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شناسایی اولویت‌های پوشش خدمات پیشگیرانه توسط سازمان‌های بیمه‌ای در نظام‌های سلامت جهان Identifying the Priorities of Coverage of Preventive Services by Insurance Organizations in the World Health Systems 1 1 مقدمه: درصورت توسعه خدمات پیشگیرانه در سطوح مختلف، هزینه‌های روزافزون حوزه سلامت در کشورهای جهان به نحو چشمگیری کاهش خواهد یافت. ذی نفعان مختلفی در گسترش بهره‌مندی از منافع خدمات پیشگیرانه تأثیرگذارند که از جمله آنها به سازمان‌های بیمه به‌عنوان خریداران خدمت می‌توان اشاره کرد. تجربه کشورهای جهان در به‌کارگیری خدمات پیشگیرانه و آگاهی‌رسانی منافع حاصل از آن می تواند نقشی انگیزاننده در بین ذی نفعان اجرای چنین سیاستی در ایران داشته باشد. هدف این مطالعه شناسایی مهم‌ترین مداخلات تحت پوشش سازمان‌های بیمه‌گر فعال در نظام‌های سلامت کشورهای جهان است. روش بررسی: این مطالعه یک مرور نظام مند از مطالعات مرتبط با طیف متنوعی از خدمات پیشگیرانه در نظام سلامت و سازمان‌های بیمه و ارائه اطلاعات مبتنی بر شواهد از منافع مادی و غیرمادی توسعه این دسته از خدمات است که با تعریف کلیدواژه‌های جستجو در پایگاه اصلی مقالات بین ۳۰ دسامبر ۲۰۰۴ تا ژانویه ۲۰۱۹ در سال ۱۳۹۷ انجام شد. پس از مرور مطالعات توصیه‌های سازمان جهانی بهداشت برای خدمات پیشگیرانه در حوزه بیماری‌های غیرواگیر، به‌عنوان کشنده‌ترین دسته بیماری‌ها در جهان و ایران، برای خوانندگان مشخص شد. یافته‌ها: دسته‌های مختلف خدمات پیشگیرانه در حوزه بیماری‌های مختلف در سطح جهان در حال ارائه هستند که منافع مادی و غیرمادی چشمگیری را برای جوامع به ارمغان آورده‌اند. کاهش هزینه‌ها، کاهش ناعدالتی در سلامت، افزایش کیفیت زندگی و بازده شغلی کارکنان از مهم‌ترین منافع توسعه چنین خدماتی هستند. گروه‌های مختلف جوامع مانند مشاغل خاص یا گروه‌های سنی و جنسی مشخص در عین‌ حال که خدمات پیشگیرانه مشخص به خود را دارند، سازمان‌های بیمه‌گر مرتبط به خود را به وجود آورده‌اند که در حال ارائه خدمات پیشگیرانه مرتبط با وضعیت اجتماعی و محیطی خود هستند. سازمان‌های بیمه نقش به‌سزایی در بهره‌مندی و پوشش مؤثر خدمات پیشگیرانه در جوامع ایفا می‌کنند به‌طوری‌که احتمال اینکه فردی دارای بیمه از خدمات پیشگیرانه استفاده کند به‌مراتب از افراد فاقد بیمه یا دارای بیمه‌های درمان محور بیشتر است. نتیجه‌گیری: منافع خدمات پیشگیرانه در نظام‌های سلامت جهان اثبات شده‌اند به‌گونه‌ای که برخی از کشورها قانون الزام ارائه چنین خدماتی را برای سازمان‌های بیمه تصویب کرده‌اند. از سوی دیگر مواجهه سازمان‌های بیمه‌گر با هزینه‌های روبه افزایش، خدمات سطح۳ آنها را با چالش جدی مواجه ساخته و توجه سیاست‌گذاران آنها را به کنترل هزینه‌ها هدایت کرده است. با افزایش آگاهی جامعه، نظام سلامت ایران هم‌اینک بیش از هر زمان دیگری به تغییر استراتژی از خدمات درمان‌محور به خدمات پیشگیرانه و ارتقادهنده سلامت نیاز دارد. 2 Introduction: The increasing costs of health care systems will be reduced significantly if preventive services are developed at levels of prevention. The experience of countries in the world in using preventive services and raising awareness of the related benefits can play a motivating role among the stakeholders in implementing such a policy in Iran. This study aimed to identify the most critical interventions covered by insurance organizations active in the world's health systems. Methods: This study is a systematic review of studies related to a diverse range of preventive services in the health system and insurance organizations and provides evidence-based information on the benefits of developing this category of services and interventions. The study was done by defining the search keywords in the main database between December 30, 2004, to January 2019, carried out in 2020. Results: Different categories of disease prevention services are being offered around the world that has brought significant benefits to communities. Among the most important benefits of developing such services are reducing costs, reducing health inequalities, increasing quality of life, and higher job productivity. In addition, different groups in the community, such as specific occupations or specific age and gender groups, while having specific preventive services, have developed their insurance policies that provide related preventive services. Therefore, insurance organizations play an essential role in the benefit and effective coverage of preventive services in communities, which has made the possibility of a person with insurance to use preventive services far more than people without insurance or with treatment-oriented insurance. Conclusion: The benefits of preventive services in the world health systems have been proven, and some countries have adopted a law requiring the provision of such services to insurance organizations. On the other hand, insurance companies are facing increasing health costs, which has led the attention of policy makers of insurance companies to control costs. With the relevant evidence documented, it is time to move to preventive services. 84 105 2021/04/24 1400/2/4 2021/09/14 1400/6/23 احد بختیاری Ahad Bakhtiari مرکز ملی تحقیقات بیمه سلامت، تهران، ایران ah.bakhtyari@gmail.com نادر جهان‌مهر Nader Jahanmehr گروه مدیریت، سیاست‌گذاری و اقتصاد سلامت، دانشکده مجازی، آموزش پزشکی و مدیریت، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران n.jahanmehr@gmail.com ریحان ایزدی Reyhan Izadi گروه مدیریت، سیاست‌گذاری و اقتصاد سلامت، دانشکده مجازی، آموزش پزشکی و مدیریت، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران reyhoonizadi73@gmail.com> Preventive Services Insurance Organizations Health System Service Coverage خدمات پیشگیرانه سازمان‌های بیمه نظام سلامت پوشش خدمات ## ##

روند و عوامل مؤثر بر درآمد بستری و سرپایی بیمارستان‌ها حین پاندمی کووید-19: مطالعه موردی یک مرکز درمان بیماران کووید-19 در تهران Trend and Factors Affecting Inpatient and Outpatient Revenue of Hospitals during COVID-19 Pandemic: A Case Study of a COVID-19 Treatment Center in Tehran, Iran 1 1 مقدمه: شناسایی عوامل مؤثر بر جنبه‌های مالی بیمارستان، گام مهمی برای کنترل استراتژیک آن محسوب می‌شود. هدف این مطالعه بررسی روند و عوامل مؤثر بر درآمد بستری و سرپایی در یک مرکز درمان بیماران کووید-۱۹ است. روش بررسی: مطالعه حاضر یک پژوهش توصیفی- تحلیلی و از نوع تجزیه و تحلیل سری زمانی بود. با مراجعه مستقیم به بخش‌های اداری بیمارستان، درآمد بیمارستان (به تفکیک بستری و سرپایی) و فاکتورهای اثرگذار بر آن برای سال‌های ۱۳۹۴ تا ۱۳۹۹ به صورت ماهیانه گردآوری شد. برای سنجش مانایی متغیرهای مورد مطالعه از آزمون آماری Dickey-fuller استفاده شد. برای بررسی اثر متغیرهای مستقل بر درآمد بیمارستان از مدل خودرگرسیونی با وقفه‌های توزیعی(ARDL) استفاده شد. تمام آنالیزها در نرم‌افزار EViews ۱۰ انجام شد. یافته‌ها: طی دوره مورد بررسی به طور متوسط ۷۳.۶۵درصد از درآمدهای بیمارستان مربوط به درآمد بستری و مابقی مربوط به درآمدهای سرپایی بود. درآمد کل بیمارستان به قیمت جاری از فروردین ۱۳۹۴ تا شهریورماه ۱۳۹۹ رشد معناداری داشته است (P<۰.۰۰۰۱) درحالی که درآمد کل بیمارستان به قیمت جاری (با ثابت نگهداشتن اثر تورم) کاهش معناداری داشته است (P<۰.۰۰۰۱). هنگام شروع پذیرش بیماران کرونایی (اسفندماه ۹۸) درآمد بیمارستان کاهش معناداری داشته و بعد از گذشت ۳ماه در خرداد ماه ۱۳۹۹ به روند رشد بلندمدت خود بازگشته است. نتایج مطالعه نشان داد درآمد بستری و سرپایی به صورت معنادار تحت تأثیر متغیرهای کمیت ارائه خدمت، کیفیت ارائه خدمت و شاخص‌های عملکردی بیمارستان قرار گرفته است (P<۰.۰۵).  