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استفاده از الگوی باور سلامت در آموزش حفظ سلامت بر اساس طب ایرانی به بیمه شدگان سازمان بیمه سلامت ایران: کاربردی از تحلیل مسیر Using the Health Belief Model in Health Care Education Based on Iranian Medicine to the Insured of the Iran Health Insurance Organization: An Application of Path Analysis 1 1 مقدمه: سبک زندگی انسان ها بر سلامت جسم و روان آنها مؤثر است و آموزش حفظ سلامت می تواند نقش مهمی در بهبود رفتار و سبک زندگی افراد داشته باشد. این مطالعه با هدف بررسی تأثیر استفاده از الگوی باور سلامت در آموزش حفظ سلامت بر   اساس طب ایرانی به بیمه شدگان سازمان بیمه سلامت ایران انجام شد. روش بررسی: این مطالعه شبه تجربی و تک گروهی در شهر تهران در سال ۱۳۹۶ انجام شد. شرکت کنندگان در این مطالعه به صورت حضوری و مجازی تحت آموزش حفظ الصحه مستخرج از طب ایرانی، مطابق الگوی باور سلامت قرار گرفتند. در این مطالعه از روش تحلیل مسیر و نرم افزارهای AMOS و SPSS برای تحلیل داده ها استفاده شد. یافته ها: این مطالعه روی ۵۱ نفر (۲۳ مرد و ۲۸ زن) انجام شد. نتایج این مطالعه نشان دهنده ضریب تبیین ۵۹%=R۲ برای متغیر رفتار براساس سازه  های مدل بود. همچنین نتایج بیشتر نشان داد که با افزایش طول مطالعه، رفتار رعایت اصول حفظ سلامت مطابق با طب ایرانی افزایش می یابد و آموزش انجام شده بر خودکارآمدی، منافع، حساسیت و شدت درک شده تأثیر افزایشی و بر موانع درک شده، تأثیر کاهشی داشته است. نتایج تحلیل مسیر (RMSEA=۰,۰۳۱) نیز نشان داد که سازه  های حساسیت درک شده(۰.۱۶)، منافع درک شده (۰.۲۹) شدت درک شده (۰.۱۵)، خودکارآمدی (۰.۵۹) و زمان (۰.۴۷) باعث افزایش رفتار شده و سازه موانع درک شده(   ۰.۳۰-) باعث کاهش رفتار می شود(P<۰.۰۰۱). نتیجه گیری: با توجه به نتایج این مطالعه، آموزش حفظ الصحه می تواند با تأکید بر منافع، موانع، حساسیت و شدت درک شده و خودکارآمدی افراد، میزان پایداری رفتار، یعنی رعایت اصول حفظ الصحه را افزایش دهد. 2 Introduction: Human lifestyle is effective on their physical and mental health. Health care education can play an important role in improving people's behavior and lifestyle. The aim of this study was to investigate the effect of using the health belief model in health care education based on Iranian medicine to the insured of the Iran Health Insurance Organization. Methods: This quasi-experimental single-group study was performed in Tehran during 2017. Participants in this study were trained in face-to-face and virtual health preservation education according to Iranian Medicine resources based on health belief model. In this study, path analysis method, SPSS and AMOS softwares were used to analyze the data. Results: The study was performed on 51 people (23 men and 28 women). The results of this study showed an explanation of R2=59% behaviors based on model constructs. Also, the results showed that with increasing the time of the study, the behavior of observing the principles of health care in accordance with Iranian medicine increases and the training has an increasing effect on self-efficacy, benefits, sensitivity and perceived severity and has a decreasing effect on perceived barriers. The results of path analysis (RMSEA = 0.031) also showed that the constructs of perceived sensitivity (0.16), perceived benefits (0.29), perceived intensity (0.15), self-efficacy (0.59) and time (0.47) increased behavior and barrier constructs. Perceived (-0.30) decrease behavior (P<0.001). Conclusion: According to the results of this study, hygiene training can increase the stability of behavior (i.e. observance of hygiene principles) by emphasizing the benefits, barriers, perceived sensitivity and severity and self-efficacy of individuals. 234 243 2020/05/31 1399/3/11 2021/01/7 1399/10/18 مصطفی عابدی Mostafa Abedi گروه طب سنتی، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران ایران mostafa_medicine84@yahoo.com فرهاد جعفری Farhad Jafari گروه پزشکی اجتماعی، دانشکده پزشکی شاهد، دانشگاه شاهد، تهران، ایران ایران jafarifarhaddr@yahoo.com علی منتظری Ali Montazeri مرکز تحقیقات سنجش سلامت، پژوهشکده علوم بهداشتی جهاد دانشگاهی، تهران، ایران ایران montazeri@acecr.ac.ir سید سعید اسماعیلی صابر Seyed Saeid Esmaeili Saber گروه طب سنتی، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران ایران dr.esmaeili@chmail.ir محمد غلامی فشارکی Mohamad Gholami Fesharaki گروه آمار زیستی، دانشکده علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران ایران mohammad.gholami@modares.ac.ir محمد باقر هداوند Mohamad Bagher Hadavand گروه طب سنتی، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران ایران dr_hadavand@yahoo.com Behavior Barriers Benefits Health Preservation Insurance رفتار موانع منافع الگوی باور سلامت حفظ الحصه بیمه 1. 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Tol, A., et al., The Relation Between Health-Promoting Lifestyle And Quality Of Life In Undergraduate Students At School Of Health, Isfahan University Of Medical Sciences. Health System Research, 2011. 7(4): p. -.##19. Mahboobi-Ardakan, P., S. Mehraban, and M. Kazemian, Estimation of total consumption function of health care services in Iran from 1981 to 2011. Journal of Management and Training for Industries, 2016. 3(2): p. 30.##20. Jacobs-van der Bruggen, M.A., et al., Cost-effectiveness of lifestyle modification in diabetic patients. Diabetes care, 2009. 32(8): p. 1453-1458.##21. Sadeghi Jahan, A., A. Sobhi, and M. Hejazi, The Effect of Life Skills Training on Reducing Anxiety and Depression in drug Dependent subjects. Zanjan University of Medical Sciences Journal, 2016. 24(104): p. 20 – 29.##22. Emlai khozani, S., A. zareiyan, and M. roshandel, The effect of training sessions based on the health belief model on soldiers in prevention of smoking persons’ attitude. 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مدل‌یابی معادلات ساختاری تفسیری مشارکت نخبگان و معتمدین در عرصه سلامت Analysis of Participation of Elites and Trustees in the Field of Health with Interpretive Structural Modeling 1 1 مقدمه: مشارکت به عنوان اساسی‌ترین عنصر در دستیابی به اهداف نظام سلامت مطرح است. مشارکت نخبگان و معتمدان در نظام سلامت وسیله ای مناسب برای توسعه و بهبود فعالیت‌ های بهداشتی و درمانی محسوب می‌شود. این مطالعه با هدف مدل یابی معادلات ساختاری تفسیری مشارکت نخبگان و معتمدان در عرصه سلامت انجام  شده است. روش بررسی: این پژوهش از نوع تحلیلی و مقطعی است که در سال ۱۳۹۹ انجام شد. برای طراحی الگوی مشارکت نخبگان و معتمدان در عرصه سلامت، از نظر ۲۳ خبره (۸ نفر از اساتید دانشگاهی رشته مدیریت و ۱۵ نفر از نخبگان) استفاده شد. در این پژوهش برای شناسایی معیار ها و بیان روابط بین معیارها، پس از مطالعه ادبیات پژوهش‌ های مرتبط و مصاحبه با نخبگان و معتمدان مورد مطالعه، از تکنیک مدل سازی ساختاری تفسیری (ISM) و تحلیل MICMAC استفاده شد. یافته ها: پس از تحلیل داده‌ها، متغیر ها در ۴سطح مختلف طبقه‌بندی شدند و با توجه به روابط، گراف ISM ترسیم شد. پس از تحلیل MICMAC متغیر ها در ۳    گروه متغیر های مستقل یا کلیدی، خودگردان و وابسته قرار گرفتند. عوامل فردی جزو متغیر های مستقل، عوامل مدیریت منابع انسانی و عوامل سازمانی در گروه متغیر های خودگردان و متغیر عوامل محیطی جزو عناصر اثرپذیر و وابسته قرار گرفتند.  نتیجه گیری: تعیین روابط بین متغیر ها و نوع متغیر ها می تواند به درک بهتر موضوع و اتخاذ تصمیم های مناسب در مسئله مشارکت نخبگان و معتمدان عرصه سلامت منجر شود. 2 Introduction: Participation is the most basic element in achieving the goals of the health system. The participation of elites and trustees in the health system is considered as a suitable tool to develop and improve health activities. The aim of this study was to Model the interpretive structural equations of participation of elites and trustees in the field of health. Methods: The present study is an analytical and cross-sectional study that was conducted in 2020. To design a model of participation of elites and trustees in the field of health, 23 experts (8 professors of management and 15 elites) were used. In this study, interpretive structural modeling (ISM) and MICMAC analysis techniques were used to identify the criteria and express the relationships between the criteria, after studying the literature of related research and interviewing the elites and trustees. Results: After analyzing the data, the variables were classified into four different levels and plotted according to the ISM graph relationships. After MICMAC analysis, the variables were divided into three groups of independent or key variables, autonomous and dependent. Individual factors were among the independent variables; human resource management factors and organizational factors in the group of self-governing variables and the variable "environmental factors" were among the effective and dependent elements. Conclusion: Determining the relationships between variables and the type of variables can lead to a better understanding of the issue and make appropriate decisions on the issue of participation of elites and trustees in the field of health. 244 253 2020/05/312020/10/1 1399/7/10 2021/01/72021/02/15 1399/11/27 روزیتا سعیدی Rozita Saeedi گروه مدیریت، واحد رفسنجان، دانشگاه آزاد اسلامی، رفسنجان، ایران ایران saeedi.rozita@gmail.com ملیکه بهشتی فر Malikeh Beheshtifar گروه مدیریت، واحد رفسنجان، دانشگاه آزاد اسلامی، رفسنجان، ایران ایران m.beheshtifar@yahoo.com محمد ضیاء الدینی Mohammad Zeyaadin گروه مدیریت، واحد رفسنجان، دانشگاه آزاد اسلامی، رفسنجان، ایران ایران mziaaddini@yahoo.com Participation Elites and Trustees Individual Factors مشارکت نخبگان و معتمدین عوامل فردی 1. Bagheri Kahkesh M, Mahmoodi Majd Abadi farahani M, Riahi L, Hajinabi K. Factors affecting the occurrence of public participation in the health system: a comparative study. Iran J Health Insur. 2020;3(2):116-27. [Persian]##2. Etemadian M, Mosadeghrad AM, Mohaghegh Dolatabadi M R, Dehnavi H. The challenges of public private partnership in hospital operations: A case study. Payesh. 2019;18(2):127-48. [Persian]##3. Ramezanpour D, Abdolhamid M, Rezaeian A. Presentation of a model for factors affecting the participation of elites in the process of formulation of the public policymaking of the Islamic Republic of Iran. Management Researches. 