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سیاست‌های کلی تأمین اجتماعی: جعبه ابزار اصلاح نظام تأمین مالی سلامت در ایران 1 78 85 2022/07/25 1401/5/3 2022/09/3 1401/6/12 محمدمهدی تدین Mohammad Mehdi Tadayon مرکز ملی تحقیقات بیمه سلامت، تهران، ایران m.m.tadayon@gmail.com منال اعتمادی Manal Etemadi مرکز ملی تحقیقات بیمه سلامت، تهران، ایران mnletemadi@gmail.com ## ##

عوامل مرتبط با بهرهمندی از خدمات بستری در ایران: کاربرد مدل رفتاری بهرهمندی از خدمات سلامت Factors Related to the Utilization of In-patients Health Services in Iran: Application of Andersen’s Behavioral Model of Health Services Use 1 1 مقدمه: آگاهی از بهره‌مندی از خدمات سلامت و تعیین‌کننده‌های آن برای برنامه‌ریزی‌های حوزه سلامت اهمیت دارد. در مدل رفتاری اندرسن، عوامل مستعد‌کننده، عوامل توانا کننده و عوامل مرتبط با نیاز، بهره‌مندی از خدمات سلامت را تبیین می‌کنند. هدف این مطالعه شناسایی عوامل مرتبط با بهره‌مندی از خدمات بستری در ایران بر اساس مدل مذکور است. روش بررسی: پژوهش حاضر یک مطالعه تحلیل ثانویه است که براساس داده‌های پیمایش ملی بهره‌مندی از خدمات سلامت در سال‌های ۱۳۸۷ و ۱۳۹۴ انجام شد. تعداد افراد نمونه در سال ۱۳۸۷، ۸۳۲۶ و در سال۱۳۹۴، ۵۶۸۴ نفر بود. از رگرسیون لاجیت برای بررسی عوامل مرتبط با بهره‌مندی از خدمات سلامت استفاده شد. یافته ها: بیماران زن (۰۱/۰> P؛۴۸/=OR)، بیماران با سن بالاتر (05/0>P؛01/1=OR)، بیمارانی که نیاز آنها توسط پزشک یا پرسنل درمانی تشخیص داده شده بود (۰۱/۰> P؛۹۸/۱=OR)، بیمارانی که سرپرست خانوارشان دارای تحصیلات بالاتر از دیپلم بود (۰۱/۰> P؛۶۵/۱=OR)، و ساکنان مناطق محروم کشور (۰۵/۰> P؛۴۲/۱=OR) با شانس بیشتری از خدمات بستری بهره‌مند شدند. شانس بهره‌مندی از خدمات بستری در سال ۱۳۹۴ نسبت به سال ۱۳۸۷، بیشتر بود (۰۱/۰> P؛۱۵/۲=OR). نتیجه‌گیری: مدل رفتاری اندرسن می‌تواند چارچوب نظری مناسبی برای تبیین تعیین‌کننده‌های بهره‌مندی از خدمات بستری در ایران باشد. پیشنهاد می‌شود سه دسته عوامل تشکیل‌دهنده این مدل رفتاری، به طور پیوسته در سیاست‌گذاری‌های مرتبط با بهره‌مندی از خدمات بستری مورد توجه قرار گیرد.   2 Introduction: Awareness of benefiting from health services and its determinants is important for health care planning. In Andersen’s behavioral model, predisposing and enabling factors and factors related to need explain the use of health services. The purpose of this study is to identify the factors related to the use of inpatient services in Iran based on the mentioned model. Methods: The present study is a secondary analysis study that was conducted based on the data of the national survey of the use of health services in 2008 and 2015. The number of sampled people was 8326 in 2008 and 5684 in 2015. Logit regression was used to examine the factors related to the use of health services. Results: Female patients (OR=1.48, P<0.01), older patients (OR=0.01, P<0.05), patients whose needs were diagnosed by doctors or medical personnel (OR=1.98, P<0.01), patients whose head of household had higher than diploma education (OR=1.65, P<0.01), and residents of disadvantaged areas of the country (OR=1.42, P<0.05) were more likely to benefit from inpatient services. The chance of benefiting from inpatient services was higher in 2015 than in 2008 (OR=2.15, P<0.01). Conclusion: Andersen’s Behavioral Model of Health Services can be a suitable the theoretical framework to explain the determinants of the use of inpatient health services in Iran. It is suggested that the 3 categories of factors constituting this behavioral model should be continuously considered in policies related to the use of inpatient services. 86 95 2022/07/252022/03/1 1400/12/10 2022/09/32022/07/6 1401/4/15 مژگان نظام‌زاده اژیه Mozhgan Nezamzadeh Ezhieh دانشکده مدیریت و اطلاع‌‌رسانی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران marjan.nezamzade@gmail.com شیرین نصرت‌نژاد Shirin Nosratnejad قطب علمی آموزشی مدیریت سلامت کشور، گروه اقتصاد سلامت، دانشکده مدیریت و اطلاع‌رسانی پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران sh_nosratnejad@yahoo.com مریم معینی Maryam Moeeni مرکز تحقیقات مدیریت و اقتصاد سلامت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران mmoeini1387@gmail.com Health Services Benefits Hospitalization Iran خدمات سلامت بهره مندی بستری ایران 1. 1. Herrmann WJ, Haarmann A, Bærheim A. A sequential model for the structure of health care utilization. PloS one. 2017;12(5):e0176657.##2. Rattay P, Butschalowsky H, Rommel A, Prütz F, Jordan S, Nowossadeck E, et al. Utilisation of outpatient and inpatient health services in Germany. 2013.##3. Motlagh SN, Sabermahani A, Hadian M, Lari MA, Mahdavi MRV, Gorji HA. Factors affecting health care utilization in Tehran. Global journal of health science. 2015;7(6):240.##4. Ghadamgahi HB, Norouzi K, Mohammadi F, Norouzi M, jandaqhi J. uts and determiants of health services utilization among elderly rural hubitants in the Iraninan population. Journal of Semnan University of Medical Sciences. 2018;20(4):603-807.##5. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine. 2012;9:1-15.##6. National Academies of Sciences E, Medicine. Health-Care Utilization as a Proxy in Disability Determination: National Academies Press; 2018.##7. Getaw Walle B, Mhiret Teshome A. Modern health services utilization and associated factors in North East Ethiopia. PLoS One. 2017;12(9).##8. Oladipo JA. Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems. African health sciences. 2014;14(2):322-33.##9. Etemad K, Yavari P, Mehrabi Y, Haghdoost A, Motlagh ME, Kabir MJ, et al. Inequality in utilization of in-patients health services in Iran. International journal of preventive medicine. 2015;6.##10. Qureshi W, Hassan G. A five year retrospective study of bed utilization trends in a tertiary care teaching institution. JK Science. 2014;16(3):119.##11. Al-Omar B, Al-Ghanim S. Utilization of hospital resources: a survey-based study of Saudi hospitals in Riyadh City. Clinical Governance: an international journal. 2010;15(2):134-41.##12. Malcolm L. Trends in hospital bed utilisation in New Zealand 1989 to 2006: more or less beds in the future? The New Zealand Medical Journal (Online). 2007;120(1264).##13. Kanwar V, Gupta AK, Goel S, Gupta PK. Hospital bed utilization: perceptions of healthcare practitioners from Northern India. International Journal of Hospital Research. 