نتیجه گیری: شروع پاندمی کووید-۱۹ با شوک کاهشی در درآمد بیمارستان همراه بوده است. افزایش ظرفیت تخت‌های مراقبت ویژه، افزایش تعرفه‌های خدمات هتلینگ، تغییرسیاست‌های بیمه‌ای و حمایت سازمان‌های بالادستی می‌تواند استراتژی مناسبی برای کنترل پیامد‌های اقتصادی پاندمی کرونا در بیمارستان‌ها باشد. 2 Introduction: Identifying factors affecting the financial aspects of hospital is an important step for its strategic control. Therefore, this study aimed to assessment the trend and determinants of inpatient and outpatient revenue in a COVID-19 patient s’ treatment center. Methods: The present study was a descriptive-analytical research by applying time series analysis. Raw data on the hospital income (by inpatient and outpatient) and the potential factors were gathered monthly by referring to the administrative departments of the hospital, during 2015-2020. Dickey-fuller unit root test was used to measure stationary trend of the variables. The auto-regression distributed lagged model (ARDL) was used to study the effect of independent variables on hospital income. All analyzes were performed in Eviews software. Results: During the study period, on average 73.65% of hospital revenues were related to inpatient income and the rest were outpatient income. The total revenue trend of the hospital at the current price has increased significantly from April 2015 to august 2020 (P<0.0001), while this at the fixed price has decreased significantly (P<0.0001). At the beginning of the admission of a Covid-19 patient (February 2020), the hospital income has decreased significantly and after three months in May 2020, it has returned to its long-term trend. The results showed that inpatient and outpatient income was significantly affected by the variables of quantity of service, quality of care and hospital performance indicators (P<0.05). Conclusion: Hospital revenue was significantly declined at the commence of Covid-19 pandemic. Increasing the capacity of intensive care beds, raising hotel service tariffs, changing insurance policies and supporting upstream organizations can be effective strategies to control the economic consequences of the Covid-19 epidemic on hospitals. 106 117 2021/04/242021/06/8 1400/3/18 2021/09/142021/09/5 1400/6/14 رستم زالوند Rostam Zalvand گروه مدیریت و اقتصاد سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، ایران zalvandr@alumnus.tums.ac.ir عبدالرضا دلاوری Abdowreza Delavari مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه الله (عج)، تهران، ایران rzalvand@yahoo.com نورالدین دوپیکر Nooredin Dopeykar مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه الله (عج)، تهران، ایران N.dopeykar@gmail.com مجید اله‌پنبه‌چی Majid Allahpanbechi مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه الله (عج)، تهران، ایران zalvandrostam@gmail.com محمد مسگرپور امیری Mohammad Meskarpour-Amiri مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه الله (عج)، تهران، ایران mailer.amiri@gmail.com Inpatient Income Outpatient Income COVID-19 Time Series Hospital Iran درآمد بستری درآمد سرپایی کووید- 19 سری زمانی بیمارستان ایران 1. World Bank. World Health Organization Global Health Expenditure database. 2016.##2. Asgari H. The Estimation Of Cost Function In Ilam Hospitals (2003-2012). sjimu. 2014; 22 (4) :190-198. Available from: https://www.sid.ir/fa/journal/ViewPaper.aspx?id=234996. [ In Persian]##3. Rezapour A, Khalaj M. Study of the economic behavior of public-teeching hospitals of Iran University of Medical Sciences during 1997-2004. Journal of Shahrekord University of Medical Sciences. 2006;8(3):11-1. Available from: https://www.sid.ir/fa/journal/ViewPaper.aspx?id=52278. [ In Persian]##4. Rezapour A, Asifzadeh S. Estimating the cost function of educational and medical centers affiliated to Qazvin University of Medical Sciences. Scientific Journal of Qazvin University of Medical Sciences, 11 (4 (45)), 77-82. Available from: https://www.sid.ir/fa/journal/ViewPaper.aspx?id=73456 [ In Persian]##5. Roberts RR, Scott RD, Cordell R, Solomon SL, Steele L, Kampe LM, et al. The use of economic modeling to determine the hospital costs associated with nosocomial infections. Clinical Infectious Diseases. 2003;36(11):1424-32.##6. Nevola A. Revisiting ‘The Determinants of Hospital Profitability’in Florida. Journal of health care finance. 2016;43(2).##7. Narine L, Pink G, Leatt P. Prediction of the financial performance of Ontario hospitals: A test of environmental determinist and adaptationist perspectives. Health services management research. 1996;9(3):137-55.##8. Ngorsuraches S, Sornlertlumvanich A. Determinants of hospital loss in Thailand: experience from the first year of a universal coverage health insurance program. Health care management science. 2006;9(1):59-70.##9. Menke TJ. The effect of chain membership on hospital costs. Health services research. 1997;32(2):177.##10. Shen Y-C, Melnick G. The effects of HMO ownership on hospital costs and revenues: is there a difference between for-profit and nonprofit plans? INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2004;41(3):255-67.##11. Shepard DS, Hodgkin D, Anthony YE. Analysis of hospital costs: a manual for managers: World Health Organization; 2000.##12. California Health Care Foundation. The Financial Impact of COVID-19 on California##Hospitals. 2020 Jun. Available from: https://www.chcf.org/wp-content/uploads/2020/06/FinancialImpactCOVID19CAHospital##s.pdf.##13. Baldwin R, Di Mauro BW. Economics in the time of COVID-19: A new eBook. VOX CEPR Policy Portal. 2020.##14. Carlsson-Szlezak P, Reeves M, Swartz P. Understanding the economic shock of coronavirus. Harvard Business Review. 2020;27.##15. Kraus S, Clauss T, Breier M, Gast J, Zardini A, Tiberius V. The economics of COVID-19: initial empirical evidence on how family firms in five European countries cope with the corona crisis. International Journal of Entrepreneurial Behavior & Research. 2020.##16. Nasiri T, Shams L, Hosseini-Shokouh S. The Economic Effects of COVID-19 on the Hospital Industry in Iran and the World. Annali di igiene: medicina preventiva e di comunita. 2021;33(1):103-4.##17. Graves N. Economics and preventing hospital-acquired infection. Emerging infectious diseases. 2004;10(4):561.##18. Haley RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. The American journal of medicine. 1991;91(3):S32-S8.##19. Akinleye DD, McNutt L-A, Lazariu V, McLaughlin CC. Correlation between hospital finances and quality and safety of patient care. Plos one. 2019;14(8):e0219124.##20. Karim S, Holmes G, Pink G. The effect of surgery on the profitability of rural hospitals. Journal of Health Care Finance. 2015;41(4).##21. Amir Esmaeili MR, Mosleh A, Isfahani P, Emami M. Factors affecting the improvement of hospital efficiency from the perspective of Zabol hospital managers. Health and Development. 2012. [cited 2021May31];1(1):56-66. 