2020;12(46):37-67. [Persian]##4. Khademi A, Sadeghie Fasai S. Meta-analysis of four decades of research in the field of women's participation, Women's Studies Sociological and Psychological. 2016;14(2):34-70. [Persian]##5. Safaeipour Z. A study of factors affecting public participation in urban development; Case study: Shahralam. Quarterly Journal of Urban Development Studies. 2017;1(1). [Persian]##6. Hosseini SA, Abbasi R, Rezaei R. Identifying the factors affecting the participation of elites in developing an Islamic-Iranian model of progress. Basij Strategic Studies. 2015;18(66):25-45. [Persian]##7. McCauley C, Wakefield M. Talent management in the 21st century: Help your company find, develop, and keep its strongest workers. The Journal for Quality and Participation. 2006;29(4):4.##8. Barlow E, Handfield JH, Axelrod B. The war for talent. Boston: Harvard Business School Publishing, 2007.##9. Ali Akbari A, Akbari M. Structural-interpretive modeling of factors affecting the livability of the metropolis of Tehran. Journal of Planning and Space Planning. 2018;21(443):1-31. [Persian]##10. Ramezanian MR, Moradi M, Soltani F. Analysis of barriers to cultural interaction in the automotive industry supply chain using structural-interpretive modeling (ISM) approach. Journal of Organizational Culture Management. 2015;13(2):391-6. [Persian]##11. Ramezanpour D, Abdolhamid M, Rezaeian A. Presentation of a model for factors affecting the participation of elites in the process of formulation of the public policymaking of the Islamic Republic of Iran. Management Researches. 2020;12(46):37-67. [Persian]##12. Amiri Eghtaei R, Teymourpour B. Designing banking customer knowledge management modeling using interpretive structural modeling. Journal of Human Resource Management Research. 2014;4(3). [Persian]##13. Lafont C. Deliberation, participation, and democratic legitimacy: Should deliberative mini‐publics shape public policy?. Journal of Political Philosophy. 2015;23(1):40-63.##14. Wong S. Building social capital in Hong Kong by institutionalising participation: Potential and limitations. Urban Studies. 2008;45(7):1413-37.##1. Bagheri Kahkesh M, Mahmoodi Majd Abadi farahani M, Riahi L, Hajinabi K. Factors affecting the occurrence of public participation in the health system: a comparative study. Iran J Health Insur. 2020;3(2):116-27. [Persian]##2. Etemadian M, Mosadeghrad AM, Mohaghegh Dolatabadi M R, Dehnavi H. The challenges of public private partnership in hospital operations: A case study. Payesh. 2019;18(2):127-48. [Persian]##3. Ramezanpour D, Abdolhamid M, Rezaeian A. Presentation of a model for factors affecting the participation of elites in the process of formulation of the public policymaking of the Islamic Republic of Iran. Management Researches. 2020;12(46):37-67. [Persian]##4. Khademi A, Sadeghie Fasai S. Meta-analysis of four decades of research in the field of women's participation, Women's Studies Sociological and Psychological. 2016;14(2):34-70. [Persian]##5. Safaeipour Z. A study of factors affecting public participation in urban development; Case study: Shahralam. Quarterly Journal of Urban Development Studies. 2017;1(1). [Persian]##6. Hosseini SA, Abbasi R, Rezaei R. Identifying the factors affecting the participation of elites in developing an Islamic-Iranian model of progress. Basij Strategic Studies. 2015;18(66):25-45. [Persian]##7. McCauley C, Wakefield M. Talent management in the 21st century: Help your company find, develop, and keep its strongest workers. The Journal for Quality and Participation. 2006;29(4):4.##8. Barlow E, Handfield JH, Axelrod B. The war for talent. Boston: Harvard Business School Publishing, 2007.##9. Ali Akbari A, Akbari M. Structural-interpretive modeling of factors affecting the livability of the metropolis of Tehran. Journal of Planning and Space Planning. 2018;21(443):1-31. [Persian]##10. Ramezanian MR, Moradi M, Soltani F. Analysis of barriers to cultural interaction in the automotive industry supply chain using structural-interpretive modeling (ISM) approach. Journal of Organizational Culture Management. 2015;13(2):391-6. [Persian]##11. Ramezanpour D, Abdolhamid M, Rezaeian A. Presentation of a model for factors affecting the participation of elites in the process of formulation of the public policymaking of the Islamic Republic of Iran. Management Researches. 2020;12(46):37-67. [Persian]##12. Amiri Eghtaei R, Teymourpour B. Designing banking customer knowledge management modeling using interpretive structural modeling. Journal of Human Resource Management Research. 2014;4(3). [Persian]##13. Lafont C. Deliberation, participation, and democratic legitimacy: Should deliberative mini‐publics shape public policy?. Journal of Political Philosophy. 2015;23(1):40-63.##14. Wong S. Building social capital in Hong Kong by institutionalising participation: Potential and limitations. Urban Studies. 2008;45(7):1413-37. ##

بار مراجعه و هزینه بیماران بستری تحت پوشش صندوق بیمه روستایی قبل و بعد از اجرای برنامه نظام ارجاع در استان گلستان Investigation the Referral Burden and Costs of Hospitalization Patients Covered by the Rural Insurance Fund Before and After the Implementation of the Referral System Program 1 1 مقدمه: سنجش و پایش هزینه‌ های سلامت، سیاست‌گذاران نظام سلامت را در انتخاب سیاست‌ های مناسب برای حمایت از بیماران کمک خواهد کرد. هدف این مطالعه بررسی بار مراجعه و هزینه بیماران بستری تحت پوشش صندوق بیمه روستایی، قبل و بعد از اجرای برنامه نظام ارجاع در استان گلستان بود. روش بررسی: این تحقیق، مطالعه ای توصیفی و مقطعی براساس اطلاعات ۶ماهه اول سال ۱۳۹۶ و ۱۳۹۷ از تمامی بیماران بستری بیمه‌شدگان بیمه سلامت در تمام بیمارستان  های استان گلستان بود که برای جمع‌آوری داده ها از سامانه  های اطلاعاتی و اسناد موجود اداره کل بیمه سلامت استفاده شد. یافته ها: در مقایسه با سال ۱۳۹۶، بار مراجعات بستری بیمه‌شدگان بیمه سلامت در بخش دولتی در سال ۱۳۹۷ در کل صندوق‌ ها و صندوق روستایی به ترتیب ۱۳درصد و ۱۰ درصد و در بخش خصوصی، در کل صندوق ها و صندوق روستایی بترتیب ۳۹درصد و ۹۸درصد کاهش یافت. هزینه بستری بیمه‌شدگان بیمه سلامت در بخش دولتی در کل صندوق‌ ها و صندوق روستایی به ترتیب ۱۳درصد  و ۱۲درصد و در بخش خصوصی به ترتیب ۲۴درصد و ۹۹ درصد کاهش یافت. این کاهش بار مراجعات و هزینه بستری در بخش دولتی و خصوصی در صندوق‌ های روستایی و همگانی و در کل صندوق‌ ها معنادار بوده است (۰۵/۰ > P). نتیجه گیری: طبق یافته ها، برای کاهش تقاضای بستری، پیشنهاد می‌شود دستورالعمل برنامه پزشک خانواده روستایی و نظام ارجاع در سطح ۱، به طور کامل اجرا شود. با افزایش امکانات و ظرفیت فیزیکی خدمات در سطح یک و ارائه خدماتی جامع و به موقع که در سطح۲ نیز تداوم داشته باشد، از تقاضای القایی ایجاد شده در بستری بیماران جلوگیری می شود. 2 Introduction: Measuring and monitoring health costs will help health system policy makers choose appropriate policies to protect patients. The purpose of this study was to investigate the referral burden and cost of hospitalized patients covered by the Rural Insurance Fund before and after the implementation of the referral system program in Golestan province, Iran.. Methods: A cross-sectional descriptive study was performed based on the information of the first six months of 2017 and 2018 of all patients admitted to health insurance in all hospitals of Golestan province. The information systems and existing documents of the General Directorate of Health Insurance were used to collect data. Results: Compared to 2017, the number of hospitalizations of health insurance policyholders in the public sector in 2018 in total funds and rural funds decreased by 13 and 10 percent, respectively, and in the private sector, in all funds and rural funds decreased by 39 and 98 percent, respectively. The cost of hospitalization of health insurance policyholders in the public sector in total funds and rural funds decreased by 13 and 12 percent, respectively, and in the private sector by 24 and 99 percent, respectively. This reduction in referral burden and hospitalization costs in the public and private sectors in rural and public funds and in all funds has been significant (P <0.05). Conclusion: According to the findings, in order to reduce the demand for hospitalization, it is recommended that the guidelines of the rural family physician program and the referral system at level one be fully implemented. By increasing the facilities and physical capacity of services in level one and providing comprehensive and timely services that continue in level two, the induced demand created in patients' hospitalization should be prevented. 254 263 2020/05/312020/10/12020/10/9 1399/7/18 2021/01/72021/02/152021/02/5 1399/11/17 فاطمه کاویان تلوری Fatemeh Kavian Telouri مرکز تحقیقات مدیریت سلامت و توسعه اجتماعی، دانشگاه علوم پزشکی گلستان، گرگان، ایران ایران kavian.t.fatemeh@gmail.com علیرضا حیدری Alireza Heidari مرکز تحقیقات مدیریت سلامت و توسعه اجتماعی، دانشگاه علوم پزشکی گلستان، گرگان، ایران ایران alirezaheidari7@gmail.com انیس عباسی Anis Abbasi مرکز تحقیقات مدیریت سلامت و توسعه اجتماعی، دانشگاه علوم پزشکی گلستان، گرگان، ایران ایران anis1299@yahoo.com محمدجواد کبیر Mohammad Javad Kabir مرکز تحقیقات مدیریت سلامت و توسعه اجتماعی، دانشگاه علوم پزشکی گلستان، گرگان، ایران ایران kabirmj63@gmail.com عباس بدخشان Abbas Badakhshan مرکز تحقیقات مدیریت سلامت و توسعه اجتماعی، دانشگاه علوم پزشکی گلستان، گرگان، ایران ایران dr_badakhshan@yahoo.com زهرا خطیرنامنی Zahra Khatirnamani مرکز تحقیقات مدیریت سلامت و توسعه اجتماعی، دانشگاه علوم پزشکی گلستان، گرگان، ایران ایران khatirzahra@gmail.com Referral Referral Burden Inpatients Hospitalization Costs Health Insurance Organization Rural Insurance Fund ارجاع بار مراجعه بیماران بستری هزینه بستری سازمان بیمه سلامت صندوق بیمه روستایی 1. Etienne C, Asamoa-Baah A, Evans DB. Health systems financing: the path to universal coverage. World Health Organization; 2010.##2. Kabir MJ, Heidari A, Jafari N, Khatirnamani Z, Honarvar MR. Dimensions and components for designing the basic health services package in Iran: Exploratory and confirmatory factor analyses. Payesh. 