2015;4(3):113-8.##14. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health sector evolution plan in Iran; equity and sustainability concerns. International journal of health policy and management. 2015;4(10):637.##15. Observatory on Health System, Islamic Republic of Iran: National Institute for Health Research; 2015.##16. Kim H-K, Lee M. Factors associated with health services utilization between the years 2010 and 2012 in Korea: using Andersen's behavioral model. Osong public health and research perspectives. 2016;7(1):18-25.##17. Hosseinpoor A-R, Naghavi M, Alavian SM, Speybroeck N, Jamshidi H, Vega J. Determinants of seeking needed outpatient care in Iran: results from a national health services utilization survey. Archives of Iranian medicine. 2007;10(4):439-45.##18. Esmailnasab N, Hassanzadeh J, Rezaeian S, Barkhordari M. Use of health care services and associated factors among women. Iranian journal of public health. 2014;43(1):70.##19. Andersen RM. National Health Surveys and the Behavioral Model of Health Services Use. Medical Care. 2008;46(7):647-53.##20. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly. 2005;83(4):Online‐only-Online‐only.##21. Erlangga D, Ali S, Bloor K. The impact of public health insurance on healthcare utilisation in Indonesia: evidence from panel data. International Journal of Public Health. 2019.##22. Lotfi F, Nouraei Motlagh S, Mahdavi G, Keshavarz K, Hadian M, Abolghasem Gorji H. Factors Affecting the Utilization of Outpatient Health Services and Importance of Health Insurance. Shiraz E-Medical Journal. 2017;18(8).##23. Girma F, Jira C, Girma B. Health services utilization and associated factors in jimma zone, South west ethiopia. Ethiopian journal of health sciences. 2011;21(3):91-100.##24. Li Y-N, Nong D-x, Wei B, Feng Q-M, Luo H-y. The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China. BMC health services research. 2016;16(1):592.##25. Tesfaye G, Chojenta C, Smith R, Loxton D. Application of the Andersen-Newman model of health care utilization to understand antenatal care use in Kersa District, Eastern Ethiopia. PloS one. 2018;13(12):e0208729.##26. SoleimanvandiAzar N, Kamal SHM, Sajjadi H, Harouni GG, Karimi SE, Djalalinia S, et al. Determinants of outpatient health service utilization according to Andersen’s Behavioral Model: A systematic scoping review. Iranian Journal of Medical Sciences. 2020;45(6):405.##27. Aliakbari Saba R, Safakish M. Utilization of health services in the country of Iran. Journal of Amar. 2015;16:9-16.##28. Fan X, Su M, Zhao Y, Si Y, Zhou Z. Trends in equity of inpatient health service utilization for the middle-aged and elderly in China: based on longitudinal data from 2011 to 2018. BMC Public Health. 2021;21(1):1-10.##29. Zhou Z, Gao J, Fox A, Rao K, Xu K, Xu L, et al. Measuring the equity of inpatient utilization in Chinese rural areas. BMC health services research. 2011;11(1):201.##30. Park JM. Equity in the utilization of physician and inpatient hospital services: evidence from Korean health panel survey. International journal for equity in health. 2016;15(1):1-9.##31. Tajvar M, MOSADEGHRAD A, Yaseri M, Mohammadi M. Utilization of Inpatient Services by Older People in Iran and its Determinants. 2020.##32. Narcisse M-R, Felix H, Long CR, Hudson T, Payakachat N, Bursac Z, et al. Frequency and predictors of health services use by Native Hawaiians and Pacific Islanders: evidence from the US National Health Interview Survey. BMC health services research. 2018;18(1):1-14.##33. Nooraiee Motlagh S, Sabermahani A, Barooni M, Asadi Lari M, Vaez Mahdavi MR, Hadian M. Determining factors related to health services utilization:case of Tehran. Razi Journal ofMedical Sciences. 2015;21(127):61-72.##34. Rezapoor A, Roumiani Y, Azar F, Ghazanfari S, Mirzaei S, Asiabar A, et al. Effective factors on utilization and access to health care: a population-based study in Kerman. Journal of Health Administration (JHA). 2015;18(60).##35. Moreno-Lostao A, Lostao L, Beller J, Sperlich S, Ronda-Pérez E, Geyer S, et al., editors. Trends and equity in the use of health services in Spain and Germany around austerity in Europe2021: BMC.##36. Olyaeemanesh A, Manavi S, Aghajani M. Implementing the Health Transformation Plan with Emphasis on Supporting the Survival of Physicians in Deprived Areas: The Results and Challenges. Hakim Health Sys Res. 2017;19(4):228-37.##37. Bose M, Dutta A. Inequity in hospitalization care: a study on utilization of healthcare services in West Bengal, India. International journal of health policy and management. 2015;4(1):29.##38. Fan X, Su M, Si Y, Zhao Y, Zhou Z. The benefits of an integrated social medical insurance for health services utilization in rural China: evidence from the China health and retirement longitudinal study. International journal for equity in health. 2021;20(1):1-10.##39. BAŞAR DİKMEN D, ÖZTÜRK S, ÇAKMAK İ. An Application of the Behavioral Model to the Utilization of Health Care Services in Turkey: A Focus on Equity. 2021.##40. Tungu M, Amani PJ, Hurtig A-K, Dennis Kiwara A, Mwangu M, Lindholm L, et al. Does health insurance contribute to improved utilization of health care services for the elderly in rural Tanzania? A cross-sectional study. Global Health Action. 2020;13(1):1841962.##1. Herrmann WJ, Haarmann A, Bærheim A. A sequential model for the structure of health care utilization. PloS one. 2017;12(5):e0176657.##2. Rattay P, Butschalowsky H, Rommel A, Prütz F, Jordan S, Nowossadeck E, et al. Utilisation of outpatient and inpatient health services in Germany. 2013.##3. Motlagh SN, Sabermahani A, Hadian M, Lari MA, Mahdavi MRV, Gorji HA. Factors affecting health care utilization in Tehran. Global journal of health science. 2015;7(6):240.##4. Ghadamgahi HB, Norouzi K, Mohammadi F, Norouzi M, jandaqhi J. uts and determiants of health services utilization among elderly rural hubitants in the Iraninan population. Journal of Semnan University of Medical Sciences. 2018;20(4):603-807.##5. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine. 2012;9:1-15.