Jahan Ara Mamikhani, Seyed Moosa Tabatabaie, Marziyeh Zangeneh,
Volume 2, Issue 3 (12-2019)
Abstract
Introduction: Health insurance organizations are the main purchasers in Iran health system. Ordinarily, financial documents are delivered to the health insurers by the hospitals. It is possible there be other processes according to circumstances. Both these offices protect their own organizations' benefits, so there may occur some conflicts, which may harm patients. This study was conducted with a systemic approach employing organizational ecosystem technique for demonstrating the space of decisions and behaviors much better, in order to achieve better management in the interaction between hospitals and insurers.
Methods: This is a model building study, conducted in four phases. Initially a literature review study was performed for gathering higher national and institutional level documents, and for situational analysis of processes and functions. Then an FGD was performed according to Harris framework of ecosystems, the elements were identified under four domains, i.e. community, public policy, organizational, and interpersonal. In the third phase employing tables of program evaluation model of CDC, revealed the key stakeholders of the interaction, continued by explaining their functions and roles in the interaction. In the last phase, graphical model showing the direct effects among the elements of interaction was depicted and in the last step finalized by the experts in an FGD.
Results: In the insurer-hospital interaction ecosystem there were 30 elements identified in domains of community, public policy, organizational, and interpersonal; containing 11, 8, 4 and 7 elements respectively. The key stakeholder analysis for the interaction program, revealed the number of stakeholders which were dropped in these distinctive groups: who are affected by the program, who perform the program, and who benefit the results of the program, 2, 6, and 7 respectively. The graphical model was drawn using these findings.
Conclusion: In the organizational ecosystem of insurer-hospital interaction more than 63 percent of elements belong to community and public policy domains; less than 23 percent are related to organizational and interpersonal domains. This emphasizes that insurer-hospital interaction is more affected by community and public policy rather internal factors of insure organizations and hospitals.
Dr Jahanara Mamikhani, Yousef Mahmoodi, Shahram Tofighi, Mohammad Javad Kabir,
Volume 6, Issue 4 (Winter 2024)
Abstract
The marginal cost of public funding (MCPF) is a key factor in resource allocation. It's also an important measure of financial stability, especially in public health. The MCPF shows how much one more unit of public spending (including taxation) changes household spending. It also shows how much it affects society's welfare and security. We can restructure the tax system to rely less on aggressive taxes. We can also add progressive taxes. These changes could reduce the MCPF and spread the tax burden across income deciles. This research, describing the many sides of this cost, talks about its impact on social costs and public health, which are less discussed. We investigated the impact of this cost on health care services. It also affects fairness in health and social costs. Researchers have proposed different methods to calculate MCPF. Osher suggested the simplest. It uses the average and median national income of countries. The cost factor is a number greater than 1. Since health projects are financed through taxes, it is necessary to multiply the project cost by MCPF. This applies to health care projects and economic evaluations. Considering the final cost can provide a more accurate estimate of budget and costs.
Shahram Tofighi, Jahanara Mamikhani, Sedigheh Khadem, Mohammad Effatpanah, Mohammadjavad Kabir, Mehdi Rezaee,
Volume 7, Issue 2 (Summer 2024)
Abstract
Introduction: The burden of psychological disorders and its financial burden has increased in the world and in Iran. Usually, these patients need financial support to improve their mental health. Sometimes basic insurance organizations hesitate to include psychological counseling services in the insurance package. The assistance of the Welfare Organization and the Ministry of Health is not enough.
Methods: It is a descriptive study with financial calculations. Using the data of the Iranian Statistics Center, demographic information until 2031 and using the data of the mental health survey reports of the Ministry of Health in 2011 and 2021, the annual growth for the 90s was calculated. Then, with the discount formula, the growth of prevalence of disorders, different severity of disorders, the number of referrals to different centers, the number of referrals was estimated up to 2031. Assuming an annual tariff growth rate of 20%; The insurer's share is 30%, 50%, and 70%; 50% and 10% annual growth in the number of clients after providing insurance coverage, the estimate was completed
Results: The financial burden of insurance organizations for psychological counseling was estimated from 708.2 million tomans (insurance share 30% in 2024, fixed rate of clients) to 23,534 million tomans (insurance share 70%, annual growth of 10% clients in 2031).
Conclusion: Psychological counseling is both necessary and cost-effective to be covered by insurance organizations. By developing a right service package, psychological counseling can be covered according to the severity of the disorder, the location of the service provision, and the different shahres of the insurance organizations. It would be wise that some disorders, considered important, be covered by basic insurance organizations, for other cases supplementary insurance along with other supportive and welfare services such as subsidies would be rational.
Jahanara Mamikhani, Seyed Abbas Motevalian, Hassan Haghparast-Bidgoli,
Volume 7, Issue 3 (Autumn 2024)
Abstract
Research governance is a critical framework that ensures the integrity, quality, and ethical conduct of scientific research in various disciplines and includes a set of principles, guidelines, and working practices designed to maintain high standards throughout the research process, from conceptualization to publication of results and from ethical oversight, especially in human or animal clinical studies, to quality assurance and accountability, i.e., establishing clear lines of responsibility between researchers, institutions, and funding bodies, and compliance, i.e., ensuring adherence to legal and regulatory requirements, including data protection and intellectual property rights, as well as transparency in communications, information flow, findings, and conflicts of interest. This study conducted a narrative review of 80 articles related to research governance. For this purpose, and for a complete and comprehensive search of articles, the Google Scholar and Scopus databases were used. This review can familiarize policymakers and senior and middle managers in the field of health research with the term governance and its types, and explain the different models used in this field.