2020;19(5):511-22. [Persian] ##3. Babazadeh Gashti A, Jafari N, Kabir MJ, Heidari A, Behnampour N, Honarvar MR, et al . Assessing rural family physicians performance according to healthcare managers, family physicians, and patients in Golestan province, Iran. J Mazandaran Univ Med Sci. 2016;25(132):23-32. [Persian] ##4. Ministry of Health and Medical Education. Guideline of program the “family physician and referral system” in urban areas. Tehran: version 02. 2012. [Persian]##5. Ministry of Health and Medical Education Family Physician Instruction. Tehran: Version 5, 2005. [Persian] ##6. Nasrollahpour Shirvani SD, Raeisi P, Motlagh ME, Kabir MJ, Ashrafi Amiri H. Evaluation of the performance of referral system in family physical program in Iran University of Medical Sciences: 2009. Hakim Research Journal. 2010;13:19-25. [Persian] ##7. Shojaeetehrani H, editor. Generalities of health services. Tehran: Samat Press; 1998. Family Physician Instruction. Ministry of Health and Medical Education. Tehran: Version 11, 2010. [Persian]##8. Ministry of Health and Medical Education, Department of Health. The Executive Guideline of Rural Insurance & Family Physician Program. 8th ed. Tehran: Ministry of Health and Medical Education Press; 2007. [Persian]##9. Coleman P, Irons R, Nicholl J. Will alternative immediate care services reduce demands for non-urgent treatment at accident and emergency?. Emerg Med J. 2001;18(6):482-7.##10. Morrell DC. Symptom interpretation in general practice. J R Coli Gen Pract. 1972;22(118):97-309. ##11. Sadeghi Mazidi A, Kharazmi E, Javanbakht M, Heidari A, Bayati M. Cost of diabetes in type II diabetic patients. Payesh. 2012;11(4):443-9. [Persian] ##12. Rahmani K, Riaziat A, Farshid A, Rezayatmand R. Cost control solutions in the most expensive laboratory services of the Health Insurance Organization. Iran J Health Insur. 2020;3(2):138-44. [Persian] ##13. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353-70.##14. Kabir MJ, Heidari A, Lotfi M, Hosseini SM, Shojaee A, Keshavarzi A. Effective factors in the improvement and effectiveness of basic health insurance: A qualitative study. Hakim Health Sys Res. 2020; 23(2):179-88. [Persian]##15. Kavosi Z, Rashidian A, Pourmalek F, Majdzadeh R, Pourreza A, Mohammad K, et al. Measuring household exposure to catastrophic health care expenditures: A longitudinal study in Zone 17 of Tehran. Hakim Health Sys Res. 2009;12(2):38-47. [Persian]##16. Ravangard R, Keshtkaran V, Niknam S, Yusefi A R, Heidari A R. The decision-making styles of managers of public and private hospitals in Shiraz. Hospital Journal. 2013;12(3):39-45. [Persian]##17. Yusefi A, Jabbari A, Koushki J, Heidarei A. The relationship between personality type and leadership style of managers in educational hospitals of Shiraz University of Medical Sciences. Health Develop J. 2014;3(1):84-93. [Persian]##18. Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet. 2004;364(9437):900-6.##19. Van Ulden CJ, Winkens RA, Weeseling GJ, Cerbolder HF, Vanscayck CP. Use of out of hours services: a comparison between two organizations. Emerg Med J. 2003;20(2):184-7.##20. Khoja TA, Al Shehri AM, Abdul Aziz AA, Aziz K. Patterns of referral from health centres to hospitals in Riyadh region. EMHJ-Eastern Mediterranean Health Journal. 1997;3(2):236-43.##21. Chaman R, Amiri M, Raee M. Family doctor design and quality referral system. Payesh. 2012;875-79. [Persian]##22. Ebadi Farde Azar F. Patients admission and referral system observance in five educational centers (IUMS). J Qazvin Univ Med Sci. 2002;23:30-5. [Persian]##23. Mirzaeyan S, Iezady A, Ebrazeh A, Mohammady P. Prediction of readmission based on LACE index in medical ward of Hajar hospital of Shahrekord. J Clin Nurs Mid. 2014;3(2):1-12. [Persian]##24. Ghasempour R, Nasiripour A, Hosseini S. A Study of causes of readmission patient’s toxicological ward of the Loghman Hakim Hospital, in Tehran in 2014. Alborz University Medical Journal. 2016;5(1):8-12. [Persian] ##25. Sajadi S, Hosseini S M, Alimohammadzadeh K. Assessment of prevalence of readmission in admitted ward of Tehran Oil Company’s hospital in 2016. J Urmia Nurs Midwifery Fac. 2018;16(1):1-11. [Persian]##26. Masoudi Asl I, Bakhtiari Aliabad M, Akhavan Behbahani A, Rahbari Bonab M. Health care costs in Iran and how to control it. Iran J Health Insur. 2019;1(4):117-27. [Persian]##27. Heimly V. Electronic referrals in healthcare: a review. Stud Health Technol Inform. 2009;150:327-31.##28. Naseriasl M, Amini A, Doshmangir L, Adham D, Janati A. Challenges of establishing specialty referal system in Iran’s health sector (A qualitative study). Acta Medica Mediterranea. 2017;33(s1):921-6.##1. Etienne C, Asamoa-Baah A, Evans DB. Health systems financing: the path to universal coverage. World Health Organization; 2010.##2. Kabir MJ, Heidari A, Jafari N, Khatirnamani Z, Honarvar MR. Dimensions and components for designing the basic health services package in Iran: Exploratory and confirmatory factor analyses. Payesh. 2020;19(5):511-22. [Persian] ##3. Babazadeh Gashti A, Jafari N, Kabir MJ, Heidari A, Behnampour N, Honarvar MR, et al . Assessing rural family physicians performance according to healthcare managers, family physicians, and patients in Golestan province, Iran. J Mazandaran Univ Med Sci. 2016;25(132):23-32. [Persian] ##4. Ministry of Health and Medical Education. Guideline of program the “family physician and referral system” in urban areas. Tehran: version 02. 2012. [Persian]##5. Ministry of Health and Medical Education Family Physician Instruction. Tehran: Version 5, 2005. [Persian] ##6. Nasrollahpour Shirvani SD, Raeisi P, Motlagh ME, Kabir MJ, Ashrafi Amiri H. Evaluation of the performance of referral system in family physical program in Iran University of Medical Sciences: 2009. Hakim Research Journal. 2010;13:19-25. [Persian] ##7. Shojaeetehrani H, editor. Generalities of health services. Tehran: Samat Press; 1998. Family Physician Instruction. Ministry of Health and Medical Education. Tehran: Version 11, 2010. [Persian]##8. Ministry of Health and Medical Education, Department of Health. The Executive Guideline of Rural Insurance & Family Physician Program. 8th ed. Tehran: Ministry of Health and Medical Education Press; 2007. [Persian]##9. Coleman P, Irons R, Nicholl J. Will alternative immediate care services reduce demands for non-urgent treatment at accident and emergency?. Emerg Med J. 2001;18(6):482-7.##10. Morrell DC. Symptom interpretation in general practice. J R Coli Gen Pract. 1972;22(118):97-309. ##11. Sadeghi Mazidi A, Kharazmi E, Javanbakht M, Heidari A, Bayati M. Cost of diabetes in type II diabetic patients. Payesh. 2012;11(4):443-9. [Persian] ##12. Rahmani K, Riaziat A, Farshid A, Rezayatmand R. Cost control solutions in the most expensive laboratory services of the Health Insurance Organization. Iran J Health Insur. 2020;3(2):138-44. [Persian] ##13. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353-70.##14. Kabir MJ, Heidari A, Lotfi M, Hosseini SM, Shojaee A, Keshavarzi A. Effective factors in the improvement and effectiveness of basic health insurance: A qualitative study. Hakim Health Sys Res. 2020; 23(2):179-88. [Persian]##15. Kavosi Z, Rashidian A, Pourmalek F, Majdzadeh R, Pourreza A, Mohammad K, et al. Measuring household exposure to catastrophic health care expenditures: A longitudinal study in Zone 17 of Tehran. Hakim Health Sys Res. 2009;12(2):38-47. [Persian]##16. Ravangard R, Keshtkaran V, Niknam S, Yusefi A R, Heidari A R. The decision-making styles of managers of public and private hospitals in Shiraz. Hospital Journal. 2013;12(3):39-45. [Persian]##17. Yusefi A, Jabbari A, Koushki J, Heidarei A. The relationship between personality type and leadership style of managers in educational hospitals of Shiraz University of Medical Sciences. Health Develop J. 2014;3(1):84-93. [Persian]##18. Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet. 2004;364(9437):900-6.##19. Van Ulden CJ, Winkens RA, Weeseling GJ, Cerbolder HF, Vanscayck CP. Use of out of hours services: a comparison between two organizations. Emerg Med J. 2003;20(2):184-7.##20. Khoja TA, Al Shehri AM, Abdul Aziz AA, Aziz K. Patterns of referral from health centres to hospitals in Riyadh region. EMHJ-Eastern Mediterranean Health Journal. 1997;3(2):236-43.##21. Chaman R, Amiri M, Raee M. Family doctor design and quality referral system. Payesh. 2012;875-79. [Persian]##22. Ebadi Farde Azar F. Patients admission and referral system observance in five educational centers (IUMS). J Qazvin Univ Med Sci. 2002;23:30-5. [Persian]##23. Mirzaeyan S, Iezady A, Ebrazeh A, Mohammady P. Prediction of readmission based on LACE index in medical ward of Hajar hospital of Shahrekord. J Clin Nurs Mid. 2014;3(2):1-12. [Persian]##24. Ghasempour R, Nasiripour A, Hosseini S. A Study of causes of readmission patient’s toxicological ward of the Loghman Hakim Hospital, in Tehran in 2014. Alborz University Medical Journal. 2016;5(1):8-12. [Persian] ##25. Sajadi S, Hosseini S M, Alimohammadzadeh K. Assessment of prevalence of readmission in admitted ward of Tehran Oil Company’s hospital in 2016. J Urmia Nurs Midwifery Fac. 2018;16(1):1-11. [Persian]##26. Masoudi Asl I, Bakhtiari Aliabad M, Akhavan Behbahani A, Rahbari Bonab M. Health care costs in Iran and how to control it. Iran J Health Insur. 2019;1(4):117-27. [Persian]##27. Heimly V. Electronic referrals in healthcare: a review. Stud Health Technol Inform. 2009;150:327-31.##28. Naseriasl M, Amini A, Doshmangir L, Adham D, Janati A. Challenges of establishing specialty referal system in Iran’s health sector (A qualitative study). Acta Medica Mediterranea. 2017;33(s1):921-6. ##