##6. National Academies of Sciences E, Medicine. Health-Care Utilization as a Proxy in Disability Determination: National Academies Press; 2018.##7. Getaw Walle B, Mhiret Teshome A. Modern health services utilization and associated factors in North East Ethiopia. PLoS One. 2017;12(9).##8. Oladipo JA. Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems. African health sciences. 2014;14(2):322-33.##9. Etemad K, Yavari P, Mehrabi Y, Haghdoost A, Motlagh ME, Kabir MJ, et al. Inequality in utilization of in-patients health services in Iran. International journal of preventive medicine. 2015;6.##10. Qureshi W, Hassan G. A five year retrospective study of bed utilization trends in a tertiary care teaching institution. JK Science. 2014;16(3):119.##11. Al-Omar B, Al-Ghanim S. Utilization of hospital resources: a survey-based study of Saudi hospitals in Riyadh City. Clinical Governance: an international journal. 2010;15(2):134-41.##12. Malcolm L. Trends in hospital bed utilisation in New Zealand 1989 to 2006: more or less beds in the future? The New Zealand Medical Journal (Online). 2007;120(1264).##13. Kanwar V, Gupta AK, Goel S, Gupta PK. Hospital bed utilization: perceptions of healthcare practitioners from Northern India. International Journal of Hospital Research. 2015;4(3):113-8.##14. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health sector evolution plan in Iran; equity and sustainability concerns. International journal of health policy and management. 2015;4(10):637.##15. گزارش سالانه دیدبانی طرح تحول سلامت در سال 1393 موسسه تحقیقات سلامت 1394.##16. Kim H-K, Lee M. Factors associated with health services utilization between the years 2010 and 2012 in Korea: using Andersen's behavioral model. Osong public health and research perspectives. 2016;7(1):18-25.##17. Hosseinpoor A-R, Naghavi M, Alavian SM, Speybroeck N, Jamshidi H, Vega J. Determinants of seeking needed outpatient care in Iran: results from a national health services utilization survey. Archives of Iranian medicine. 2007;10(4):439-45.##18. Esmailnasab N, Hassanzadeh J, Rezaeian S, Barkhordari M. Use of health care services and associated factors among women. Iranian journal of public health. 2014;43(1):70.##19. Andersen RM. National Health Surveys and the Behavioral Model of Health Services Use. Medical Care. 2008;46(7):647-53.##20. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly. 2005;83(4):Online‐only-Online‐only.##21. Erlangga D, Ali S, Bloor K. The impact of public health insurance on healthcare utilisation in Indonesia: evidence from panel data. International Journal of Public Health. 2019.##22. Lotfi F, Nouraei Motlagh S, Mahdavi G, Keshavarz K, Hadian M, Abolghasem Gorji H. Factors Affecting the Utilization of Outpatient Health Services and Importance of Health Insurance. Shiraz E-Medical Journal. 2017;18(8).##23. Girma F, Jira C, Girma B. Health services utilization and associated factors in jimma zone, South west ethiopia. Ethiopian journal of health sciences. 2011;21(3):91-100.##24. Li Y-N, Nong D-x, Wei B, Feng Q-M, Luo H-y. The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China. BMC health services research. 2016;16(1):592.##25. Tesfaye G, Chojenta C, Smith R, Loxton D. Application of the Andersen-Newman model of health care utilization to understand antenatal care use in Kersa District, Eastern Ethiopia. PloS one. 2018;13(12):e0208729.##26. SoleimanvandiAzar N, Kamal SHM, Sajjadi H, Harouni GG, Karimi SE, Djalalinia S, et al. Determinants of outpatient health service utilization according to Andersen’s Behavioral Model: A systematic scoping review. Iranian Journal of Medical Sciences. 2020;45(6):405.##27. Aliakbari Saba R, Safakish M. Utilization of health services in the country of Iran. Journal of Amar. 2015;16:9-16.##28. Fan X, Su M, Zhao Y, Si Y, Zhou Z. Trends in equity of inpatient health service utilization for the middle-aged and elderly in China: based on longitudinal data from 2011 to 2018. BMC Public Health. 2021;21(1):1-10.##29. Zhou Z, Gao J, Fox A, Rao K, Xu K, Xu L, et al. Measuring the equity of inpatient utilization in Chinese rural areas. BMC health services research. 2011;11(1):201.##30. Park JM. Equity in the utilization of physician and inpatient hospital services: evidence from Korean health panel survey. International journal for equity in health. 2016;15(1):1-9.##31. Tajvar M, MOSADEGHRAD A, Yaseri M, Mohammadi M. Utilization of Inpatient Services by Older People in Iran and its Determinants. 2020.##32. Narcisse M-R, Felix H, Long CR, Hudson T, Payakachat N, Bursac Z, et al. Frequency and predictors of health services use by Native Hawaiians and Pacific Islanders: evidence from the US National Health Interview Survey. BMC health services research. 2018;18(1):1-14.##33. Nooraiee Motlagh S, Sabermahani A, Barooni M, Asadi Lari M, Vaez Mahdavi MR, Hadian M. Determining factors related to health services utilization:case of Tehran. Razi Journal ofMedical Sciences. 2015;21(127):61-72.##34. Rezapoor A, Roumiani Y, Azar F, Ghazanfari S, Mirzaei S, Asiabar A, et al. Effective factors on utilization and access to health care: a population-based study in Kerman. Journal of Health Administration (JHA). 2015;18(60).##35. Moreno-Lostao A, Lostao L, Beller J, Sperlich S, Ronda-Pérez E, Geyer S, et al., editors. Trends and equity in the use of health services in Spain and Germany around austerity in Europe2021: BMC.##36. Olyaeemanesh A, Manavi S, Aghajani M. Implementing the Health Transformation Plan with Emphasis on Supporting the Survival of Physicians in Deprived Areas: The Results and Challenges. Hakim Health Sys Res. 2017;19(4):228-37.##37. Bose M, Dutta A. Inequity in hospitalization care: a study on utilization of healthcare services in West Bengal, India. International journal of health policy and management. 2015;4(1):29.##38. Fan X, Su M, Si Y, Zhao Y, Zhou Z. The benefits of an integrated social medical insurance for health services utilization in rural China: evidence from the China health and retirement longitudinal study. International journal for equity in health. 2021;20(1):1-10.##39. Tungu M, Amani PJ, Hurtig A-K, Dennis Kiwara A, Mwangu M, Lindholm L, et al. Does health insurance contribute to improved utilization of health care services for the elderly in rural Tanzania? A cross-sectional study. Global Health Action. 2020;13(1):1841962.##40. BAŞAR DİKMEN D, ÖZTÜRK S, ÇAKMAK İ. An Application of the Behavioral Model to the Utilization of Health Care Services in Turkey: A Focus on Equity. 2021. ##