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تبیین دستاوردها و مخاطرات احتمالی سیاستهای مختلف ارزی در حوزه دارو: یک مطالعه کیفی Explaining the Possible Achievements and Consequences of Various Exchange Rate Policies in Pharmaceutical Sector: A Qualitative Study 1 1 مقدمه: در سالیان اخیر، تحریم‌‌ها عامل محدودیت تبادلات مالی، نوسانات نرخ ارز و افزایش نرخ تورم بوده است. در چنین شرایطی، تخصیص ارز دولتی به کالاهای اساسی از جمله دارو با هدف کنترل قیمت آنها اعمال  شد، اما مشکلات چند نرخی سازی ارز سبب طرح سیاست‌های جایگزین شد. این مطالعه پس از تحلیل وضعیت موجود، به بررسی آثار مثبت و منفی اجرای سیاست‌های جایگزین بر ذی نفعان پرداخته و چارچوبی از سیاست‌های حمایتی با هدف کاهش آسیب‌پذیری ذی نفعان به دنبال اجرای این سیاست‌ها ارائه کرده است. روش بررسی: پژوهش حاضر از نوع کیفی است که در سال ۱۴۰۰ انجام شد. پس از مرور متون و استخراج مؤلفه‌های مربوطه، از مصاحبه نیمه‌ساختاریافته و بحث گروهی متمرکز برای گردآوری اطلاعات استفاده  شد و داده‌ها توسط روش کیفی تحلیل مضمون در نرم‌افزار MAXQDA تحلیل شدند. یافته ها: با دسته‌بندی ۱۶۸۶ کد حاصله، مضامین اصلی شامل «تحلیل پیشینه سیاست جاری»، «ارزیابی شرایط فعلی»، «شناسایی سیاست‌های ارزی جایگزین»، «تحلیل شرایط پیش  رو»، «تعیین سیاست‌های حمایتی» و «ضرورت استقرار سیستم بازخورد» به دست آمد. تجمیع نظر خبرگان نشان می دهد هرچند تخصیص ارز  دولتی در کنترل قیمت‌ها در حوزه دارو موفق بوده، اما تبعات آن نظیر آسیب سلامت  سازمانی، اختلال در قیمت گذاری، افزایش بوروکراسی، اخلال در زنجیره  تأمین و محدودسازی صنعت دارو، ضرورت تغییر این سیاست را برجسته می‌کند. از  طرفی، چنین تغییری مستلزم اتخاذ یک مجموعه سیاستی حمایتی است. این مجموعه شامل تخصیص مابه التفاوت نرخ ارز فعلی و جدید به بیمه، قیمت‌گذاری چند فازه و تهاتر مالیاتی برای کاهش آسیب‌پذیری صنعت دارو، بازبینی تفاهم‌نامه‌ دارویی سازمان غذا و دارو با بیمه‌های پایه و ایجاد بیمه مکمل برای دهک‌های پایین‌تر جامعه است. با تحلیل پیشینه سیاست جاری و ارزیابی شرایط فعلی ۴ سیاست ارزی مطرح می شود. نتیجه‌گیری: به  نظر  می‌رسد تغییر نرخ ارز دارو به نرخ ثابتی در نزدیک نرخ نیما، به‌عنوان راه‌حلی میانه می‌تواند به اصلاح فضای موجود منجر شود. در این راستا، با رویکرد کاهش آسیب پذیری گروه های مختلف ذی نفعان، اتخاذ مجموعه ای از سیاست های حمایتی و استقرار سیستم بازخوردگیری، به عنوان الزامات اجرایی در کنار اتخاذ سیاست ارزی بهینه پیشنهاد می‌شود. همچنین از میان روش های اجرا، با لحاظ تبعات مثبت و منفی، روش آزادسازی تدریجی در کنار برقراری بستر نظارتی، می تواند به عنوان مکانیزم مناسب در نظر گرفته  شود. 2 Introduction: In recent years, sanctions have led to limitations in financial transactions, exchange rate fluctuations, and inflation rate rising in Iran. Under such circumstances, official exchange rate was allocated to essential goods such as pharmaceuticals, aiming to promote medicines’ affordability; but problems caused by the multiple-exchange-rate system have raised the idea of alternative policies development. After analyzing the current situation, this study examines the positive and negative impacts of implementing alternative policies on stakeholders as well as providing a framework for supportive policies to protect stakeholders against negative effects. Methods: The present study is of qualitative type that was conducted in 2021. Besides literature review and extracting main indicators, semi-structured interviews and a focus group discussion were conducted for qualitative data collection. Then the data was analyzed by “content analysis” approach using MAXQDA software. Results: By categorizing the 1686 primary codes, the main themes were obtained, including “Depicting the policy background”, “Evaluating current situation”, “Identifying alternative exchange rate policies”, “Analyzing predictable conditions”, “Determining supportive policies”, and “Necessity of establishment a feedback system”. Considering expert opinions, although allocating official currency to medicines has been successful in controlling pharmaceuticals’ affordability; the consequences such as increasing organizational corruptions, pricing challenges, growth of bureaucracy, supply chain disruption, and limitations on the pharmaceutical industry highlights the need for a change in this policy. Moreover, this change requires a supportive policy package, including performing “multi-phasing” pricing, and tax-offsetting to protect the pharmaceutical industry; as well as allocating recourses obtained from two currency differences to insurance systems, revising in “Iran FDA-insurance organizations memorandum of understanding”, and developing supplemental insurance plans for the lower deciles to protect the community. By depicting the exchange rate policy background and evaluating current situation, four alternative exchange rate policies emerge. Conclusion: It seems that switching pharmaceutical exchange rate to a fixed rate near “Nima”, would best improve the current situation. In this regard, considering special supportive policies for different stakeholders and development of a feedback system are considered as the requirements beside implementation of exchange-rate policies. Also, among the implementation methods, considering positive and negative consequences, the gradual method along with the establishment of an inspecting framework, is considered as a suitable mechanism. 118 127 2021/04/242021/06/82021/02/21 1399/12/3 2021/09/142021/09/52021/09/6 1400/6/15 مهنا اخلاصی Mahna Ekhlasi دانشکده داروسازی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران Ekhlasi.mahna@gmail.com محمد پیکان پور Mohammad Peikanpour گروه اقتصاد و مدیریت دارو، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران M_peikanpour@yahoo.com حمیدرضا راسخ Hamidreza Rasekh گروه اقتصاد و مدیریت دارو، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران Hrasekh@gmail.com Pharmaceutical Exchange Rate Exchange Rate Policy Supportive Policies Pharmaceutical Exchange Rate Liberalization نرخ ارز دارو سیاست ارزی سیاست‌های حمایتی آزادسازی ارز دارو 1. Yadav P, Smith RD, Hanson K. Pharmaceuticals and the Health Sector. 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تحلیل آثار سرمایۀ اجتماعی بر استراتژی رعایت فاصلۀ اجتماعی و کنترل همه گیری کووید-19 با رویکرد پویایی شناسی سیستم  Analysis of the Effects of Social Capital on the Strategy of Observing Social Distance and Controlling the COVID-19 Pandemic with a System Dynamics Approach 1 1 مقدمه: همه گیری کووید-۱۹ مخاطرات بی سابقه ای برای نظام سلامت به عنوان یکی از ارکان اصلی توسعه و رفاه اجتماعی در سراسر جهان و ایران پدیدار ساخته و در ۲۰ماه اخیر، دنیا شاهد پارادایم های نوین زیست بشر، ازجمله الزام رعایت فاصلۀ اجتماعی برای مقابله با این بیماری جان گیر و عالم‏گیر بوده است. این پژوهش با هدف تعیین عوامل مؤثر بر تولید و انباشت سرمایۀ اجتماعی و آثار آن بر روند رعایت فاصلۀ اجتماعی به عنوان یکی از سیاست های غیردارویی برای مقابله با شیوع کووید-۱۹، در راستای تحقیقات سایر کشورها و پرکردن شکاف موجود در تحقیقات ایران انجام شد. روش بررسی: استخراج، کمّی سازی و تعیین معادلات متغیرها و تعیین مرز سیستم در روند تولید و انباشت سرمایۀ اجتماعی در این پژوهش با جمع بندی دیدگاه‏های نظریه‏پردازان، نظر خبرگان با انجام مصاحبه های نیمه ساختاریافته و تلفیق آن با روش دلفی فازی انجام شد. مدل سازی و تحلیل داده ها نیز با رویکرد سیستمی و متدولوژی پویایی‏شناسی سیستم ها و استفاده از نرم افزار ونسیم به انجام رسید. یافته ها: پس از شبیه سازی مدل و انجام آزمون هایی برای تأیید اعتبار آن، مشخص شد بین سرمایۀ اجتماعی و روند رعایت فاصلۀ اجتماعی به عنوان یکی از سیاست های غیردارویی نظام سلامت برای کنترل همه گیری کووید-۱۹، رابطۀ علّی و مثبتی وجود دارد. با انجام آزمون هایی برای ساختار مدل، رفتار سیستم و تحلیل حساسیت سیاست ها، سناریوهای خوش بینانه، بدبینانه و واقع بینانه براساس ۸سیاست منتخب، سیاست  بهینه برای انجام اصلاحات و تغییرات بلندمدت انتخاب و پیشنهاد شد. نتیجه گیری: یافته های این مطالعه ضمن تبیین برخی از زوایای ناشناخته رفتار مردم و آثار سرمایۀ اجتماعی بر رعایت فاصلۀ اجتماعی برای کنترل همه گیری کووید-۱۹، راهبردهایی در اختیار سیاست‏گذاران عرصۀ سلامت قرار می دهد که درصورت اجرایی شدن آنها، شاهد جلب بیش از پیش اعتماد عمومی به عنوان اصلی ترین عامل بازتولید و انباشت سرمایۀ اجتماعی و همراهی مردم برای رعایت بیشتر فاصلۀ اجتماعی با هدف گذار از وضعیت نامطلوب