مطالعه عوامل فردی واجتماعی موثر بر معلولیت در جامعه ایران Study of Individual and Social Factors Affecting Disability in Iranian Society 1 1 مقدمه: هدف این مطالعه، بررسی نقش توسعه اقتصادی و اجتمـاعی درتفاوت های الگو های شیوع معلولیت منطقه ای است و مطالعه این الگو ها برای شـناخت و رفع موانع اقتصادی،  اجتماعی و بهداشتی موجود در مسیر کاهش شیوع معلولیـت ضـروری بـه نظـرمی رسد. از این رو، سؤال اساسی این است که مهم تـرین تعیـین کننده معلولیت در سطح فردی چیست و ویژگی شهرستان (توسعه شهرستان) چه تأثیری در معلولیت دارد؟ روش بررسی: این مطالعه از نوع کمّی و متّکی بر داده  های ثانویه است. برای نیل به اهداف مطالعه، از مدل چندسطحی و نرم افزار HLM، استفاده شد. برای سطح اول این مطالعه، از داده  های فردی سرشماری سال ۱۳۹۵ و برای سطح دوم از اطلاعات وزارت بهداشت یا مراکز خدمات پزشکی استان ها، سالنامه آماری کشور و اطلاعات سرشماری سال ۱۳۹۵ بهره گرفته  شد. یافته ها: در سطح اول، سن با معلولیت رابطه مثبت و معناداری دارد؛ به طوری که با افزایش یک سال سن، معلولیت ۶/۲ درصد افزایش یافت. جنسیت نیز رابطه معناداری با معلولیت دارد و زنان، ۱/۴۱درصد کمتر از مردان دچار معلولیت می شوند. رابطه رفاه اقتصادی افراد با معلولیت، منفی و معنادار است و با افزایش رفاه اقتصادی افراد، معلولیت ۶/۳ درصد کاهش پیدا می کند. میان محل سکونت و معلولیت رابطه معناداری دیده نشد. در سطح دوم مطالعه نیز مشاهده شد که تفاوت های بین منطقه ای در شیوع معلولیت، فقط نشئت گرفته از توسعه اقتصادی و اجتماعی نیست، بلکه باید علت اصلی شیوع معلولیت را باید در تفاوت های درون منطقه جستجو کرد. نتیجه گیری: با توجه به افزایش جمعیت سالمندان در ایران، انتظار می رود تعداد معلولان نیز افزایش پیدا کند. از طرفی، با توجه به اهمیت رفاه اقتصادی افراد جامعه و وجود نابرابری امکانات و خدمات در سطح فردی، ضروری است برای نیل به افزایش رفاه افراد، برنامه ریزی اساسی و هدفمندی انجام شود و در این راستا، توجه به کاهش نابرابری  های درون منطقه ای در مقایسه با نابرابری  های بین منطقه ای، اهمیت بیشتری دارد. 2 Introduction: The purpose of this study is to investigate the role of economic and social development in differences of regional disability prevalence patterns and the study of these patterns in order to identify and eliminate economic, social and health barriers to reduce the prevalence of disability is necessary. Therefore, the fundamental question is what is the most important determinant of disability at the individual level? What effect does urban characteristics (city development) have on disability? Methods: The current study is quantitative and relies on secondary data. To achieve the objectives of the study, a multilevel model and HLM software were used. For the first level of this study, the personal data of the 2016 census and for the second level of the study, the information of the Ministry of Health or medical service centers of the provinces, the statistical yearbook of the country and the data of the 2016 census have been used. Results: The results showed that in the first level, age has a positive and significant relationship with disability, so that, with increasing one year of age, disability increases by 2.6%. Gender also has a significant relationship with disability and women are 41.1% less likely than men to have disabilities. The relationship between economic well-being and disability is negative and significant, and with increasing economic well-being, disability decreases by 3.6 percent. There was no significant relationship between residence and disability. In the second level of the study, it was observed that inter-regional differences in the prevalence of disability do not only originate from socio-economic development, but the main cause of the prevalence of disability should be sought in differences within the region. Conclusion: Due to the increase in the elderly population in Iran, it is expected that the number of disabled people will also increase. On the other hand, due to the importance of economic welfare of individuals in society and the existence of inequality of facilities and services at the individual level, it is necessary to achieve basic welfare, to do basic and purposeful planning, and in this regard to reduce inequalities Intra-regional is more important than inter-regional inequalities. 264 275 2020/05/312020/10/12020/10/92020/07/16 1399/4/26 2021/01/72021/02/152021/02/52021/01/2 1399/10/13 جواد منظمی تبار Javad Monazami Tabar گروه علوم اجتماعی، دانشکده علوم و فنون اطلاعات و آگاهی، دانشگاه علوم انتظامی، تهران، ایران ایران javadmonazamitabar@gmail.com Disability Socio-Economic Development Age Gender Economic Well-Being معلولیت توسعه اقتصادی- اجتماعی سن جنس رفاه اقتصادی 1. World Health Organization. World Report on Disability, World Health Organization. 2019:14-74.##2. Health Canada Agency.A Population Health Approach, Health Promotion and Programs.Branch Manitabo/Saskatchewan Region, Health Canada, Ottawa. 2019:103.##3. B oyce, W., T. Broers, and J. Paterson."CBR and disability indicators." Asia Pacific Disability Rehabilitation Journal, 2019:12(1):3-21. ##4. Davarmanesh, Abbas and Farideh Barati Sedeh. Introduction to the principles of rehabilitation of the disabled. Tehran: Roshd Publications;.1398:p.72.##5. Maket, P., S. J. Burki, U. Haq, N. Hicks and F. Stewart. First Things First: Meeting Basic Human Needs in the Developing Countries, London, Oxford University Press. 2019:72.##6. Sen, A. Freedom as development, Oxford, Oxford University Press. 2019:89. 6-##7. Harriss-White, B.The Political Economy of Disability and Development with Special Reference to India (No. 73). UNRISD,2016:49..##8. Baylies, C."Disability and the notion of human development: questions of rights and capabilities." Disability & Society, 2018:17(7):725-739. ##9. Murray, C. J., and L. C. Chen.Understanding morbidity change." The Population and Development Review , 2019: 18(3):305-.481.##10. Shams Ghahfarkhi, Mehri, Farideh Shams Ghahfarkhi and Mehdi Rezaei. Prevalence assessment.##11. Hosseini, Seyed Hassan and Fatemeh Safari. Disability, poverty and social exclusion. Social Welfare Quarterly 1397. ; (8) 30: pp. 284-265.##12. Ahmadi, Ali Mohammad, Hossein Mohammad Ghaffari and Seyed Javad Emadi. The relationship between macroeconomic variables and health in Iran. Social Welfare Chapter. 1397; (10) 39: 32-7.##13. Ghaed Rahmati, Safar and Mehdi Dehbashi. The relationship between health services and disability status in the provinces of the country. Journal of Social Welfare. 1397:50 (13): pp. 333-351.##14. Sajjadi Homeira and Nasibeh Zanjari. Disability in Iran: Prevalence, its characteristics and economic and social correlations. Journal of Rehabilitation. 1397: 1 (16): pp. 47-36.##15. Kane, P. Women's health: from womb to tomb, New York, NY: St. Martin’s Press. 2019:51. 15-##16. Groce, N., E. Challenger, R. Berman-Bieler, A. Farkas, N. Yilmaz, W. Schultink, D. Clark, C. Kaplan, and M. Kerac."Malnutrition and disability: unexplored opportunities for collaboration." Paediatrics and International Child Health, 2018 ,34(4):308-314.##17. Mont, D. and C. Nguyen.Spatial Variation in the Poverty Gap between People with and without Disabilities: Evidence from Vietnam." Social Indicators Research , 2018: 137(2):367-754.##18. Beheshti, Mohammad Baqer and Mahmoud Saeidan. Introduction of numerical taxonomy in simple language. East Azerbaijan Province: Program and Budget Organization 1398; p.39.##19. Raudenbush, S. W. and A. S. Bryk. Hierarchical Linear Models: Applications and Data Analysis Methods. Sage. 2018:66.##20. Hafizi, Lily, Kazem Ghodsi and Marzieh Ghasemi. Study of consanguineous marriage and the incidence of physical disabilities. Iranian Journal of Obstetrics, Gynecology and Infertility. 1397:3 (15): pp. 15-10. ##21. Mowaffaq, Abolfazl. A study of avoiding marriage with close relatives and the effects of disability on children. Journal of Medical Ethics, 1396:3 (7): pp. 99-109.##22. Abbasi Shavazi, Mohammad Jalal and Fatemeh Torabi. Level, trend and pattern of consanguineous marriage in Iran. Letter of the Iranian Demographic Association, 1398:2 (1) : pp. 61-88.##23. Lucas, David and Paul Meyer. An Introduction to Demographic Studies. Translated by Hossein Mahmoudian, Tehran, University of Tehran Press, 1397:p.106.##1. World Health Organization. World Report on Disability, World Health Organization. 2019:14-74.##2. Health Canada Agency.A Population Health Approach, Health Promotion and Programs.Branch Manitabo/Saskatchewan Region, Health Canada, Ottawa. 2019:103.##3. B oyce, W., T. Broers, and J. Paterson."CBR and disability indicators." Asia Pacific Disability Rehabilitation Journal, 2019:12(1):3-21. ##4. Davarmanesh, Abbas and Farideh Barati Sedeh. Introduction to the principles of rehabilitation of the disabled. Tehran: Roshd Publications;.1398:p.72.##5. Maket, P., S. J. Burki, U. Haq, N. Hicks and F. Stewart. First Things First: Meeting Basic Human Needs in the Developing Countries, London, Oxford University Press. 2019:72.##6. Sen, A. Freedom as development, Oxford, Oxford University Press. 2019:89. 6-##7. Harriss-White, B.The Political Economy of Disability and Development with Special Reference to India (No. 73). UNRISD,2016:49..##8. Baylies, C."Disability and the notion of human development: questions of rights and capabilities." Disability & Society, 2018:17(7):725-739. ##9. Murray, C. J., and L. C. Chen.Understanding morbidity change." The Population and Development Review , 2019: 18(3):305-.481.##10. Shams Ghahfarkhi, Mehri, Farideh Shams Ghahfarkhi and Mehdi Rezaei. Prevalence assessment.##11. Hosseini, Seyed Hassan and Fatemeh Safari. Disability, poverty and social exclusion. Social Welfare Quarterly 1397. ; (8) 30: pp. 284-265.##12. Ahmadi, Ali Mohammad, Hossein Mohammad Ghaffari and Seyed Javad Emadi. The relationship between macroeconomic variables and health in Iran. Social Welfare Chapter. 1397; (10) 39: 32-7.##13. Ghaed Rahmati, Safar and Mehdi Dehbashi. The relationship between health services and disability status in the provinces of the country. Journal of Social Welfare. 1397:50 (13): pp. 333-351.##14. Sajjadi Homeira and Nasibeh Zanjari. Disability in Iran: Prevalence, its characteristics and economic and social correlations. Journal of Rehabilitation. 