رویکرد باورمندی به پیشگویی هزینه‌های درمان: مطالعه موردی بررسی هزینه‌های دندانپزشکی A Credibility Approach to Predicting Healthcare Costs: A Case Study of Dental Costs 1 1 مقدمه: افزایش هزینه‌های خدمات پزشکی و سالمند شدن جمعیت ایران، مشکلاتی را برای صنعت بیمه درمان به وجود آورده که این حوزه را به یکی از پرمخاطره‌ترین حوزه‌ها تبدیل کرده است. در این شرایط یکی از اساسی‌ترین نیازهای این حوزه، برازش مدلی مناسب به خسارت‌های درمان است، به‌طوری‌که بیمه‌گر بتواند روند هزینه‌های درمان را بررسی کند، برآورد دقیقی از خسارت‌های سال آینده داشته باشد و حق بیمه متناسب با آن را محاسبه کند. روش بررسی: با مطالعه بنیادی تجربی، داده‌های خسارت‌ مربوط به بیمه‌نامه‌های درمان گروهی صادره از اواسط سال ۱۳۹۷ تا اواسط ۱۳۹۹ شرک بیمه دی جمع‌آوری شد و با استفاده از توزیع‌های آمیخته، خسارت‌های دندانپزشکی مدل‌بندی شد و با استفاده از روش باورمندی خسارت سال آینده پیش‌بینی شد. یافته‌ها: باتوجه به ناهمگنی موجود در دادها، توزیع‌ های آمیخته به دلیل انعطاف‌پذیری بالا برازش مناسب‌ تری خواهد داشت. افراد بیمه ‌ شده باتوجه به مشخصات آنها در 2 دسته پرریسک و کم‌ریسک تقسیم‌ شدند و به هر یک از این دسته‌ها یک توزیع برازش داده‌ شده است. توزیع کلی خسارت ‌ها را یک توزیع آمیخته از این توزیع‌ ها در نظر گرفته که وزن‌های آمیختگی این توزیع با استفاده از رگرسیون لجستیک برآورد شد. نتیجه‌گیری: یکی از اساسی‌ترین مسائل در انواع بیمه‌ها، تعیین حق بیمه‌‌‌ آنهاست. در این پژوهش با استفاده از نظریه‌ باورمندی، برای هر یک از بیمه‌ شده‌ها باتوجه به پارامتر ریسک آنها حق بیمه سال آینده محاسبه می‌شود. درواقع باورمندی، حق بیمه‌‌‌ موجود را با خسارت‌های گذشته ترکیب کرده و حق بیمه‌‌ ‌تعدیل‌ شده را ارائه می‌دهد. 2 Introduction: The increase in the cost of medical services and the aging of Iran's population have created problems for the medical insurance industry, which has turned this field into one of the most risky fields. In this situation, one of the most basic needs of this field is to fit a suitable model to the treatment losses, so that the insurer can check the trend of the treatment costs, have an accurate estimate of the next year's losses, and calculate the corresponding insurance premium. Methods: Based on an empirical fundamental study, the loss data related to group treatment insurance policies issued from the middle of 2017 to the middle of 2019 was collected by Day insurance company and using mixed distributions, dental claims were modeled and the loss of the next year was predicted using the credibility method. Results: Due to the heterogeneity in the data, mixed distribution will be more suitable due to its high flexibility. The insured people were divided into 2 high-risk and low-risk categories according to their characteristics, and a distribution was given to each of these categories. The general distribution of damages is considered as a mixed distribution of these distributions, and the mixed weights of this distribution were estimated using logistic regression. Conclusion: One of the most basic issues in all types of insurances is determining their insurance premiums. In this research, using the theory of credibility, the next year's insurance premium is calculated for each of the insured according to their risk parameter. In fact, credibility theory combines the existing insurance premium with past losses and provides the adjusted premium.   96 107 2022/07/252022/03/12022/03/16 1400/12/25 2022/09/32022/07/62022/07/24 1401/5/2 احسان جهان‌بانی Ehsan Jahanbani گروه بیم‌سنجی، دانشکده علوم ریاضی، دانشگاه شهید بهشتی، تهران، ایران e.jahanbani1370@gmail.com امیرتیمور پاینده نجف‌آبادی Amirteymor Payandeh Najafabadi گروه بیم‌سنجی، دانشکده علوم ریاضی، دانشگاه شهید بهشتی، تهران، ایران amirtpayandeh@gmail.com خالد معصومی‌فرد Khaled Masoumifard گروه بیم‌سنجی، دانشکده علوم ریاضی، دانشگاه شهید بهشتی، تهران، ایران masoumifardk@yahoo.com Finite Mixed Distribution Complementary Treatment Logistic Regression Dentistry توزیع آمیخته متناهی درمان تکمیلی رگرسیون لجستیک دندانپزشکی 1) World Health Organization. (2015). World report on ageing and health. World Health Organization.##2) Sadeghu, R. (2009). Population and development in Iran: Dimensions and challenges. Tehran: National Population Studies & Comprehensive Management Institute.##3) REZAEIAN, M., ASADPOUR, M., & HADAVI, M. (2013). Research barriers from the perspective of academic members and strategies for confronting with these barriers in Rafsanjan University of Medical Sciences, Iran.##4) Hakimzadeh, S. M., Hosseini Shokouh, S. M., Bahadori, M., & Tahernezhad, K. (2014). Research needs assessment and priority setting for health economics: a mixed method study in Iran. Journal Mil Med, 16(1), 23-28.##5) Akbarzadeh BAR, M, Esmaeili M, Kimiafar Kh. Medical information management and assessment of direct costs of treatment of lung cancer. Health Information Management. 2009;5(210):151-8.[Persian]##6) Pearson, K. (1894). Contributions to the mathematical theory of evolution. Philosophical Transactions of the Royal Society of London. A, 185, 71-110.##7) Feddern, H. A. (1968). Hybridization between the western Atlantic angelfishes, Holacanthus isabelita and H. ciliaris. Bulletin of Marine Science, 18(2), 351-382.##8) Whitney, A.W. The theory of experience rating, Proceedings of the Casualty Actuarial Society, vol. 4, 275–293, 1918.##9) Keffer, R. (1929). An experience rating formula. Transactions of the Actuarial Society of America, 30, 130-139.##10) Bailey, A. L. (1950). Credibility Procedures: Laplace's generalization of Bayes' Rule and the combination of collateral knowledge with observed data. New York State Insurance Department.##11) Bühlmann, H., & Straub, E. (1970). Glaubwürdigkeit für schadensätze. Bulletin of the Swiss Association of Actuaries, 70(1), 111-133.##12) Norberg, R. (2004). Credibility theory. Encyclopedia of Actuarial Science.