کنونی به شرایطی بهتر و کاهش هزینه های نظام سلامت خواهیم بود. 2 Introduction: Introduction: The Covid-19 pandemic unprecedented risks to the health system as one of the main pillars of development and social welfare has emerged around the world and in Iran, and in the last 20 months, the world has witnessed new paradigms of human life, including the need to observe social distance to deal with this pervasive and global disease. The aim of this study was to determine the factors affecting the production and accumulation of social capital and its effects on the process of observing social distance as one of the non-pharmacological policies to deal with the prevalence of Covid-19 pandemic, in line with research from other countries and filling the gap available in Iranian research. Methods: Extracting, quantifying and determining the equations of variables and determining the boundaries of the system in the process of production and accumulation of social capital in this study by summarizing the views of theorists, experts by conducting semi-structured interviews and combining it was done by fuzzy Delphi method. Modeling and data analysis was performed with a systemic approach and methodology of systems dynamics and the use of Wensim software. Results: After simulating the model and performing tests to confirm its validity, it was found that there is a gap between social capital and the process of observing social distance as one of the non-pharmacological policies of the health system to control the Covid-19 pandemic. There is a causal and positive relationship. By performing tests for model structure, system behavior and policy sensitivity analysis, optimistic, pessimistic and realistic scenarios based on 8 selected policies, the optimal policy for long-term reforms and changes were selected and proposed. Conclusion: The findings of this study, while explaining some unknown aspects of people’s behavior and the effects of social capital on the observance of social distance to control the Covid-19 pandemic, provide strategies for health policymakers that if implemented, we will see more and more public confidence as the main factor in the reproduction and accumulation of social capital and the support of people to transition from the current unfavorable situation to better conditions. 128 141 2021/04/242021/06/82021/02/212021/06/29 1400/4/8 2021/09/142021/09/52021/09/62021/09/6 1400/6/15 امین فغفوری آذر Amin Faghfouri Azar گروه مدیریت صنعتی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران amin.faghfouri@gmail.com فاطمه باکوئی Fatemeh Bakouie گروه مدل‌سازی کارکردهای عالی شناختی، پژوهشکده علوم شناختی و مغز، دانشگاه شهید بهشتی، تهران، ایران fatemeh.bakouie@gmail.com محمدحسین مهدوی عادلی Mohammad Hosein Mahdavi Adeli گروه اقتصاد، دانشکده علوم اداری و اقتصادی، دانشگاه فردوسی، مشهد، ایران رضا رادفر Reza Radfar گروه مدیریت صنعتی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران محمدعلی افشارکاظمی Mohammad Ali Afshar Kazemi گروه مدیریت صنعتی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران COVID-19 Pandemic Social Distance Health System Social Capital System Dynamics کووید-19 فاصلۀ اجتماعی نظام سلامت سرمایۀ اجتماعی پویایی شناسی سیستم  1. 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وضعیت پوشش صندوق های بازنشستگی و نهادهای حمایتی از سالمندان در ایران The Coverage Status of Pension Funds and Elderly Supportive Institutions in Iran 1 1 مقدمه: وضعیت پوشش صندوق های بازنشستگی و نهادهای حمایتی از سالمندان، از جمله موضوع های مهم و اساسی در مطالعات رفاه اجتماعی است. پژوهش حاضر با هدفِ مقایسه و بررسی وضعیت پوشش مستمری بیمه ای و حمایتی از سالمندان در سطح کشوری و استانی طی سال‌های ۱۳۹۴ تا ۱۳۹۷ انجام شده است. پرسش  اصلی در این کاوش، چگونگی سهم پوشش صندوق های بازنشستگی و نهادهای حمایتی از سالمندان کشور است و دیگر اینکه سالخوردگان کدام استان‌ها  از پوشش بیشتری بهره مندند و در کدام استان‌ها پوشش مستمری و حمایتی از آنان کمتر است؟ روش بررسی: پژوهش حاضر یک پژوهش توصیفی- تحلیلی و روش مورد استفاده برمبنای روش تحلیل ثانویه است. داده های مورد استفاده مربوط به پوشش های بیمه ای و حمایتی از منابع آماری و اطلاعاتی صندوق های بازنشستگی و نهادهای حمایتی و دفتر آمار و اطلاعات وزارت تعاون کار و رفاه اجتماعی اخذ شده است. داده های مربوط به تغییرات ساختار سنی جمعیت کشور، از مرکز آمار ایران اخذ شده است. اطلاعات آماری استحصال شده پس از پردازش و ترسیم جداول و نمودارها به وسیله نرم افزارهای Word و  Excel، در سطح کشوری و استانی از نظر وضعیت پوشش مستمری و حمایتی سالمندان در نظر گرفته شده است. یافته ها: در سال ۱۳۹۴ نسبت مستمری بگیران سالمند تحت پوشش صندوق های بازنشستگی برابر با ۳۶.۲ درصد و نسبت مستمری بگیران سالمند تحت پوشش نهادهای حمایتی برابر با ۳۳.۷ درصد بوده است. در سال ۱۳۹۵ نسبت مستمری بگیران سالمند تحت پوشش صندوق های بازنشستگی برابر با ۳۳ درصد و نسبت مستمری بگیران سالمند تحت پوشش نهادهای حمایتی برابر با ۳۰.۲ درصد بوده است. در سال ۱۳۹۶ نسبت مستمری بگیران سالمند تحت پوشش صندوق های بازنشستگی برابر با ۳۴.۹ درصد و نسبت مستمری بگیران سالمند تحت پوشش نهادهای حمایتی برابر با ۳۱.۱ درصد بوده است. در سال ۱۳۹۷ نسبت مستمری بگیران سالمند تحت پوشش صندوق های بازنشستگی برابر با ۳۷ درصد و نسبت مستمری بگیران سالمند تحت پوشش نهادهای حمایتی برابر با ۲۷.۴ درصد بوده است. به عبارت دیگر روند پوشش مستمری بیمه ای و حمایتی سالمندان از ۷۰ درصد در سال ۱۳۹۴به ۶۴.۴ درصد در سال ۱۳۹۷ کاهش داشته است. این وضعیت پایین تر از میانگین این پوشش در مقیاس جهانی(۶۷.۹) است. نتیجه گیری: نتایج این پژوهش نشان داد چتر حمایتی صندوق ها و سازمان‌های بازنشستگی و حمایتی از سالمندان ایرانی گسترده نیست و متناسب با رشد جمعیت سالخورده، نه‌تنها افزایش قابل توجهی نداشته، بلکه روندی کاهشی نیز داشته است. 2 Introduction: The coverage status of pension funds and supportive institutions of the elderly is one of the most important and fundamental issues in social welfare studies. The present study aims to compare and evaluate the status of insurance and support for the health of the elderly at the national and provincial level during the years 2015-2018.  The main questions in this research are:  how is the share of the coverage of pension funds and supportive institutions for the elderly in the country?, in which provinces the elderly benefit from more coverage?, and in which provinces the pension coverage and support is less for them? Methods: The present study is a descriptive-analytical research and the method used is based on the secondary analysis method. The data used for insurance and support coverage were obtained from statistical and information sources of pension funds and supportive institutions and the Statistics and Information Office of the Ministry of Labor Cooperation and Social Welfare. Data related to changes in the age structure of the country's population have been obtained from the Statistics Center of Iran. The statistical data extracted after processing and drawing tables and graphs by Microsoft Word & Office Excel software, at the national and provincial level in terms of pension coverage and support for the elderly. Results: In 2015, the ratio of elderly pensioners covered by pension funds was 36.2% and the ratio of elderly pensioners covered by supportive institutions equaled in 33.7%. In 2016, the ratio of elderly pensioners covered by pension funds was 33% and the ratio of elderly pensioners covered by supportive institutions equaled in 30.2%. In 2017, the ratio of elderly pensioners covered by pension funds was 34.9% and the ratio of elderly pensioners covered by supportive institutions was equaled in 31.1%. In 2018, the ratio of elderly pensioners covered by pension funds was 37 percent and the ratio of elderly pensioners covered by supportive institutions was 27.4 percent. In other words, the trend of insurance and supportive pension coverage for the elderly has decreased from 70% in 2015 to 64.4% in 2018. This situation is lower than the average of this coverage on a global scale (67.9). Conclusion: The results of the study showed that the supportive coverage of funds, pensions and supportive organizations for the elderly in Iran is not widespread and in accordance with the growth of the elderly population, it has not only had a significant increase, but a decline. 