1397: 1 (16): pp. 47-36.##15. Kane, P. Women's health: from womb to tomb, New York, NY: St. Martin’s Press. 2019:51. 15-##16. Groce, N., E. Challenger, R. Berman-Bieler, A. Farkas, N. Yilmaz, W. Schultink, D. Clark, C. Kaplan, and M. Kerac."Malnutrition and disability: unexplored opportunities for collaboration." Paediatrics and International Child Health, 2018 ,34(4):308-314.##17. Mont, D. and C. Nguyen.Spatial Variation in the Poverty Gap between People with and without Disabilities: Evidence from Vietnam." Social Indicators Research , 2018: 137(2):367-754.##18. Beheshti, Mohammad Baqer and Mahmoud Saeidan. Introduction of numerical taxonomy in simple language. East Azerbaijan Province: Program and Budget Organization 1398; p.39.##19. Raudenbush, S. W. and A. S. Bryk. Hierarchical Linear Models: Applications and Data Analysis Methods. Sage. 2018:66.##20. Hafizi, Lily, Kazem Ghodsi and Marzieh Ghasemi. Study of consanguineous marriage and the incidence of physical disabilities. Iranian Journal of Obstetrics, Gynecology and Infertility. 1397:3 (15): pp. 15-10. ##21. Mowaffaq, Abolfazl. A study of avoiding marriage with close relatives and the effects of disability on children. Journal of Medical Ethics, 1396:3 (7): pp. 99-109.##22. Abbasi Shavazi, Mohammad Jalal and Fatemeh Torabi. Level, trend and pattern of consanguineous marriage in Iran. Letter of the Iranian Demographic Association, 1398:2 (1) : pp. 61-88.##23. Lucas, David and Paul Meyer. An Introduction to Demographic Studies. Translated by Hossein Mahmoudian, Tehran, University of Tehran Press, 1397:p.106. ##

رویکرد سیستم های تقاضا در ارائه تابع تقاضای بیمه عمر کشور ایران The Approach of Demand Systems in Presenting the Demand Function of Life Insurance in Iran 1 1 مقدمه: بیمه عمر یکی از ابزار های مدیریت ریسک است که تأثیر مثبتی بر کاهش ریسک مالی افراد داشته و پوششی در مقابل ضرر و زیان ها در کوتاه مدت و بلندمدت محسوب می شود. بیمه عمر مانند نوعی سرمایه گذاری بلندمدت عمل می کند و آثار مستقیمی بر رشد اقتصادی کشور ها می گذارد. روش بررسی: هدف این مطالعه، بررسی سیستم  های تقاضا و ارائه تابع تقاضای بیمه عمر در ایران بود که بتوان به ارزیابی تحلیلی عوامل مؤثر بر تقاضای بیمه عمر در دوره زمانی ۱۳۸۴ تا  ۱۳۹۷ با استفاده از نرم افزار Eviews ۱۰ پرداخت. شاخص  های منتخب مورد استفاده در تابع تقاضای بیمه عمر ایران، ضریب نفوذ بیمه عمر، متغیر های درآمد، توسعه مالی، نرخ بهره واقعی، نرخ تورم، نرخ وابستگی، آموزش و امید به زندگی بودند که عوامل مؤثر بر تقاضای بیمه عمر ایران را در دوره زمانی مورد بررسی، نشان دادند. یافته ها یافته  های حاصل از برآورد تابع تقاضای بیمه عمر، نشان می دهد که شاخص  های اقتصادی، نرخ وابستگی و بارتکفل، از مهم ترین عوامل اقبال پایین ایرانیان به بیمه عمر بودند. همچنین متغیر های درآمد سرانه، امید به زندگی، نرخ وابستگی، آموزش و توسعه مالی بر تقاضای بیمه عمر ایران، تأثیر مثبت و نرخ تورم و نرخ بهره تأثیر منفی داشت. همچنین متغیر های درآمد سرانه، نرخ تورم و نرخ وابستگی به ترتیب، بیشترین اثرگذاری را بر تابع تقاضای بیمه عمر ایران داشتند. نتیجه گیری: شاخص  های اقتصادی از اثرگذارترین عوامل تابع تقاضای بیمه عمر در کشور ایران بود. 2 Introduction: Life insurance is one of the risk management tools that has a positive effect on reducing the financial risk of individuals, and is a cover for short-term and long-term losses and acts as a kind of long-term investment. It also has a direct impact on economic growth. Methods: The current study intends to present the demand systems, extract the life insurance demand function of Iran and to make an analytical evaluation of the factors affecting life insurance demand in the period 2004-2018, using Eviews 10 software. The selected indices used in the life insurance demand function of Iran are life insurance penetration coefficient, income variables, financial development, real interest rate, inflation rate, dependency rate, education and life expectancy, which are the factors affecting Iran's life insurance demand. In the period under review, shows. Results: The findings of estimating the life insurance demand function show that, Economic indicators, dependency rates and barter are the most important factors in Iranians' low interest in life insurance. The variables of per capita income, life expectancy, dependency rate, education and financial development have a positive effect on Iran's life insurance demand and a negative effect on inflation and interest rates. The variables of per capita income, inflation rate and dependency rate, respectively, have the greatest impact on the demand for life insurance in Iran. Conclusion: The results show that economic indicators are one of the most influential factors in the demand for life insurance in Iran. 276 287 2020/05/312020/10/12020/10/92020/07/162020/10/13 1399/7/22 2021/01/72021/02/152021/02/52021/01/22021/01/30 1399/11/11 سمیرا متقی Samira Motaghi گروه اقتصاد، دانشگاه پیام نور، تهران، ایران ایران samira.motaghi@gmail.com علیرضا فتحی‌زاده Alireza Fathizadeh گروه مدیریت دولتی، دانشگاه پیام نور، تهران، ایران ایران a_fathii@yahoo.com اکبر بهمنی Akbar Bahmani گروه مدیریت دولتی، دانشگاه پیام نور، تهران، ایران ایران bahmani.akbar@gmail.com فرزانه صادقی Farzane Sadeghi گروه اقتصاد، دانشگاه پیام نور، تهران، ایران ایران f.sa.deghi21@gmail.com Demand Life Insurance Dependency Rate Penetration Rate تقاضا بیمه عمر نرخ وابستگی ضریب نفوذ 1. Beenstock M, Dickinson G, Khajuria S. The determination of life premiums: An international cross-section analysis 1970–1981. Insurance: Mathematics and Economics. 1986;5(4):261-70.##2. Browne MJ, Kim K. An international analysis of life insurance demand. Journal of Risk and Insurance. 1993:616-34.##3. Lewis FD. Dependents and the demand for life insurance. The American Economic Review. 1989;79(3):452-67.##4. Beck T, Webb I. Economic, demographic, and institutional determinants of life insurance consumption across countries. The World Bank Economic Review. 2003;17(1):51-88.##5. Central Insurance of the Islamic Republic of Iran. Office of Statistical Analysis. Insurance Industry Yearbook, 2019. [Persian]##6. Yaari ME. Uncertain lifetime, life insurance, and the theory of the consumer. The Review of Economic Studies. 1965;32(2):137-50.##7. Fortune P. A theory of optimal life insurance: Development and test. The Journal of Finance. 1973;28(3):587-600.##8. Hammond JD, Houston DB, Melander ER. Determinants of household life insurance premium expenditures: An empirical investigation. Journal of Risk and Insurance. 1967:397-408.##9. Burnett JJ, Palmer BA. Examining life insurance ownership through demographic and psychographic characteristics. Journal of risk and insurance. 1984:453-67.##10. Cargill TF, Troxel TE. Modeling life insurance savings: Some methodological issues. Journal of Risk and Insurance. 1979:391-410.##11. Headen RS, Lee JF. Life insurance demand and household portfolio behavior. Journal of Risk and Insurance. 1974:685-98.##12. Skipper HD, Klein RW. Insurance regulation in the public interest: The path towards solvent, competitive markets. The Geneva Papers on Risk and Insurance-Issues and Practice. 2000;25(4):482-504.##13. Ma YL, Pope N. Determinants of International Insurers’ Participation in Foreign Non‐Life Markets. Journal of Risk and Insurance. 2003;70(2):235-48.##14. Bernheim BD. How strong are bequest motives? Evidence based on estimates of the demand for life insurance and annuities. Journal of Political Economy. 1991;99(5):899-927.##15. Momeni H, Daghighi A, Al Ahmadi E. The Effect of inflation on life insurance and its neutralization strategies. Financial Economics Quarterly. 2013;7(23):31-60. [Persian]##16. Mahdavi G. Investigation of quantitative and qualitative factors affecting the demand for life insurance and development strategies and expanding its influence in the country's insurance industry. Tehran: Alam Tabatabai University Publication, 1998. [Persian]##17. Esfandiyari A. Reasons for not developing life insurance in Iran. Tazehaye Jahane Bime. 2006;94:35-47. [Persian]##18. Sheykhi M, Investigating the factors affecting life expectancy using data mining method. Fifth Iran Data Mining Conference. Tehran: Amirkabir University of Technology, 2016. [Persian]##19. Noorizadeh S. The role of insurance industry in economic growth and its place in economic organization. Journal of Bank and Eghtesad. 1999;2:58-71. [Persian]##20. Gujarati D. Fundamentals of Econometrics. Penerbit Erlangga, Jakarta. 2006.##21. Nofaresti M. The Unified and Cohesive Root in Econometrics. Tehran: Rasa Cultural Services Publications, 1999. [Persian]##22. Wang H, Zhang D, Guariglia A, Fan GZ. ‘Growing out of the growing pain’: Financial literacy and life insurance demand in China. Pacific-Basin Finance Journal. 2020:101459.##23. Strzelecka A, Kujawska A, Zawadzka D. Application of multidimensional correspondence analysis to identify socioeconomic factor conditioning voluntary life insurance. Procedia Computer Science. 2020;176:3407-17.##24. Dragos SL, Dragos CM, Muresan GM. From intention to decision in purchasing life insurance and private pensions: different effects of knowledge and behavioural factors. Journal of Behavioral and Experimental Economics. 2020;87:101555.##25. Shahabadi A, Ahmadi M, Moradi A. The mutual impact of financial development and economic freedom on the influence of insurance in selected countries failed to develop the insurance industry. Quarterly Journal of Economic Modeling Research. 2018;31(97):41-70. [Persian]##26. Hedayati Zafarghandi S, Soloukdar A, Sedighi A. Dynamic Analysis Of the Relationship Between Monetary And Banking Variables And Life Insurance Demand in Iran. Journal of Monetary & Banking Research. 2017;10(32):293-318. [Persian]##1. Beenstock M, Dickinson G, Khajuria S. The determination of life premiums: An international cross-section analysis 1970–1981. Insurance: Mathematics and Economics. 1986;5(4):261-70.##2. Browne MJ, Kim K. An international analysis of life insurance demand. Journal of Risk and Insurance. 