##13) Box, G. E. (1976). Science and statistics. Journal of the American Statistical Association, 71(356), 791-799.##14) Redner, R. A., & Walker, H. F. (1984). Mixture densities, maximum likelihood and the EM algorithm. SIAM review, 26(2), 195-239.##15) McLachlan, G. J., & Basford, K. E. (1988). Mixture models: Inference and applications to clustering (Vol. 84). New York: M. Dekker.##16) Berger, J. O. (1985). Prior information and subjective probability. In Statistical Decision Theory and Bayesian Analysis (pp. 74-117). Springer, New York, NY.##17) Besag, J., Green, P., Higdon, D., & Mengersen, K. (1995). Bayesian computation and stochastic systems. Statistical science, 10(1), 3-41.##18) Payandeh Najafabadi, A. T.,, Barmalzan, G., & Aghaei, S. (2017). A weighted model confidence set: applications to local and mixture model confidence sets. International Journal of Mathematical Modelling and Numerical Optimisation, 8(2), 127-144.##19) Hunter, D. R., & Lange, K. (2004). A tutorial on MM algorithms. The American Statistician, 58(1), 30-37.##20) Lange, K. (2013). The MM algorithm. In Optimization (pp. 185-219). Springer, New York, NY.##21) Nguyen, H. D., & McLachlan, G. J. (2016). Maximum likelihood estimation of triangular and polygonal distributions. Computational Statistics & Data Analysis, 102, 23-36.##22) Dempster, Arthur P., Nan M. Laird, and Donald B. Rubin. "Maximum likelihood from incomplete data via the EM algorithm." Journal of the Royal Statistical Society: Series B (Methodological) 39.1 (1977): 1-22.##23) Payandeh Najafabadi, A. T., & Sakizadeh, M. (2019). Designing an Optimal Bonus--Malus System Using the Number of Reported Claims, Steady-State Distribution, and Mixture Claim Size Distribution. International Journal of Industrial and Systems Engineering, 32(3), 304-331.## ##

مقایسه دو الگوریتم خوشه ­بندی PAM و CLARA به‌منظور بررسی علل مرگ و میر در جمعیت تحت پوشش دانشگاه علوم پرشکی مشهد Comparison of PAM and CLARA Clustering Algorithms for Assessing the Causes of Mortality in the Population Covered by Mashhad University of Medical Sciences, Iran 1 1 مقدمه: تحلیل اطلاعات مربوط به مرگ و میر یکی از ابزارهای مهم در سیاست گذاری سلامت برای هر کشوری است. مطالعه حاضر به منظور خوشه بندی افراد فوت شده در سال ۱۳۹۶ در منطقه تحت پوشش دانشگاه علوم پزشکی مشهد انجام شد. روش بررسی: مطالعه تحلیلی و مقطعی بر روی تعداد ۲۱۸۳۸ مرگ گزارش شده در سال ۱۳۹۶ در جمعیت تحت پوشش دانشگاه علوم پزشکی مشهد که از سامانه نظام ثبت مرگ این دانشگاه استخراج شد، انجام شد. پس از پاک سازی داده ها و رفع نواقص موجود، افراد با دو الگوریتم PAM و CLARA براساس ۴ متغیر سن، جنس، علت مرگ و منطقه محل سکونت خوشه‌بندی شدند. تعداد بهینه خوشه ها و ارزیابی عملکرد خوشه بندی با استفاده از معیار میانگین سیلوئت حاصل شد. یافته ها: براساس معیار سیلوئت، بیشترین تفاوت بین خوشه ها با تعداد ۵ خوشه مشاهده شد. در تمامی خوشه ها (به جز خوشه سوم) که شامل افراد بالای ۶۵ سال (۵/۶۴ درصد) بودند، به ترتیب بیماری های گردش خون (۴۳ درصد)، نئوپلاسم-ها (۱۷ درصد)، بیماری های تنفسی (۱۰ درصد) و بیماری های غدد دورن ریز، تغذیه ای و سوخت و ساز (۶ درصد) شایع-ترین علت مرگ و میر بودند. در خوشه سوم، مهم ترین علل مرگ و میر ناهنجاری های مادرزادی، تغییر شکل و شرایط خاص ناشی از ناهنجاری مادرزادی (۴۴ درصد) و بیماری با منشأ قبل از دوران تولد (۱۹ درصد) برای کودکان زیر یک سال (۷۴ درصد) بود. نتیجه گیری: توزیع سنی علل مرگ جزو موارد بسیار مهم است. وجود ناهنجاری های مادرزادی و بیماری با منشأ قبل از دوران تولد در کودکان زیر یک‌سال، همچنین علت مرگ به دلیل وجود سرطان در سنین کمتر از ۱۴ سال، با توجه به سیاست های پیش  رو درمورد جوانی جمعیت باید مد نظر سیاست گذاران سلامت قرار گیرد. درصد بالای مرگ به دلیل بیماری های عصبی، از جمله مواردی است که می‌توان با مطالعه دقیق درباره آن  نقشه راه سلامت را برنامه ریزی کرد. 2 Introduction: Analysing data related to morality is one of the important tools in health policy for any country. The present study was conducted in order to cluster people who died in 2017 in the area covered by Mashhad University of Medical Sciences. Methods: An analytical and cross-sectional study was conducted on the number of 21,838 deaths reported in 2017 in the population covered by Mashhad University of Medical Sciences, which were extracted from the death registration system of this university. After cleaning the data and fixing the existing defects, people were clustered with PAM and CLARA algorithms based on 4 variables: age, gender, cause of death and region of residence. The optimal number of clusters and the evaluation of the clustering performance were obtained using the average silhouette criterion. Results: According to the silhouette criterion, the biggest difference between the clusters was observed with the number of five clusters. In all clusters (except the third cluster), which included people over 65 years old (64.5%), circulatory diseases (43%), neoplasms (17%), diseases of the respiratory system (10%) and Endocrine, nutritional and metabolic diseases (6%) were the most common cause of death. In the third cluster, the most important causes of death were congenital malformations, deformation (44%) and diseases of prenatal origin (19%) for children under 1 year of age (74%). Conclusion: Age distribution of the causes of death is one of the most important cases. The existence of congenital malformations, deformation, and diseases of prenatal origin for children under 1 year of age, as well as the cause of death due to the presence of cancer at the age of less than 14 years, according to the upcoming policies regarding the youth of the population, should be considered by health care providers. The high percentage of death due to neurological diseases is one of the cases that can be studied carefully to plan a health road map. 108 117 2022/07/252022/03/12022/03/162022/04/5 1401/1/16 2022/09/32022/07/62022/07/242022/07/26 1401/5/4 مریم سالاری Maryam Salari گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران salarimr@mums.ac.ir سارا صباغیان طوسی Sarah Sabbaghian Tousi گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران SabbaghianS9@mums.ac.ir صدیقه رستاقی Sedighe Rastaghi کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی مشهد، مشهد، ایران RastaghiS971@mums.ac.ir پرستو گلپور Parastoo Golpour گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران GolpourP9@mums.ac.ir محمد وجدانی Mohammad Vejdani گروه جراحی عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران vejdanim1@mums.ac.ir سید مسعود ساداتی Seyyed Masoud Sadati گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران sadatim1@mums.ac.ir محمدتقی شاکری Mahammad Taghi Shakeri گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران ShakeriMT@mums.ac.ir Cluster Analysis Mortality Cause of Death تحلیل خوشه‌ای مرگ و میر علت مرگ. 1. Organization WH. International statistical classification of diseases and related health problems: World Health Organization; 2004.