142 151 2021/04/242021/06/82021/02/212021/06/292021/04/13 1400/1/24 2021/09/142021/09/52021/09/62021/09/62021/07/19 1400/4/28 رضا کیانی reza kiani موسسه تحقیقات جمعیت کشور rezakiani@nipr.ac.ir Elderly Pension Supportive funds Pension funds Supportive Institutions سالمند مستمری مقرری حمایتی صندوق های بازنشستگی نهادهای حمایتی 1. Mohajerani,Ali Asghar(2019) Demography of Iran. The Organization for Researching and Composing University Textbooks in the Humanities. Institute for Research and Development in the Humanities. .[Persian] ##2. Yavari K, Basakha M, Sadeghi H, Naseri A. (2015) Economic Aspects of Ageing . Salmand. 2015,10.(1) 92-105. .[Persian]##3. Sheikh Muhammad Taqi, Javaheri Mahmoud (2017) Elderly and social services in Iran. population magazine. Volume 23, Issue 95 And 96 p52.[Persian]##4. Zanjani H. (1989) Population and Demography. University Publication Center. P94.[Persian]##5. Zanjani H. (2016) Demography of Iran .Statistics Research Institute .P.[Persian]##6. Barry ,Norman (1999 )Walfare ,open university press, p9##7. International Social Security Association. ISSA.(2016)TEN GLOBAL CHALLENGES FOR SOCIAL SECURITY. Geneva##8. ILO (2019) World Social Protection Report 2017-19: Universal social protection to achieve the Sustainable Development Goals. INTERNATIONAL LABOUR OFFICE .GENEVA##9. UNFPA (2017) Perspectives on Population Ageing Report.UNFPA Asia and the Pacific Regional Office. Bangkok, Thailand##10. Ortiz ,Isabel and Oters (2018) Reversing Pension Privatization: Rebuilding Public Pension Systems in Eastern European and Latin American Countries, Intrenational Labour Organization, Geneva##11. Matin Karami and Oters (2013). Ageing in Iran in 1410, a warning to health care system. Teb va tazkiye journal Volume 22, Issue 2 - Serial Number 2. pp9-18 [Persian] ##12. Safdari R, Sadeghi F, Mohammadiazar M.(2016). Aged Care and Services Programs in Iran: Looking at the Performance of Relevant Organizations. payavard. 2016; 10 (2) :155-166. [Persian] ##13. ILO (2013) Nationa l tripartite social dialogue: an ILO guide for improved governance, Intrenational Labour Organization, Geneva.[Persian]##14. Moridi, Siavash(1999) Social Insurance Dictionary Social Security Research Institute.p15. [Persian] ##15. Bazr afcan, Farhad and Oters (2019) A Glossary of Welfare and Social Policy. Tehran. Mazear Pop..[Persian]##16. Ministry of Cooperatives, Labor and Social Welfare (2019) Statistical study of socio-economic characteristics of the elderly in Iran. Statistics and Strategic Information Center. [Persian]##1.Sheikh Muhammad Taqi, Javaheri Mahmoud (2017) Elderly and social services in Iran. population magazine. Volume 23, Issue 95 And 96 p52.[Persian]##2. Sadeghi, aziz. Masoudi Nodooshan (2019) Ranking of Growth, Development and Progress of the Provinces of the Country in Different Areas. modiriyatfarda magazine. No 54. Pp17-36. [Persian] ##3. ILO (2013) Nationa l tripartite social dialogue: an ILO guide for improved governance, Intrenational Labour Organization, Geneva.[Persian]##4. Barry ,Norman (1999 )Walfare ,open university press, p9##5. Bazr afcan, Farhad and Oters (2019) A Glossary of Welfare and Social Policy. Tehran. Mazear Pop..[Persian]##6. Moridi, Siavash(1999) Social Insurance Dictionary Social Security Research Institute.p15. [Persian] ##7. International Social Security Association. ISSA.(2016)TEN GLOBAL CHALLENGES FOR SOCIAL SECURITY. Geneva##8. ILO (2019) World Social Protection Report 2017-19: Universal social protection to achieve the Sustainable Development Goals. INTERNATIONAL LABOUR OFFICE .GENEVA##9. UNFPA (2017) Perspectives on Population Ageing Report.UNFPA Asia and the Pacific Regional Office. Bangkok, Thailand##10. Ortiz ,Isabel and Oters (2018) Reversing Pension Privatization: Rebuilding Public Pension Systems in Eastern European and Latin American Countries, Intrenational Labour Organization, Geneva##11. B. Matin Karami and Oters (2013). Ageing in Iran in 1410, a warning to health care system. Teb va tazkiye journal Volume 22, Issue 2 - Serial Number 2. pp9-18 [Persian] ##12. Safdari R, Sadeghi F, Mohammadiazar M.(2016). Aged Care and Services Programs in Iran: Looking at the Performance of Relevant Organizations. payavard. 2016; 10 (2) :155-166. [Persian] ##13. Ministry of Cooperatives, Labor and Social Welfare (2019) Statistical study of socio-economic characteristics of the elderly in Iran. Statistics and Strategic Information Center. [Persian] ##

طراحی و تبیین مدل استقرار خدمات هوشمند در بخش سلامت ایران با استفاده از رویکرد مدلسازی ساختاری-تفسیری Designing and Explaining the Model of Implementation of Smart Services in Iranian Health Sector Using Interpretive Structural Modelling Approach 1 1 مقدمه: انقلاب اینترنت در دهه‌های اخیر و ظهور فنّاوری‌های هوشمند باعث متحول شدن تمام ابعاد کسب و کارها شده و صنعت سلامت نیز از این قاعده مستثنی نیست و باوجود پیشرفت‌های چشمگیر در سال‌های اخیر، این حوزه با چالش‌های جدی نیز روبه‌روست و استفاده از فنّاوری‌های هوشمند می‌تواند بسیاری از آنها را برطرف سازد. به همین دلیل پژوهش حاضر با هدف ارائه مدل ساختاری تفسیری به‌منظور استقرار خدمات هوشمند در بخش سلامت کشور ایران انجام شده است. روش بررسی:  این پژوهش به لحاظ هدف توسعه‌ای کاربردی بوده و بر اساس ماهیت و روش توصیفی- پیمایشی است. همچنین با استفاده از تکنیک مدل‌سازی ساختاری- تفسیری و تحلیل نفوذ- وابستگی در سال ۱۳۹۹ انجام شده است. ابزار جمع‌آوری داده‌ها نیز مراجعه به اسناد، مصاحبه‌های نیمه‌ساختاریافته و فرم نظر‌خواهی مقایسه زوجی بوده است. یافته ها: براساس یافته‌های پژوهش، آمادگی ملی، برنامه‌ریزی استقرار، فراهم‌سازی زمینه‌ها، مدیریت اجرا، سازمان کار، تمهیدات سازمانی و مدیریت مقاومت به عنوان ابعاد مدل شناسایی شدند. بعد «آمادگی ملی» در سطح سوم مدل به‌عنوان متغیری مستقل قرار گرفت. ابعاد «فراهم‌سازی زمینه‌ها و برنامه‌ریزی استقرار» هم به عنوان متغیر مستقل و سایر ابعاد جزو متغیر‌های پیوندی قرار گرفتند. نتیجه گیری:  نتایج پژوهش حاضر کمک می‌کند سیاستگذاران حوزه سلامت کشور از مدل ارائه شده برای ارتقا و بهبود مستمر در این بخش و همچنین دستیابی به اهداف تکالیف قانونی برنامه‌های پنجم و ششم توسعه کشور در حوزه سلامت جامعه مبنی بر استقرار سامانه پرونده الکترونیکی سلامت با هدف ارائه خدمات الکترونیکی سلامت و از آن جمله پروژه نسخه الکترونیک استفاده کنند. 2 Introduction: The Internet revolution in recent decades and the emergence of smart technologies have changed all aspects of business and the health industry is no exception to this rule.  