1993:616-34.##3. Lewis FD. Dependents and the demand for life insurance. The American Economic Review. 1989;79(3):452-67.##4. Beck T, Webb I. Economic, demographic, and institutional determinants of life insurance consumption across countries. The World Bank Economic Review. 2003;17(1):51-88.##5. Central Insurance of the Islamic Republic of Iran. Office of Statistical Analysis. Insurance Industry Yearbook, 2019. [Persian]##6. Yaari ME. Uncertain lifetime, life insurance, and the theory of the consumer. The Review of Economic Studies. 1965;32(2):137-50.##7. Fortune P. A theory of optimal life insurance: Development and test. The Journal of Finance. 1973;28(3):587-600.##8. Hammond JD, Houston DB, Melander ER. Determinants of household life insurance premium expenditures: An empirical investigation. Journal of Risk and Insurance. 1967:397-408.##9. Burnett JJ, Palmer BA. Examining life insurance ownership through demographic and psychographic characteristics. Journal of risk and insurance. 1984:453-67.##10. Cargill TF, Troxel TE. Modeling life insurance savings: Some methodological issues. Journal of Risk and Insurance. 1979:391-410.##11. Headen RS, Lee JF. Life insurance demand and household portfolio behavior. Journal of Risk and Insurance. 1974:685-98.##12. Skipper HD, Klein RW. Insurance regulation in the public interest: The path towards solvent, competitive markets. The Geneva Papers on Risk and Insurance-Issues and Practice. 2000;25(4):482-504.##13. Ma YL, Pope N. Determinants of International Insurers’ Participation in Foreign Non‐Life Markets. Journal of Risk and Insurance. 2003;70(2):235-48.##14. Bernheim BD. How strong are bequest motives? Evidence based on estimates of the demand for life insurance and annuities. Journal of Political Economy. 1991;99(5):899-927.##15. Momeni H, Daghighi A, Al Ahmadi E. The Effect of inflation on life insurance and its neutralization strategies. Financial Economics Quarterly. 2013;7(23):31-60. [Persian]##16. Mahdavi G. Investigation of quantitative and qualitative factors affecting the demand for life insurance and development strategies and expanding its influence in the country's insurance industry. Tehran: Alam Tabatabai University Publication, 1998. [Persian]##17. Esfandiyari A. Reasons for not developing life insurance in Iran. Tazehaye Jahane Bime. 2006;94:35-47. [Persian]##18. Sheykhi M, Investigating the factors affecting life expectancy using data mining method. Fifth Iran Data Mining Conference. Tehran: Amirkabir University of Technology, 2016. [Persian]##19. Noorizadeh S. The role of insurance industry in economic growth and its place in economic organization. Journal of Bank and Eghtesad. 1999;2:58-71. [Persian]##20. Gujarati D. Fundamentals of Econometrics. Penerbit Erlangga, Jakarta. 2006.##21. Nofaresti M. The Unified and Cohesive Root in Econometrics. Tehran: Rasa Cultural Services Publications, 1999. [Persian]##22. Wang H, Zhang D, Guariglia A, Fan GZ. ‘Growing out of the growing pain’: Financial literacy and life insurance demand in China. Pacific-Basin Finance Journal. 2020:101459.##23. Strzelecka A, Kujawska A, Zawadzka D. Application of multidimensional correspondence analysis to identify socioeconomic factor conditioning voluntary life insurance. Procedia Computer Science. 2020;176:3407-17.##24. Dragos SL, Dragos CM, Muresan GM. From intention to decision in purchasing life insurance and private pensions: different effects of knowledge and behavioural factors. Journal of Behavioral and Experimental Economics. 2020;87:101555.##25. Shahabadi A, Ahmadi M, Moradi A. The mutual impact of financial development and economic freedom on the influence of insurance in selected countries failed to develop the insurance industry. Quarterly Journal of Economic Modeling Research. 2018;31(97):41-70. [Persian]##26. Hedayati Zafarghandi S, Soloukdar A, Sedighi A. Dynamic Analysis Of the Relationship Between Monetary And Banking Variables And Life Insurance Demand in Iran. Journal of Monetary & Banking Research. 2017;10(32):293-318. [Persian] ##

شناسایی پیامد های ارائه هم زمان بیمه پایه و مکمل درمان توسط سازمان تأمین اجتماعی Identify the Consequences of Providing Basic and Supplementary Health Insurance Simultaneously by the Social Security Organization 1 1 مقدمه: انسان همیشه در معرض خطر انواع مختلف بیماری هاست و به ناچار برای بهبود و معالجه، متقبل هزینه  های سنگین پزشکی و مخارج بیمارستانی می شود. به منظور کمک به مردم در چنین مواردی، طرح  های گوناگون بیمه درمان به صورت پایه و مکمل ارائه،، اما به دلیل فقدان بیمه گر واحدی در ارائه، مسائلی در حوزه بیمه درمان پدیدار شده است. هدف این پژوهش شناسائی پیامد های ارائه بیمه مکمل در کنار بیمه پایه توسط سازمان تأمین اجتماعی ایران، برای حل  این مسائل است. روش بررسی: این پژوهش ازنظر هدف کاربردی با رویکردی ترکیبی بوده، که دربخش کیفی با تمرکز بر مصاحبه نیمه ساختار یافته و در بخش کمی براساس روش اکتشافی و استنباطی اجرا شد. جامعه آماری آن شامل مدیران و کارشناسان خبره در زمینه بیمه -درمانی شاغل در سازمان  تأمین اجتماعی کشور در سال 1399 هستند، که نمونه گیری به صورت هدفمند انجام و در بخش کیفی تا رسیدن مقوله ها به اشباع (15 نمونه) ادامه یافت. یافته ها: براساس داده  های احصاء شده، مفاهیم استخراج (95 مفهوم) و در27 مقوله فرعی دسته بندی شدند. که مقوله  های فرعی نیز در 5مقوله اصلی طبقه بندی و بدین ترتیب پیامد های ارائه بیمه مکمل توسط سازمان تأمین اجتماعی مشخص شدند. در بخش کمی نیز باتوجه به اینکه مقدار بارعاملی آن بالای0.5 و مقدار CRشاخص ها کمتر از 0.7 است، لذا داده ها با ساختار عاملی زیربنای نظری پژوهش، برازش مناسبی داشته و همسو با آنها بودند. نتیجه گیری: مطابقه یافته ها، اجرای این طرح منجر به امکان برخورداری بیمه شدگان انفرادی خاص و فاقد کارفرما از بیمه مکمل درمان، کاهش هزینه  های درمان بیمه شدگان و سازمان، امکان تخفیف در حق بیمه تکمیلی و تجمیع بیمه  های درمانی خواهد شد. 2 Introduction: Humans are always at risk of various diseases and inevitably incur high medical costs and hospital costs for recovery and treatment. In order to help people in such cases, various health insurance plans are provided as a basis and complementary, but due to the lack of a single insurer in the presentation, problems have arisen in the field of health insurance. The purpose of this study is to identify the consequences of providing supplementary insurance along with basic insurance by the Social Security Organization of Iran to solve these problems. Methods: This research was applied in terms of purpose with a combined approach, which was conducted in the qualitative part with a focus on semi-structured interviews in the quantitative part based on exploratory and inferential methods. Its statistical population includes managers and experts in the field of insurance-treatment working in the country's social security organization in 1399, which sampling is done purposefully and in the qualitative section until the categories are saturated (15 samples). Results: Based on the calculated data, extraction concepts (95 concepts) were classified into 27 sub-categories. The sub-categories were also classified into 5 main categories and thus the consequences of providing supplementary insurance by the Social Security Organization were identified. In the quantitative part, due to the fact that the value of the factor load is above 0.5 and the value of CR indicators is less than 0.7, so the data had a good fit with the factor structure of the theoretical basis of the research and were consistent with them. Conclusion: According to the findings, the implementation of this plan leads to the possibility of special individual insured and no employer with supplementary health insurance, reducing the treatment costs of the insured and the organization, the possibility of discounts on supplementary premiums and consolidation of health insurance will be. 288 297 2020/05/312020/10/12020/10/92020/07/162020/10/132020/08/4 1399/5/14 2021/01/72021/02/152021/02/52021/01/22021/01/302020/12/26 1399/10/6 علی‌جواد کریمی Alijavad Karimi گروه مدیریت، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران ایران aj13601354@gmail.com اسفندیار محمدی Esfandiar Mohammadi گروه مدیریت بازرگانی، دانشگاه ایلام، ایلام، ایران ایران e.mohamadi@ilam.ac.ir محمود محمدی Mahmoud Mohammadi گروه مدیریت، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران ایران mah.mohammadi@iauctb.ac.ir Insurance Basic Health Insurance Complementary Health Insurance Social Security Organization بیمه بیمه درمانی پایه بیمه درمانی مکمل سازمان تأمین اجتماعی 1. Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PloS One. 2019;14(8):e0219731.##2. Piri M, Jalali R, Amini A A. Factors contributing to development of justice the centrality health insurance organization. Iran J Health Insur. 2019;2(4):228-37. [Persian]##3. World Health Organization. Research for universal health coverage: World health report, 2013.##4. Stimpson JP, Kemmick Pintor J, McKenna RM, Park S, Wilson FA. Association of medicaid expansion with health insurance coverage among persons with a disability. JAMA Netw Open. 2019;2(7):e197136.##5. Dey P, Bach PB. The 6 functions of health insurance. JAMA. 2019;321(13):1242-3.##6. Levy H, Meltzer D. The impact of health insurance on health. Annu Rev Public Health. 2008;29:399-409.##7. Yahyavi Dizaj J, Saeidpour J, Na'emani F, Irandoust K. Inequality in payments for health insurance in Iran: during the study period 2011-2017. Iran J Health Insur. 2019;2(2):81-87. [Persian[##8. Almasi R. Study of expanding the insurance model in different dimensions in Iran. [Master Thesis]. Isfahan: Department of management, Isfahan University, 2017. [Persian]##9. Vafaee Najjar A, Karimi A, Sadeghiani A. Information system process of supplementary health insurance services packages in selected countries and model presentation for Iran. Health Information Management. 2006;3(1). [Persian[##10. Badiee Aval S, Adel A, Ebrahimipour H, Javan Biparva A, Askarzadeh E. 