##2. http://www.sbmu.ac.ir/uploads.##3. England PHEJHPf. Chapter 2: Major causes of death and how they have changed. 2017.##4. Vallin J, Schofield R, Reher D, Bideau A. The decline of mortality in Europe. Mortality in Europe from 1720 to 1914: long-term trends and changes in patterns by age and sex. 1991:38-67.##5. Meslé F, Vallin J, Andreyev Z. Mortality in Europe: the divergence between east and west. Population. 2002;57(1):157-97.##6. Aghamohammadi S, Kazemi E, Khosravi A, Kazemeini H. The trend of ten leading causes of death in the Islamic Republic of Iran, 2006-2011. Iranian Journal of Epidemiology. 2017;12(4):1-11.##7. Han J, Kamber M, Pei J. Data mining concepts and techniques third edition. The Morgan Kaufmann Series in Data Management Systems. 2011:83-124.##8. Kaufman L, Rousseeuw PJ. Finding groups in data: an introduction to cluster analysis: John Wiley & Sons; 2009.##9. Reynolds AP, Richards G, de la Iglesia B, Rayward-Smith VJ. Clustering rules: a comparison of partitioning and hierarchical clustering algorithms. Journal of Mathematical Modelling and Algorithms. 2006;5(4):475-504.##10. Kaufman L, Rousseeuw PJ. Clustering by means of medoids. Statistical Data Analysis based on the L1 Norm. Y Dodge, Ed. 1987:405-16.##11. Gower J. Coeffecients of association and similarity, based on binary (presence-absence) data: An evaluation. Biometrics. 1971;27:857-71.##12. Sasanipour M, Mohebi M, Shahbazin S. Changes in the Mortality pattern in Iran with an emphasis on the Working age population in recent decade. Journal of Population Association of Iran. 2016;11(21):190-210.##13. Aungkulanon S, Tangcharoensathien V, Shibuya K, Bundhamcharoen K, Chongsuvivatwong V. Area-level socioeconomic deprivation and mortality differentials in Thailand: results from principal component analysis and cluster analysis. International journal for equity in health. 2017;16(1):117.##14. KAZEMIPOUR SH.. A REVIEW OF MORTALITY RATES AND CAUSES IN GREATER TEHRAN IN THE PERSIAN CALENDAR YEAR 1375 (1996-1997). NAMEH-YE OLUM-E EJTEMAI. ##15. Roger VL. Epidemiology of myocardial infarction. Med Clin North Am. 2007;91(4):537-52; ix.##16. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146.##17. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35(42):2950-9.##18. Heron M. Deaths: Leading Causes for 2016. Natl Vital Stat Rep. 2018;67(6):1-77.##19. Kochanek KD, Murphy SL, Xu J, Arias E. Deaths: final data for 2017. 2019.##20. Torkashvand Moradabadi M, Abbasi M. An Epidemiological study of mortality among elderly in Iran using Years of Life Lost (YLL) index during 2011 to 2017. Payesh. 2020; 19 (1) :85-97 .##21. O'Neill S, O'Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obesity reviews. 2015;16(1):1-12.##22. Hess PL, Al‐Khalidi HR, Friedman DJ, Mulder H, Kucharska‐Newton A, Rosamond WR, et al. The metabolic syndrome and risk of sudden cardiac death: the atherosclerosis risk in communities study. Journal of the American Heart Association. 2017;6(8):e006103.##23. Celine T. A study on childhood death at a tertiary care level in ernakulam district. Annals of medical and health sciences research. 2013;3(3):407-11.##24. Pickett W, Streight S, Simpson K, Brison RJ. Injuries experienced by infant children: a population-based epidemiological analysis. Pediatrics. 2003;111(4):e365-e70.## ##

کاربرد رهیافت مدل‌های پویا در صندوق‌های بیمه‌گر اجتماعی با لحاظ تبعات ناشی از همه‌گیری بیماری کرونا؛ مطالعه موردی سازمان تأمین اجتماعی ایران The Application of the Dynamic Model Approach in Social Insurance Funds in Terms of the Consequences of the Corona Epidemic; A Case Study of Social Security Organization of Iran 1 1 مقدمه: سازمان تأمین اجتماعی به عنوان بزرگ‌ترین سازمان بیمه اجتماعی کشور نقش مهم و تعیین‌کننده‌ای در تأمین سلامت و پویایی جامعه ایفا می‌کند و از مهم‌ترین اهداف آن تامین خدمات متنوع بیمه‌ای و درمانی افراد تحت پوشش است. اما دستیابی به این مهم زمانی به نحو مطلوب امکان‌پذیر است که منابع و مصارف و عوامل موثر بر آنها، که پیش شرط ارائه خدمات و مصارف آنهاست، با دقت و شفافیت شناخته شود و مورد تجزیه و تحلیل قرار گیرد. روش بررسی: در این پژوهش، با مدل‌سازی منابع و مصارف سازمان تأمین اجتماعی با روش پویایی‌شناسی سیستم‎ها، اقدام به بررسی تاثیرات بیماری کرونا و همچنین پیش‎بینی شرایط این سازمان در سال‌های آتی و ارائه پیشنهاداتی برای رفع مشکلات آن شده است. یافته‌ها: بنا بر یافته‎های این پژوهش، افزایش حق بیمه دریافتی از ۳۰ به ۳۵درصد و همچنین افزایش سن بازنشستگی به میزان ۵ سال، می‎تواند منابع این سازمان را افزایش داده و از ورشکستگی آن جلوگیری کند. نتیجه گیری: اتخاذ سیاست‎های پیشنهاد شده در این پژوهش، باوجود تاثیرگذاری بعضا بسیار زیاد، به تنهایی نمی‎تواند برای جلوگیری از ورشکستگی صندوق تأمین اجتماعی رویکرد مفیدی ارائه دهد. به منظور اطمینان از بهبود شرایط صندوق، پیشنهاد می‌شود علاوه بر سیاست‎های پیشنهاد شده در زمینه تغییر سیستم تأمین اجتماعی و همچنین اتخاذ سیاست‎های بلندمدت و میان‎مدت کارآمدتر تغییراتی انجام شود تا رویکرد مناسبی برای برون‌رفت از شرایط کنونی انتخاب شود. 2 Introduction: The Social Security Organization, as the largest social insurance organization in the country, plays an important and decisive role in ensuring the health and dynamism of the society, and one of its most important goals is to provide various insurance and medical services to the covered people. But achieving this goal is possible when the sources and costs and the factors affecting them, which are the prerequisites for providing services and their costs, are accurately and transparently known and analysed. Method: In this research, by modelling the resources and expenses of the social security organization with the