Despite of significant advances in recent years, this field has been facing serious challenges and the use of smart technologies can address many of them. Therefore, this study aimed to provide an interpretive structural model for the establishment of smart services in the Iranian health sector. Methods: This research in terms of purpose was development- applied and based on method and nature was descriptive- survey. It has also been done using Interpretive- Structural Modeling technique and penetration- dependence analysis in 2020. Data collection tools were document references, semi-structured interviews, and paired comparison survey forms. Results: Based on the research findings, national preparedness, deployment planning, stage-setting, execution management, task organization framework, organizational interventions and resistance management were identified as dimensions of the model. “National preparedness” dimension was settled at the third level of the model as an independent variable. The dimensions of “stage- setting and deployment planning” were also included as independent variables and other dimensions were included as related variables. Conclusion: The results of the current study help policymakers in the health sector to use the proposed model as a framework for promotion and continuous improvement in this field and also, achieving the goals of the legal duties of the fifth and sixth development plans of the country in the Health field based on the establishment of an Electronic Health Record System for Iranians with the aim of providing Electronic Health Services, including the Electronic Prescription project. 152 163 2021/04/242021/06/82021/02/212021/06/292021/04/132021/05/26 1400/3/5 2021/09/142021/09/52021/09/62021/09/62021/07/192021/09/1 1400/6/10 شراره میرسعیدی فراهانی Sharareh Mirsaeidi Farahani گروه مدیریت دولتی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران sh_mirsaeidi@yahoo.com احمد ودادی Ahmad Vedadi گروه مدیریت دولتی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران ahvedadi@gmail.com علی رضائیان Ali Rezaeian گروه مدیریت دولتی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران Modern Technologies Smart Health Electronic Health Electronic Prescription Interpretive Structural Modelling فنّاوریهای نوین سلامت هوشمند سلامت الکترونیک نسخه الکترونیک مدلسازی ساختاری تفسیری 1. Neuhofer B, Buhalis D, Ladkin, A. Smart technologies for personalized experiences: A case study in the hospitality domain. Electronic Markets: The International Journal on Networked Business 2015; 25(3): 243-254.##2. Hermann S. Was sind Smart Services? Smart Urban Services Project (SUS). Available at: http://www.servlab.eu/?, 2016; p=1333.##3. Sundaravadivel P, Kougianos E, Mohanty S P, Ganapathiraju M. Everything You Wanted to Know about Smart Healthcare. IEEE Consumer Electronics Magazine 2018; 7(1):18-28.##4. Das S. Smart Healthcare – The Many Benefits for Patients. Available at: https://www.sdglobaltech.com/ 2018.##5. World Health Organization (WHO). Resolution WHA71.7 of the World Health Assembly. Digital health. Geneva, Switzerland: World Health Organization; 2018.##6. Tice D, Wetherbe J, Turban E, Mc Lean E, Translators. Riahee H, Ghatrenabie P, Tofighi M. Information Technology for Management- Organizational Transformation in the Digital Economy. Tehran: Payame Noor University, 2012; 2(5): 927 [Book in Persian].##7. Thatch, L. and Woodman, R. W. 'Organizational Change and Information Technology: Managing on the Edge of Cyberspace, Organizational Dynamics, 1994; 23(1): 30-46##8. King, W.R., He, J. A meta-analysis of the technology acceptance model, Information & Management, 2006; 43:740-755.##9. Schoville R, Titler M. Guiding Healthcare Technology Implementation: A New Integrated Technology Implementation Model, Journal of Computers, Informatics, Nursing (CIN), 2015; 33(3): 101.##10. World Health Organization (WHO). The World health report 2000: Health systems: improving performance. Geneva, Switzerland: World Health Organization; 2000.##11.World Health Organization (WHO). Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, Switzerland: World Health Organization; 2007:1-56.##12. Research Center of the Islamic Consultative Assembly, Law of the Fifth Five-Year Development Plan of the Islamic Republic of Iran (2011- 2015), 2011.##13. Research Center of the Islamic Consultative Assembly, Law of the Fifth Five-Year Development Plan of the Islamic Republic of Iran (2017- 2021), 2016.##14. Warfield J.W. Developing interconnected matrices in Structural Modelling, IEEE transcript on systems, Men and Cybernetics, 1974; 4(1), 51-81. ##15. Faisal M. Banwet D.k. Shankar R. Supply chain risk mitigation: modelling the enablers, Business Process Management, 2006; 12(4): 535-552.##16. Mandal A, Deshmukh S.G. Vendor Selection Using Interpretive Structural Modeling (ISM), International Journal of Operations & Production Management, 1994; 14: 557. ##17. Thakkar J. & Etal. Development of a balanced scorecard: An integrated approach of Interpretive Structural Modeling (ISM) and Analytic Network Process (ANP), International Journal of Productivity and Performance Management, 2007; 56(1): 25- 59. ##18. Abbaspour Esfedan Gh. Application of theory in management and engineering (classical and fuzzy) with dissertation approach, Tehran: Publications of top professors, 2014 [Book in Persian]. ##19. Asian Productivity Organization. Digitalization of Public Service Delivery in Asia. Available at: https://www.apo-tokyo.org 2021.##20. Jones L. & Etal, Promoting an overdue digital transformation in healthcare&quot;, in web site: Mckinsey and company- Health System and Services, 2019.##21. Yao M, Zhou A, Jia M. translators. Raeesi MH, Pishva N, Nikseresht A. Applied Artificial Intelligence: For Business Leaders. Tehran: Marketing Publication; 2020: 101- 108 [Book in Persian].##22. Tahir M. Ahad A. Yau KLA. 5G- Based Smart Healthcare Network: Architecture, Taxonomy, Challenges and Future Research Directions, IEEE Access, 2019; (7): 100747-62.##23. Willis M. National Digital Infrastructures for Healthcare: A Comparative Case of Estonian and British Healthcare Infrastructure. University of OXFORD, Center for Technology and Global Affairs. Available at: www.ctga.ox.ac.uk 2018; 8.##24. Webster P. Digital health technologies and health-care privatization. The Lancet Digital Health 2019;1(4): e161-e162. ##25. Nabiee F. Digital transformation in the health and medical industry. Available at: DTGroup.ir 2018; 3: 16- 21] Article in Persian [. ##26. Lahimgarzadeh N. The evolution of hospitals in the age of digital health. MEDLEAN. Available at: https://medleanmag.ir/digital-health-renovation-in-future-hospitals 2020 [Article in Persian].##1. Neuhofer B, Buhalis D, Ladkin, A. Smart technologies for personalized experiences: A case study in the hospitality domain. Electronic Markets: The International Journal on Networked Business 2015; 25(3): 243-254.##2. Hermann S. Was sind Smart Services? Smart Urban Services Project (SUS). Available at: http://www.servlab.eu/?, 2016; p=1333.##3. Sundaravadivel P, Kougianos E, Mohanty S P, Ganapathiraju M. Everything You Wanted to Know about Smart Healthcare. IEEE Consumer Electronics Magazine 2018; 7(1):18-28.##4. Das S. Smart Healthcare – The Many Benefits for Patients. Available at: https://www.sdglobaltech.com/ 2018.##5. World Health Organization (WHO). Resolution WHA71.7 of the World Health Assembly. Digital health. Geneva, Switzerland: World Health Organization; 2018.