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. Iran J Health Insur. 2019;1(4):159-164. [Persian[##11. Shahraki M. Estimation of supplementary health insurance demand in Iranian urban household: Probit model with sample selection. Iran J Health Insur. 2019;2(1):7-13. [Persian[##12. Sender J. Africa's economic performance: Limitations of the current consensus. J Econ Perspectiv. 1999;13(3):89-114.##13. Hosseinpour R. The position of supplementary insurance in the Iranian health market. Medical Weekly and Sepid Society. 2010;223:223. [Persian[##14. Sehat S, Vahid N. New World Monthly Insurance. Report: No. 140 and 141, 2009. [Persian[##15. Ayoubian A. Necessity to improve the status of complementary group and individual treatment insurance in the health system. Iran J Health Insur. 2018;1(1 and 2):48-49. [Persian]##16. Zare H, Yazdani N, Azad M, Ahmadpour M, Kashif Ghorbanpour R, Akbarian A, et al. Presenting a model for private health insurance in Iran. Quarterly Journal of Medical Research and Cultivation. 2008;20(1 and 2):58-67. [Persian]##17. Bazargan A. Introduction to qualitative and mixed research methods. Tehran: Didar Publications, 2007. [Persian]##18. Hennink M, Hutter I, Bailey A. Qualitative research methods. Sage; 2020 Jan 9.##19. Bhattacharya K. Fundamentals of qualitative research: A practical guide. Taylor & Francis; 2017 Mar 16.##20. Gol-Alizadeh E, Pirouzian A, Jabbari M R. Improving supplemental health insurance in Iran and how to achieve it. Iran J Health Insur. 2018;1(1 and 2):2-12. [Persian]##21. Bottani E. A fuzzy QFD approach to achieve agility. International Journal of Production Economics. 2009;119(2):380-91.##22. Jahangiri A, Jahangiri M. Evaluation of the performance of the provincial units of the Social Security Organization in the indirect treatment sector in 9311 using TOPSIS method. Health Management Quarterly. 2019;9(4):7-18. [Persian]##1. Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PloS One. 2019;14(8):e0219731.##2. Piri M, Jalali R, Amini A A. Factors contributing to development of justice the centrality health insurance organization. Iran J Health Insur. 2019;2(4):228-37. [Persian]##3. World Health Organization. Research for universal health coverage: World health report, 2013.##4. Stimpson JP, Kemmick Pintor J, McKenna RM, Park S, Wilson FA. Association of medicaid expansion with health insurance coverage among persons with a disability. JAMA Netw Open. 2019;2(7):e197136.##5. Dey P, Bach PB. The 6 functions of health insurance. JAMA. 2019;321(13):1242-3.##6. Levy H, Meltzer D. The impact of health insurance on health. Annu Rev Public Health. 2008;29:399-409.##7. Yahyavi Dizaj J, Saeidpour J, Na'emani F, Irandoust K. Inequality in payments for health insurance in Iran: during the study period 2011-2017. Iran J Health Insur. 2019;2(2):81-87. [Persian[##8. Almasi R. Study of expanding the insurance model in different dimensions in Iran. [Master Thesis]. Isfahan: Department of management, Isfahan University, 2017. [Persian]##9. Vafaee Najjar A, Karimi A, Sadeghiani A. Information system process of supplementary health insurance services packages in selected countries and model presentation for Iran. Health Information Management. 2006;3(1). [Persian[##10. Badiee Aval S, Adel A, Ebrahimipour H, Javan Biparva A, Askarzadeh E. 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. Iran J Health Insur. 2019;1(4):159-164. [Persian[##11. Shahraki M. Estimation of supplementary health insurance demand in Iranian urban household: Probit model with sample selection. Iran J Health Insur. 2019;2(1):7-13. [Persian[##12. Sender J. Africa's economic performance: Limitations of the current consensus. J Econ Perspectiv. 1999;13(3):89-114.##13. Hosseinpour R. The position of supplementary insurance in the Iranian health market. Medical Weekly and Sepid Society. 2010;223:223. [Persian[##14. Sehat S, Vahid N. New World Monthly Insurance. Report: No. 140 and 141, 2009. [Persian[##15. Ayoubian A. Necessity to improve the status of complementary group and individual treatment insurance in the health system. Iran J Health Insur. 2018;1(1 and 2):48-49. [Persian]##16. Zare H, Yazdani N, Azad M, Ahmadpour M, Kashif Ghorbanpour R, Akbarian A, et al. Presenting a model for private health insurance in Iran. Quarterly Journal of Medical Research and Cultivation. 2008;20(1 and 2):58-67. [Persian]##17. Bazargan A. Introduction to qualitative and mixed research methods. Tehran: Didar Publications, 2007. [Persian]##18. Hennink M, Hutter I, Bailey A. Qualitative research methods. Sage; 2020 Jan 9.##19. Bhattacharya K. Fundamentals of qualitative research: A practical guide. Taylor & Francis; 2017 Mar 16.##20. Gol-Alizadeh E, Pirouzian A, Jabbari M R. Improving supplemental health insurance in Iran and how to achieve it. Iran J Health Insur. 2018;1(1 and 2):2-12. [Persian]##21. Bottani E. A fuzzy QFD approach to achieve agility. International Journal of Production Economics. 2009;119(2):380-91.##22. Jahangiri A, Jahangiri M. Evaluation of the performance of the provincial units of the Social Security Organization in the indirect treatment sector in 9311 using TOPSIS method. Health Management Quarterly. 2019;9(4):7-18. [Persian] ##

انتخاب نامساعد و مخاطرات اخلاقی در بیمه های تکمیلی درمان Adverse Selection and Moral Hazards in Supplementary Health Insurance 1 1 مقدمه: هدف این مطالعه بررسی وجود ۲پدیده‌ انتخاب نامساعد و مخاطرات اخلاقی در بازار بیمه  های تکمیلی درمان ایران است. روش بررسی: ابتدا یک مدل تقاضا برای مصرف خدمات درمان تکمیلی، تحت کمترین فروض درباره چگونگی سیاست بازپرداخت شرکت های بیمه، توزیع وضعیت پنهان سلامت مراجعان بیمارستان ها و همچنین نوع بیمه تکمیلی آنها باوجود ۲پدیده‌ انتخاب نامساعد و مخاطرات اخلاقی تصریح شد. مدل اصـلی از روش GMM، بـرآورد و بـا اسـتفاده از روش  های آمـار ناپارامتری، وجود این ۲پدیده آزمون شد. داده  های مورد استفاده در این مطالعه از از طریق پرسش نامه و به صورت تصادفی از مراجعان ۱۱ بیمارستان در ۲گروه بیمه شدگان درمان تکمیلی و بیمه نشده در سطح شهر تهران جمع آوری شد. یافته ها: نتایج نشان داد ریسک‌گریزی برای مصرف خدمات درمانی بیش از مصرف کالا های مرکب بوده و این مقدار برای افراد بیمه‌شده بیش از افراد بیمه‌نشده است که نشانگر وضعیت پایین سلامت افراد بیمه‌شده در مقایسه به سایر افراد است. آزمون کولموگرف - اسمیرنوف نیز متفاوت بودن توزیع سلامت ۲ گروه را تأیید کرد. علاوه‌براین، مطابق با نتایج، مخاطرات اخلاقی در بازار بیمه به مقدار اندک وجود دارد. مخاطرات اخلاقی برای افراد با درآمد بالا‌تر، اندک است و هرچه بیمه از افراد با سطح درآمد بالا تقاضا داشته باشد، کاهش مخاطرات اخلاقی را به دنبال داشته و هرچه فرد در گروه پایین سلامت قرار داشته باشد، باعث افزایش مخاطرات اخلاقی خواهد شد. نتیجه گیری: نتایج، وجود انتخاب نامساعد و مخاطرات اخلاقی را در بیمه درمان تکمیلی در ایران تأیید می‌کند. 2 Introduction: The purpose of this study was to investigate the existence of two phenomena of adverse selection and moral hazards in the Iranian supplementary health insurance market. Methods: First, a demand model for the use of complementary health care services was defined under the least assumptions about how the insurance companies repay the policy, the distribution of the hidden health status of hospital clients and also the type of their supplementary insurance despite the two phenomena of unfavorable choise and moral hazards. The main model was estimated from GMM method and the existence of these two phenomena was tested using non-parametric statistical methods. The data used in this study were collected through a questionnaire and randomly from clients of 11 hospitals in the two groups of supplementary and uninsured treatment in Tehran. Results: The results showed that risk aversion for the consumption of health services is more than the consumption of composite goods and this amount is more for the insured than the uninsured, which indicates the low health status of the insured compared to other people. The Kolmogorov-Smirnov test also confirmed the different health distributions of the two groups. In addition, according to the results, there are small moral hazards in the insurance market. Moral hazards are lower for people with higher incomes, and the more insurance is demanded from people with higher incomes, the lower the moral hazards will be, and the lower the health of a person, the greater the moral hazards. Conclusion: The results confirm the existence of adverse selection and moral hazards in complementary health insurance in Iran. 298 307 2020/05/312020/10/12020/10/92020/07/162020/10/132020/08/42020/11/19 1399/8/29 2021/01/72021/02/152021/02/52021/01/22021/01/302020/12/262021/02/15 1399/11/27 قدرت الله امام‌وردی Ghodratollah Emamverdi گروه اقتصاد، واحد تهران مرکز، دانشگاه آزاد اسلامی، تهران، ایران ایران ghemamverdi2@gmail.com پرستو احمدی Parastoo Ahmadi گروه اقتصاد، واحد تهران مرکز، دانشگاه آزاد اسلامی، تهران، ایران ایران p.ahmadi2002@gmail.com Asymmetric Information adverse selection Moral Hazards Complementary Health Insurance اطلاعات نامتقارن انتخاب نامساعد مخاطرات اخلاقی بیمه درمان تکمیلی 1. Bajari P, Hong H, Khwaja A. A semiparametric analysis of adverse selection and moral hazard in health insurance contracts. Citeseer, 2011.##2. Bajari P, Dalton C, Hong H, Khwaja A. Moral hazard, adverse selection, and health expenditures: A semiparametric analysis. The RAND Journal of Economics. 2014;45(4):747-63.##3. Keshavarz Hadad GR, Zomorrodi Anbaji M. Analysis of Adverse Selection and Moral Hazard in Health Insurance of Iran Case Study of Medicine and Paraclinical Services. Tahghighat-e-Eghtesadi. 2009;44(87):139-63. [Persian]##4. Cutler DM, Zeckhauser RJ. The anatomy of health insurance. InHandbook of health economics 2000 Jan 1 (Vol. 1, pp. 563-643). Elsevier.##5. Shang B. The cost and health effects of prescription drug coverage and utilization in the Medicare population: The Pardee RAND Graduate School; 2005.##6. Rothschild M, Stiglitz J. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. In Uncertainty in economics 1978 Jan 1 (pp. 257-280). Academic Press.##7. Wilson C. The nature of equilibrium in markets with adverse selection. The Bell Journal of Economics. 1980;11(1):108-30.##8. Cave J. Subsidy equilibrium and multiple-option insurance markets. Adv Health Econ Health Serv Res. 1985;6:27-45.##9. Feldman R, Dowd B. Must adverse selection cause premium spirals? J Health Econ. 1991;10(3):349-57.##10. Cutler DM, Reber SJ. Paying for health insurance: the trade-off between competition and adverse selection. The Quarterly Journal of Economics. 1998;113(2):433-66.##11. Browne MJ. Evidence of adverse selection in the individual health insurance market. Journal of Risk and Insurance. 1992:13-33.##12. Browne MJ, Doerpinghaus H. Asymmetric information and the demand for Medigap insurance. Inquiry. 1994;31(4):445-50.##13. Gilleskie DB. A dynamic stochastic model of medical care use and work absence. Econometrica. 1998;66(1):1-45.##14. Cardon JH, Hendel I. Asymmetric information in health insurance: evidence from the National Medical Expenditure Survey. RAND Journal of Economics. 2001;32(3):408-27.##15. Arrow KJ. Uncertainty and the welfare economics of medical care: reply (the implications of transaction costs and adjustment lags). The American Economic Review. 1965;55(1/2):154-8.##16. Pauly MV. The economics of moral hazard: comment. The american economic review. 1968;58(3):531-7.##17. Zeckhauser R. Medical insurance: A case study of the tradeoff between risk spreading and appropriate incentives. Journal of Economic Theory. 1970;2(1):10-26.##18. Zweifel P, Breyer F. The indiviudal as the producer of his health. Health economics New York: Oxford University Press. 1997:52-89.##19. Roddy PC, Wallen J, Meyers SM. Cost sharing and use of health services: the United Mine Workers of America Health Plan. Medical Care. 1986;24(9):873-6.##20. Keeler EB, Rolph JE. The demand for episodes of treatment in the health insurance experiment. J Health Econ. 1988;7(4):337-67.##21. Cherkin DC, Grothaus L, Wagner EH. The effect of office visit copayments on preventive care services in an HMO. Inquiry. 1990;27(1):24-38.##22. Pauly MV, McGuire TG, Barros PP, editors. Handbook of health economics. Elsevier; 2012 Jan 5.##1. Bajari P, Hong H, Khwaja A. A semiparametric analysis of adverse selection and moral hazard in health insurance contracts. Citeseer, 2011.##2. Bajari P, Dalton C, Hong H, Khwaja A. Moral hazard, adverse selection, and health expenditures: A semiparametric analysis. The RAND Journal of Economics. 2014;45(4):747-63.##3. Keshavarz Hadad GR, Zomorrodi Anbaji M. Analysis of Adverse Selection and Moral Hazard in Health Insurance of Iran Case Study of Medicine and Paraclinical Services. Tahghighat-e-Eghtesadi. 2009;44(87):139-63. [Persian]##4. Cutler DM, Zeckhauser RJ. The anatomy of health insurance. InHandbook of health economics 2000 Jan 1 (Vol. 1, pp. 563-643). Elsevier.##5. Shang B. The cost and health effects of prescription drug coverage and utilization in the Medicare population: The Pardee RAND Graduate School; 2005.##6. Rothschild M, Stiglitz J. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. In Uncertainty in economics 1978 Jan 1 (pp. 257-280). Academic Press.##7. Wilson C. The nature of equilibrium in markets with adverse selection. The Bell Journal of Economics. 1980;11(1):108-30.##8. Cave J. Subsidy equilibrium and multiple-option insurance markets. Adv Health Econ Health Serv Res. 1985;6:27-45.##9. Feldman R, Dowd B. Must adverse selection cause premium spirals? J Health Econ. 1991;10(3):349-57.##10. Cutler DM, Reber SJ. Paying for health insurance: the trade-off between competition and adverse selection. The Quarterly Journal of Economics. 1998;113(2):433-66.##11. Browne MJ. Evidence of adverse selection in the individual health insurance market. Journal of Risk and Insurance. 1992:13-33.##12. Browne MJ, Doerpinghaus H. Asymmetric information and the demand for Medigap insurance. Inquiry. 1994;31(4):445-50.##13. Gilleskie DB. A dynamic stochastic model of medical care use and work absence. Econometrica. 1998;66(1):1-45.##14. Cardon JH, Hendel I. 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تأثیر بیماری کووید-19 بر بار مراجعات بیمه شدگان سازمان بیمه سلامت در استان بوشهر The Effect of COVID-19 Disease on the Number of Referrals of the Insured of the Iran Health Insurance Organization in Bushehr Province 1 1 سازمان بهداشت جهانی در تاریخ سی ام دسامبر 2019 گزارش اپیدمی یک بیماری مشابه پنومونی را در ووهان چین دریافت نمود (1) ، در ایران ، اولین موارد COVID-19 در فوریه 2020 (آخر بهمن 1399) گزارش شد (2) و سازمان بهداشت جهانی شیوع ویروس کرونا را در 11 مارس 2020 پاندمی اعلام کرد (3). شیوع ناگهانی و جهانی بیماری کووید 19 بسیاری از مردم را نگران کرده و زندگی افراد آلوده ، خانواده ها ، دوستان و جامعه را به دلیل اثرات احتمالی آن تهدید کرده است (4).  برای مدیریت موج همه گیری COVID-19 ، سیستم بهداشتی باید ظرفیت مراقبت حاد را افزایش دهد (5). بر اساس یک نظرسنجی WHO ، خدمات پیشگیری و درمان بیماری های غیرواگیر از زمان آغاز همه گیری کووید 19 به شدت مختل شده است (6) و پزشکان را مجبور به اولویت بندی فعالیت های بالینی خود کرده است (5). بیماری همه گیر COVID-19 منجر به اولویت بندی منابع سرویس بهداشت ملی (NHS) برای مقابله با موج افزایش بیماران آلوده شد (7). 2 On December 30, 2019, the World Health Organization received an epidemic report of a pneumonia-like disease in Wuhan, China (1), in Iran, the first cases of COVID-19 were reported in February 2020 (end of February 2016) (2) and the World Health Organization The outbreak of the Corona virus on March 11, 2020 declared a pandemic (3). The sudden and global outbreak of Covid disease has alarmed many people and threatened the lives of infected people, families, friends and the community because of its potential effects (4). To manage the COVID-19 epidemic, the health system must increase its acute care capacity (5). According to a WHO survey, services for the prevention and treatment of non-communicable diseases have been severely disrupted since the onset of the Covid 19 epidemic (6), forcing physicians to prioritize their clinical activities (5). The COVID-19 epidemic has led to the prioritization of National Health Service (NHS) resources to deal with the rising tide of infected patients (7). 308 310 2020/05/312020/10/12020/10/92020/07/162020/10/132020/08/42020/11/192021/01/14 1399/10/25 2021/01/72021/02/152021/02/52021/01/22021/01/302020/12/262021/02/152021/02/13 1399/11/25 پرویز رمضانی Parviz Ramezani مدیرکل بیمه سلامت استان بوشهر، بوشهر، ایران ایران dr.ramezani54@gmail.com Covid-19 Referral Times Iran Health Insurance Organization کووید-19 بار مراجعات سازمان بیمه سلامت ایران 1. Malmir R, Maher A, Toghiani R, Safari MS. COVID-19 crisis management: reengineering the health care system in Iran. Journal of medical Council of Iran. 2020;38(1):11-18. [Persian]##2. Haji-Maghsoudi S, Sadeghifar M, Roshanaei G, Mahjub H. The impact of control measures and holiday seasons on incidence and mortality rate of COVID-19 in Iran. J Res Health Sci. 2020;20(4):e00500##3. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19. Access in March 11, 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-atthe-media-briefing-on-covid-19---11-march-2020##4. Zakeri MA, Dehghan M. The impact of the COVID‐19 disease on the referral and admission of the non‐COVID‐19 patients. Int J Health Plann Manage. 2020:1-3.##5. Bobrovitz N, Lee J, Mahtani KR. Preventing non-COVID-19 hospital admissions during a pandemic: a rapid overview of the evidence for high-value medications. Oxford COVID-19 Evidence Service. 2020.##6. World Health Organization. COVID-19 significantly impacts health services for no communicable diseases. Access in June 1, 2020. Available from: https://www.who.int/news/item/01-06-2020-covid-19-significantly-impacts-health-services-for-noncommunicable-diseases##7. Fersia O, Bryant S, Nicholson R, McMeeken K, Brown C, Donaldson B, et al. The impact of the COVID-19 pandemic on cardiology services. Open Heart. 2020;7(2):e001359.##8. Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, et al. Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. Morbidity and Mortality Weekly Report. 2020;69(23):699.##9. Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. 2020;41(19):1852-3.##1. Malmir R, Maher A, Toghiani R, Safari MS. COVID-19 crisis management: reengineering the health care system in Iran. Journal of medical Council of Iran. 2020;38(1):11-18. [Persian]##2. Haji-Maghsoudi S, Sadeghifar M, Roshanaei G, Mahjub H. The impact of control measures and holiday seasons on incidence and mortality rate of COVID-19 in Iran. J Res Health Sci. 2020;20(4):e00500##3. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19. Access in March 11, 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-atthe-media-briefing-on-covid-19---11-march-2020##4. Zakeri MA, Dehghan M. The impact of the COVID‐19 disease on the referral and admission of the non‐COVID‐19 patients. Int J Health Plann Manage. 2020:1-3.##5. Bobrovitz N, Lee J, Mahtani KR. Preventing non-COVID-19 hospital admissions during a pandemic: a rapid overview of the evidence for high-value medications. Oxford COVID-19 Evidence Service. 2020.##6. World Health Organization. COVID-19 significantly impacts health services for no communicable diseases. Access in June 1, 2020. Available from: https://www.who.int/news/item/01-06-2020-covid-19-significantly-impacts-health-services-for-noncommunicable-diseases##7. Fersia O, Bryant S, Nicholson R, McMeeken K, Brown C, Donaldson B, et al. The impact of the COVID-19 pandemic on cardiology services. Open Heart. 2020;7(2):e001359.##8. Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, et al. Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. Morbidity and Mortality Weekly Report. 2020;69(23):699.##9. Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. 2020;41(19):1852-3. ##