system dynamics method, it has been investigated the effects of the corona disease, as well as forecasting the conditions of this organization in the coming years and providing suggestions to solve its problems. Results: According to the findings of this research, increasing the insurance premium received from 30 to 35%, as well as increasing the retirement age by 5 years, can increase the resources of this organization and prevent its bankruptcy. Conclusion: The adoption of the policies proposed in this research, despite their sometimes very high impact, alone cannot provide a useful approach to prevent the bankruptcy of the Social Security Fund. In order to ensure the improvement of the conditions of the fund, it is suggested that in addition to the proposed policies in the field of changing the social security system, as well as adopting more efficient long-term and mid-term policies, some changes should be made in order to choose a suitable approach to overcome the current situation. 118 128 2022/07/252022/03/12022/03/162022/04/52022/06/25 1401/4/4 2022/09/32022/07/62022/07/242022/07/262022/08/21 1401/5/30 کیوان مرتضوی سرایی Keyvan Mortazavi Saraee گروه اقتصاد، دانشگاه آزاد اسلامی، واحد فیروزکوه، تهران، ایران mortazavi.keyvan@yahoo.com محمود محمودزاده Mahmoud Mahmoudzadeh گروه اقتصاد، دانشگاه آزاد اسلامی، واحد فیروزکوه، تهران، ایران modellinge@yahoo.com حمیدرضا ایزدبخش Hamidreza Izadbakhsh گروه مهندسی صنایع، دانشکده فنی و مهندسی، دانشگاه خوارزمی، تهران، ایران hizadbakhsh@khu.ac.ir Social Security Organization Resources and Expenses Systems Dynamics سازمان تأمین اجتماعی منابع و مصارف پویایی‌شناسی سیستم‌ها 1- Prskawetz A, Sambt J. Economic support ratios and the demographic divided in Europe. Demographic research. 2014;34:963-1010## 2- Karimnezhad S, Najafbeigi R, Daneshfard K, Alamtabriz A. Designing A Grounded Theory Approach For Financial Governance Model In Social Security Organization. SANAAT-E-BIMEH QUARTERLY.2019; 132:63-79##3- javaheri tafti, M. Empowerment and sustainability of the Social Security Organization. Progress and Excellence Research, 2021; 3(2)##4- Azar A, Safari M. Identifying factors affecting the sustainability of private pension plans using a mixed methodology approach. Iranian Management Sciences Quarterly.2016; 23: 21-58.##5- Izadbakhsh H, Davari Ardakani A, Zarinbal M. A Systematic Approach for Asset Liability Management of Pension Funds in a Fuzzy Environment. Journal of Economic Modeling Research Kharazmi University. 2017; 8(29); 201-239.##6- Hosseini, S.H. and H. Shakouri, A study on the future of unconventional oil development under different oil price scenarios: A system dynamics approach. Energy Policy, 2016. 91: p. 64-74##7- Sterman D. System dynamics modeling: tools for learning in a complex world. California management review, 2001. 43(4): 8-25.##8- Gunnarsson B. Risk management in Almenni collective pension fund 2013.##9- Li X, Wu X, & Yao H. (2020). Multi-period asset-liability management with cash flows and probability constraints: A mean-field formulation approach. Journal of the Operational Research Society. 2020;71(10), 1563-1580.## ##

تدوین مدل سیاست گذاری برای توانمندسازی بیمه شدگان بیمه سلامت ایران Developing a Policymaking Model for Empowering the Insured of the Iran Health Insurance Organization 1 1 مقدمه: پژوهش حاضر به دنبال طراحی مدل توانمندسازی بیمه شدگان بیمه سلامت است تا طی آن بیمه شدگان بتوانند به سطح قابل قبولی از توانمندی دست پیدا کنند. دلیل انتخاب این گروه از بیمه شدگان، جمعیت زیاد و قابل ملاحظه آنان در کشور است؛ به گونه ای که اکنون حدود ۵۰ درصد از جمعیت ایران را شامل می‌شوند. روش بررسی: رویکرد روش‌شناختی این پژوهش کیفی و از نوع نظریه مبنایی، فنون داده یابی مصاحبه عمیق و نیمه ساختاریافته است. برای داده‌کاوی از روش کدگذاری نظری استفاده شد که دستیابی به مقولات اصلی و فرعی در  راستای تنظیم مدل نظری مدنظر است. تعداد نمونه ۱۵ نفر از متخصصان و خبرگان حوزه بیمه سلامت است که به صورت هدفمند انتخاب شده اند. یافته ها: نتایج پژوهش نشان می دهد که پدیده محوری توانمندی اجتماع‌محور است که مبتنی بر شرایط علّی، شرایط زمینه ای، شرایط مداخله‌کننده و راهبردها به دست آمده است. مهم ترین راهبردها حق دسترسی بیمه شدگان به خدمات و فرصت های بیمه ای است. در بحث از شرایط زمینه ای مؤلّفه های مهمی چون عاملیت، احساس برابری و شمول (ادغام) و ظرفیت سازی مورد تأکید است. همچنین یافته ها نشان می دهد مؤلفه هایی چون حفظ حقوق بیمه شدگان، منابع توانمندساز و کارآمد و کیفی بودن خدمات بیمه ای به عنوان شرایط علّی مورد توجه هستند. نتیجه‌گیری: بنا بر یافته های پژوهش حاضر ۳ مقوله اصلی آموزش و اطلاع‌رسانی، مشارکت اجتماعی و حمایت اجتماعی به عنوان شرایط مداخله گر مطرح شده اند. تکمیل کننده زنجیره مدل پارادایمی پژوهش حاضر مبتنی بر روش نظریه داده بنیاد پیامدها هستند که توانمندسازی را در ۴ بخش عمده توانمندی اجتماعی، توانمندی فرهنگی، توانمندی اقتصادی و توانمندی روانی بیمه شدگان مورد واکاوی قرار داده است 2 Introduction: The present study seeks to design a health insurance empowerment model so that the insured can achieve an acceptable level of capabilities. The reason for choosing this group of insured persons is their large and considerable population in the country, which now include about 50% of Iran’s population. Methods: The methodological approach of this research is qualitative and based of the grounded theory, deep and semi-structured interview data retrieval techniques. For data mining, the theoretical coding method was used, which aims to achieve the main and secondary categories in line with the theoretical model setting. The sample number is 15 health insurance experts who were selected purposefully. Results: The results show that the central phenomenon is community-oriented empowerment, which is based on causal conditions, contextual conditions, intervening conditions and strategies. The most important strategies are the right of the insured to access insurance services and opportunities. In the discussion of background conditions, important elements such as agency, sense of equality and inclusion (integration) and capacity building are emphasized. Also, the findings show that components such as maintaining the rights of the insured, enabling resources and the efficiency and quality of insurance services are considered as causal conditions. Conclusion: According to the findings of the present study, three main categories of education and information, social participation and social support have been proposed as intervening conditions. Completing the chain of the paradigm model of the present study is based on the data theory method of the Consequences Foundation, which analysed the empowerment in four main sections of social empowerment, cultural empowerment, economic empowerment and psychological empowerment of the insured. 