insurance as a driver of demand for doctors even in emerging and advanced world economies. Therefore, the importance of conducting review studies in the country to obtain methods for identifying induced demand is not hidden from anyone.
Methods: In this study, articles were searched from English PubMed, Scopus, ProQuest, Cochrane and Web of Science databases.
Results: The findings showed that about 90% of the studies proved the induced demand in diagnostic and therapeutic services with statistical analysis methods and investigating the relationship of variables, and the issue of induced demand is still an important issue in the world.
Conclusion: The structure of insurances is quite effective in the formation of induced demand due to the fundamental role they play in paying health service providers, and the research methods of these articles provide effective perspectives for the country's health policy makers in recognizing and controlling induced demand.

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