##6. Tice D, Wetherbe J, Turban E, Mc Lean E, Translators. Riahee H, Ghatrenabie P, Tofighi M. Information Technology for Management- Organizational Transformation in the Digital Economy. Tehran: Payame Noor University, 2012; 2(5): 927 [Book in Persian].##7. Thatch, L. and Woodman, R. W. 'Organizational Change and Information Technology: Managing on the Edge of Cyberspace, Organizational Dynamics, 1994; 23(1): 30-46##8. King, W.R., He, J. A meta-analysis of the technology acceptance model, Information & Management, 2006; 43:740-755.##9. Schoville R, Titler M. Guiding Healthcare Technology Implementation: A New Integrated Technology Implementation Model, Journal of Computers, Informatics, Nursing (CIN), 2015; 33(3): 101.##10. World Health Organization (WHO). The World health report 2000: Health systems: improving performance. Geneva, Switzerland: World Health Organization; 2000.##11.World Health Organization (WHO). Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, Switzerland: World Health Organization; 2007:1-56.##12. Research Center of the Islamic Consultative Assembly, Law of the Fifth Five-Year Development Plan of the Islamic Republic of Iran (2011- 2015), 2011.##13. Research Center of the Islamic Consultative Assembly, Law of the Fifth Five-Year Development Plan of the Islamic Republic of Iran (2017- 2021), 2016.##14. Warfield J.W. Developing interconnected matrices in Structural Modelling, IEEE transcript on systems, Men and Cybernetics, 1974; 4(1), 51-81. ##15. Faisal M. Banwet D.k. Shankar R. Supply chain risk mitigation: modelling the enablers, Business Process Management, 2006; 12(4): 535-552.##16. Mandal A, Deshmukh S.G. Vendor Selection Using Interpretive Structural Modeling (ISM), International Journal of Operations & Production Management, 1994; 14: 557. ##17. Thakkar J. & Etal. Development of a balanced scorecard: An integrated approach of Interpretive Structural Modeling (ISM) and Analytic Network Process (ANP), International Journal of Productivity and Performance Management, 2007; 56(1): 25- 59. ##18. Abbaspour Esfedan Gh. Application of theory in management and engineering (classical and fuzzy) with dissertation approach, Tehran: Publications of top professors, 2014 [Book in Persian]. ##19. Asian Productivity Organization. Digitalization of Public Service Delivery in Asia. Available at: https://www.apo-tokyo.org 2021.##20. Jones L. & Etal, Promoting an overdue digital transformation in healthcare&quot;, in web site: Mckinsey and company- Health System and Services, 2019.##21. Yao M, Zhou A, Jia M. translators. Raeesi MH, Pishva N, Nikseresht A. Applied Artificial Intelligence: For Business Leaders. Tehran: Marketing Publication; 2020: 101- 108 [Book in Persian].##22. Tahir M. Ahad A. Yau KLA. 5G- Based Smart Healthcare Network: Architecture, Taxonomy, Challenges and Future Research Directions, IEEE Access, 2019; (7): 100747-62.##23. Willis M. National Digital Infrastructures for Healthcare: A Comparative Case of Estonian and British Healthcare Infrastructure. University of OXFORD, Center for Technology and Global Affairs. Available at: www.ctga.ox.ac.uk 2018; 8.##24. Webster P. Digital health technologies and health-care privatization. The Lancet Digital Health 2019;1(4): e161-e162. ##25. Nabiee F. Digital transformation in the health and medical industry. Available at: DTGroup.ir 2018; 3: 16- 21] Article in Persian [. ##26. Lahimgarzadeh N. The evolution of hospitals in the age of digital health. MEDLEAN. Available at: https://medleanmag.ir/digital-health-renovation-in-future-hospitals 2020 [Article in Persian]. ##

عملکرد مالی آزمایشگاههای مراکز درمانی سرپایی سازمان تأمین اجتماعی در سالهای 1391 تا 1398 Financial Performance of Outpatient Clinic’s Laboratories Affiliated to Iran's Social Security Organization During 2012- 2019 1 1 مقدمه: مطالعه حاضر به بررسی هزینه‌ها و درآمدهای آزمایشگاه‌های فعال در ۲۶۰ درمانگاه سازمان تأمین اجتماعی در سال‌های ۱۳۹۱ تا ۱۳۹۸ می‌پردازد تا نشان دهد تولید خدمات آزمایشگاهی در این مراکز به لحاظ مالی در چه وضعیتی بوده است. روش بررسی: در این مطالعه با استفاده از روش هزینه‌یابی تقلیلی-  مرحله‌ای، ابتدا هزینه آزمایشگاه‌ها از هزینه درمانگاه تفکیک و سپس با محاسبه ۴ گروه از شاخص‌ها مشتمل بر سهم هزینه آزمایشگاه از هزینه‌های جاری درمانگاه، سهم هزینه‌های مستقیم، سربار و پشتیبانی از هزینه آزمایشگاه، میانگین هزینه و درآمد هر نسخه آزمایش و نسبت درآمد به هزینه آزمایشگاه، عملکرد مالی آزمایشگاه‌ها محاسبه و مقایسه شد. یافته ها: سهم آزمایشگاه‌ها از هزینه جاری درمانگاه‌ها در سال‌های۱۳۹۱ تا ۱۳۹۸ به طور متوسط ۱۱درصد بوده و میزان آن تغییر قابل توجهی نداشت. همچنین میانگین سهم هزینه‌های مستقیم، پشتیبانی و سربار در هر مراجعه به آزمایشگاه به ترتیب ۶۱درصد، ۳۳درصد و ۶درصد بود. میانگین هزینه و درآمد هر نسخه آزمایش به ترتیب سالانه ۲۸ و ۲۶درصد رشد داشت. در سال‌های مورد بررسی، درآمد آزمایشگاه‌ها به طور متوسط ۴۸درصد از هزینه‌های آنها را پوشش داده و روند آن کاهشی بود. نتیجه گیری: بین هزینه‌ها و درآمدهای آزمایشگاه‌های مراکز سرپایی تأمین اجتماعی فاصله قابل ‌توجه وجود دارد. وجود اختلاف در شاخص‌های مالی آزمایشگاه‌های مورد بررسی که در محیطی نسبتا مشابه‌ فعالیت می‌کنند، فرصت‌های بهبود را نشان می‌دهد که در صورت تحقق آن، شاهد ارتقای عملکرد مالی آزمایشگاه ها، گذار از وضعیت نامطلوب کنونی به شرایطی بهتر و کاهش هزینه های بخش درمان خواهیم بود. 2 Introduction: The aim of this study was to assess financial performance of 260 clinic’s laboratories affiliated to Social Security Organization (SSO) from 2012 to 2019. Methods: Step-down cost accounting was used. At first, the proportion of laboratory cost separated from the total clinic cost for each clinic, then four groups of indicators were measured including: ratio of laboratory cost to total clinic current cost, ratio of direct, overhead and support cost to total laboratory cost, the average cost and revenue per laboratory prescription and total revenue to total cost ratio. Results: Ratio of laboratory cost to total clinic cost has been 11% on average from 2012 to 2019 and its trend has not changed significantly. Ratio of direct, support and overhead costs to the total laboratory cost was 61%, 33% and 6% respectively. The average annual growth of cost and revenue per laboratory prescription was 28% and 26% respectively. In studied years, the revenue of laboratories covered an average of 48% of their costs with a declining trend. Conclusion: There is a significant gap between the costs and revenues of the SSO clinic’s laboratories and a wide variation in financial performance of laboratories even in similar environment as well. To conclude, the results of this study demonstrate opportunities to optimize financial performance of laboratories. 164 173 2021/04/242021/06/82021/02/212021/06/292021/04/132021/05/262021/05/7 1400/2/17 2021/09/142021/09/52021/09/62021/09/62021/07/192021/09/12021/08/13 1400/5/22 فرنوش عزیزی Farnoosh Azizi سازمان تأمین اجتماعی، تهران، ایران f.azizi114@gmail.com حسین جودکی Hossein Joudaki سازمان تأمین اجتماعی، تهران، ایران hjoudaki56@gmail.com امیرعباس فضائلی Amirabbas Fazayeli سازمان تأمین اجتماعی، تهران، ایران amirfazayeli@yahoo.com فرهاد کوهی Farhad Kouhi سازمان تأمین اجتماعی، تهران، ایران kouhifarhad@gmail.com Cost Performance Laboratory Clinic Social Security Organization هزینه تمام شده عملکرد آزمایشگاه درمانگاه سازمان تأمین اجتماعی  1. Hafezi R, Abolhallaj M, Ramezanian M. Designing New Financial Management System in Health Sector of Islamic Republic of Iran. Iranian J Publ Health. 2009; 38(1):137-8. [In Persian]##2. Social Security Organization. Summary of the Approved Annual Budget of Social Security Organization. Office of Budget.##3. Arab M, Ghiasvand H, Dorroudi R, Akbari Sari A, Hamidi M, Moghri J. Determining the Radiology Services Cost in Selected Hospitals Affiliated with Tehran University of Medical Sciences Using Activity-Based Costing Method in 2010-2011. Hospital. 2012; 11(3): 27-36. [In Persian]##4. Social Security Organization. Annual Statistics Report (2019). Statistical Indicators Assessment Group; 2020. ##5. Social Security Organization. Annual Statistics Report (2019). Department of Statistics, Information and Calculations; 2020. ##6. Social Security Organization. Evaluating of clinic performance affiliated to Social Security Organization (2019). Health Economics and Planning Group; 2020. ##7. Alamshah S. Calculating the Cost of Services of Laboratory in Alami Herandi Clinic of Isfahan Social Security Organization Using Time-Driven Activity-Based Costing and Comparing It with the Approved Tariffs in 2015. Journal of Health Accounting. 2017;6(1):88-110. [In Persian]##8. Mousavi SA, Khorvash F, Fathi H, Fadai H, Hadianzarkeshmoghadam Sh. Survey the Average of Cost in out Patient and Imaging in Alzahra Hospital and Comparing with Service's Tariff. Health Information Management. 2010;7(2):235-241. [In Persian]##9. Mehrolhassani M, Heidari M, Rahimi Z, Emami M. Cost Price Estimation of Clinical Laboratory Services in Shafa Hospital Based on Activity-Based Costing in 2011. Journal of Sabzevar University of Medical Science. 2014;21(4):587-595. [In Persian]##10. Nasiri-Poor AA, Tabibi J, Maleki MR, Nourozi T. Computing the Cost of Clinical Laboratories Services of Tehran Valiasr Hospital Using Activity-Based Costing in 2008. Hospital. 2010; 8(4):5-17. [In Persian]##11. Omrani MD, Mostafavi H, Khazar S, Ghalami S, Farajzadeh F. Laboratories Performance After Outsourcing in the Hospitals of Shahid Beheshti University of Medical Science. Medical Laboratory Journal. 2013; 7(2 (14)):49-56. [In Persian]##12. Miriyan E. Check and calculate the cost of services based on activity-based costing method in diagnostic martyr Dastgheib Hospital, Shiraz and provide a suitable model [ M.A Thesis]. Fars: Shiraz University of Medical Sciences and Health Services; 2008. [In Persian]##13. Mashadsarey A. Calculation of Total Cost Price of Diagnostic and Imayenouys Serves in Shahid Yahyanejad Treatment and Didactic Center Depends on Babul [ M.A Thesis]. Iran University of Medical Since; 2005. [In Persian]##14. Ergun FA, Agirbas İ, Kuzu I. Activity-based costing for pathology examinations and comparison with the current pricing system in Turkey. Turkish Journal of Pathology; 2013.##15. Supreme Council of Social Security. Regionalization of outpatient and inpatient health services in Social Security Organization; 1998. ##16. Supreme Council of Social Security. Clinic Establishment Regulations; 2004. ##17. Conteh L, Walker D. Cost and unit cost calculation using step-down accounting; 2004.##18. Pourreza A . Analysis of hospital costs for managers. Social Security Organization Research Institute; 2002.##1. Hafezi R, Abolhallaj M, Ramezanian M. Designing New Financial Management System in Health Sector of Islamic Republic of Iran. Iranian J Publ Health. 2009; 38(1):137-8. [In Persian]##2. Social Security Organization. Summary of the Approved Annual Budget of Social Security Organization. Office of Budget.##3. Arab M, Ghiasvand H, Dorroudi R, Akbari Sari A, Hamidi M, Moghri J. Determining the Radiology Services Cost in Selected Hospitals Affiliated with Tehran University of Medical Sciences Using Activity-Based Costing Method in 2010-2011. Hospital. 2012; 11(3): 27-36. [In Persian]##4. Social Security Organization. Annual Statistics Report (2019). Statistical Indicators Assessment Group; 2020. ##5. Social Security Organization. Annual Statistics Report (2019). Department of Statistics, Information and Calculations; 2020. ##6. Social Security Organization. Evaluating of clinic performance affiliated to Social Security Organization (2019). Health Economics and Planning Group; 2020. ##7. Alamshah S. Calculating the Cost of Services of Laboratory in Alami Herandi Clinic of Isfahan Social Security Organization Using Time-Driven Activity-Based Costing and Comparing It with the Approved Tariffs in 2015. Journal of Health Accounting. 2017;6(1):88-110. [In Persian]##8. Mousavi SA, Khorvash F, Fathi H, Fadai H, Hadianzarkeshmoghadam Sh. Survey the Average of Cost in out Patient and Imaging in Alzahra Hospital and Comparing with Service's Tariff. Health Information Management. 2010;7(2):235-241. [In Persian]##9. Mehrolhassani M, Heidari M, Rahimi Z, Emami M. Cost Price Estimation of Clinical Laboratory Services in Shafa Hospital Based on Activity-Based Costing in 2011. Journal of Sabzevar University of Medical Science. 2014;21(4):587-595. [In Persian]##10. Nasiri-Poor AA, Tabibi J, Maleki MR, Nourozi T. Computing the Cost of Clinical Laboratories Services of Tehran Valiasr Hospital Using Activity-Based Costing in 2008. Hospital. 2010; 8(4):5-17. [In Persian]##11. Omrani MD, Mostafavi H, Khazar S, Ghalami S, Farajzadeh F. Laboratories Performance After Outsourcing in the Hospitals of Shahid Beheshti University of Medical Science. Medical Laboratory Journal. 2013; 7(2 (14)):49-56. [In Persian]##12. Miriyan E. Check and calculate the cost of services based on activity-based costing method in diagnostic martyr Dastgheib Hospital, Shiraz and provide a suitable model [ M.A Thesis]. Fars: Shiraz University of Medical Sciences and Health Services; 2008. [In Persian]##13. Mashadsarey A. Calculation of Total Cost Price of Diagnostic and Imayenouys Serves in Shahid Yahyanejad Treatment and Didactic Center Depends on Babul [ M.A Thesis]. Iran University of Medical Since; 2005. [In Persian]##14. Ergun FA, Agirbas İ, Kuzu I. Activity-based costing for pathology examinations and comparison with the current pricing system in Turkey. Turkish Journal of Pathology; 2013.##15. Supreme Council of Social Security. Regionalization of outpatient and inpatient health services in Social Security Organization; 1998. ##16. Supreme Council of Social Security. Clinic Establishment Regulations; 2004. ##17. Conteh L, Walker D. Cost and unit cost calculation using step-down accounting; 2004.##18. Pourreza A . Analysis of hospital costs for managers. Social Security Organization Research Institute; 2002. ##

پیشرفت به سوی پوشش همگانی سلامت (UHC) با استفاده از مفاهیم حقّ بر سلامت Progress Towards Universal Health Coverage (UHC) Using Health Right Concepts 1 174 177 2021/04/242021/06/82021/02/212021/06/292021/04/132021/05/262021/05/72021/07/18 1400/4/27 2021/09/142021/09/52021/09/62021/09/62021/07/192021/09/12021/08/132021/08/16 1400/5/25 محمد مرادی جو Mohammad Moradi-Joo مرکز ملی تحقیقات بیمه سلامت، تهران، ایران moradi2011@yahoo.com مریم سیدنژاد Maryam Seyed-Nezhad گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران maryam.seyyednezhad@gmail.com Universal Health Coverage Health Right پوشش همگانی سلامت حق بر سلامت ## ##