129 142 2022/07/252022/03/12022/03/162022/04/52022/06/252022/05/2 1401/2/12 2022/09/32022/07/62022/07/242022/07/262022/08/212022/07/25 1401/5/3 مسعود پاک‌نیت راد Masoud Pakniyat Rad گروه جامعه‌شناسی، دانشکده علوم اجتماعی، ارتباطات و رسانه، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران pakniyat.masoud@gmail.com محمدباقر تاج الدین Mohammadbagher Tajeddin گروه جامعه‌شناسی، دانشکده علوم اجتماعی، ارتباطات و رسانه، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران Mb_tajeddin@yahoo.com کرم حبیب پورگتابی Karam Habibpour Gatabi گروه جامعه شناسی، دانشکده ادبیات و علوم انسانی، دانشگاه خوارزمی، تهران، ایران karamhabibpour@yahoo.com Community-Oriented Empowerment Social Empowerment Psychological Empowerment Cultural Empowerment Economic Empowerment Health Insurance توانمندی اجتماع محور توانمندی اجتماعی توانمندی روانی توانمندی فرهنگی توانمندی اقتصادی بیمه سلامت - R. Amdam.(2011). Planning in Health Promotion Work: An empowerment model. Taylor & Francis or Routledge.##- Creswell, J.W. (1998).Qualitativecinquiry and research design: choosing among five traditions, sage publication Ltd.##- Kabeer,N.(2005).Gender equality and womonsempowerment:Acritical analysis of the third millennium development goal. Gender and development,vol. Vol. 13, No.1, pp. 13-24.##- Lekoko,R.N &Merwe,M.D. (2006). Beyond the rhetoric of empowerment: speak thelanguage,live the experience of rural poor, internationalreview of education, 52,No.3-4,pp. 323-332.##- Lau .D. H.(2002). “Patient empowerment--a patient-centred approach to improve care.,” Hong Kong Med. J., vol. 8, no. 5, pp. 372–374.##- Laverack .G.(2009).Public Health: Power, Empowerment and Professional Practice. Palgrave Macmillan.##- Malhatra,R.S. (2002). Measuring wemen Empowerment as Variable In International Development.World Bank. ##- Monkman,K & Miles, R & Easton, p. (2007). The transformatory potential of a village empowerment program:The Tostan replication in Mali, womens studies international forum, Vol.30,pp. 451-464.##- Moyle,T.L & Dollard, M.F.(2008). Rural Indian and indigenous Australian women working towards empowerment: A proposed Cross-cultural study. International journal of rural management, Vol. 4, No.1-2, pp. 153-168.##- Rifkin,S.B.(2003). A framework linking community empowerment and health equality:It is matter.##- Schuler,S.R.and Hashemi,S.M.(1994). Credit programs, womans empowerment and contraceptive use in rural Bangladesh.studies in family planning,Vol.3,No.7 & 8,pp.538.527.##-##- استرواس، انسلم و جولیت کربین.(1396). «مبانی پژوهش کیفی»، ترجمه ابراهیم افشار، تهران : نشر نی. ##- ایزدنیا، مصطفی و همکاران.(1399). مدل سازی استراتژی های توانمندسازی بیمه شدگان در نظام بیمه درمان مبتنی بر روش نگاشت شناختی زی نامبر، مجله مدیریت بهداشت و درمان، سال 11 شماره 3.##- دالوند، سمیرا.(1394). بررسی عوامل اجتماعی-فرهنگی موثر بر توانمندسازی زنان از دیدگاه زنان سرپرست خانوار تحت پوشش کمیته امداد شهرستان خرم‌آباد، پایان نامه کارشناسی ارشد، دانشگاه شهید چمران اهواز.##- سن، آمارتیاسن(1381). توسعه به مثابه آزادی،ترجمه وحید محمودی، تهران: انتشارات دستان. ##- سهیلی، حمید و همکاران.(1398). شناسایی عوامل فردی مؤثر بر توانمندسازی کارکنان بیمه سلامت (موردمطالعه: سازمان بیمه سلامت)، نشریه علمی پژوهش های مدیریت منابع انسانی، سال 12 شماره 2، صص 189-215. ##- غفاری، غلامرضا، دارابی، حسین و جهانگیری، پرویز(1388). مروری بر شاخص های توانمندسازی با تأکید بر زنان سرپرست خانوار، مجموعه مقالات دومین همایش توانمندسازی و توانافزایی زنان سرپرست خانوار، اداره کل امور بانوان شهر تهران، صص 340-319.##- غنبرطهرانی، نسیم حمیدرضا ایزدبخش و مرضیه زرین بال ماسوله (1395). طراحی کلان سیستم توانمندسازی بیمه‌شدگان سازمان بیمه سلامت ایران، دانشگاه خوارزمی.##- کبیر، نایال.(1389) .جنسیت و توانمندی، ترجمه اعظم خاتم. تهران: انتشارات آگاه.##- کتابی، محمود و یزدخواستی، بهجت و فرخی راستایی، زهرا.(1382). توانمندسازی زنان برای مشارکت در توسعه، زن در توسعه و سیاست(پژوهش زنان)، سال اول، شماره7، صص 30-5.##- کوهی، مریم. (1398). مطالعه انواع نظام های رفاهی و توانمند سازی زنان (مطالعه مقایسه ای ایران و شش کشور جهان). پایان نامه کارشناسی ارشد، دانشگاه الزهرا##- گلبادی، احمد.(1398). ارزیابی عوامل موثر بر توانمند سازی کارکنان سازمان بیمه خدمات درمانی(بیمه سلامت) در چهارچوب نظریه لشلی، پایان نامه کارشناسی ارشد، دانشگاه آزاد اسلامی واحد دهاقان.##- محمدپور، احمد.(1392). روش پژوهش کیفی، ضد روش، تهران، انتشارات جامعه شناسان. ##

بررسی رابطۀ سرمایۀ اجتماعی با سلامت عمومی در شاخص رفاه لگاتوم ایران با تحلیل همبستگی کانونی Investigation the Relationship Between Social Capital and Public Health in Iran’s Legatum Prosperity Index with Canonical Correlation Analysis 1 1 مقدمه: سلامت به عنوان ارزش ذاتی برای انسان ها، نقش مهمی در بهبود سعادت جامعه و رفاه افراد دارد و اغلب به‌عنوان مؤلفه ای کلیدی از سرمایۀ انسانی تلقی می‌شود که به رشد اقتصادی بیشتر منجر می‌شود. مفهوم سرمایۀ اجتماعی نشان دهندۀ آن است که چگونه ساختار اجتماعی یک گروه می‎تواند به عنوان منبعی با ارزش برای افراد آن عمل کند تا با هزینۀ کمتر، به اهداف خود دست یابند. تلقّی سلامت به عنوان یک دارایی، به معنای تمرکززدایی سیاست ها از عوامل مخاطره آمیز به  دیدگاهی جامع تر و مبتنی بر عوامل اجتماعی، ازجمله سرمایۀ اجتماعی است و تحقیق پیش رو نیز برهمین اساس انجام شد. روش بررسی: این تحقیق از نوع توصیفی و همبستگی بود. تحلیل داده ها از طریق همبستگی کانونی و رگرسیون چندگانه با استفاده از داده های ثانویۀ گردآوری شده ازسوی مؤسسۀ لگاتوم در سال ۲۰۲۱ میلادی و داده های مرتبط با ایران در بازۀ زمانی ۱۳۸۶ تا ۱۳۹۹، با ویرایش ۲۴ نرم افزار SPSS انجام شد. یافته ها: با توجه به معناداری آزمون های پیلایس و ویلکز در سطح معناداری ۵درصد، ضریب همبستگی سرمایۀ اجتماعی و سلامت ۸۹/۰ تعیین شد. با توجه به ضرایب ساختاری، عناصر طول عمر، سلامت جسم، سلامت روان، نظام های مراقبت، مداخلات پیشگیرانه و عوامل رفتاری پرخطر، به ترتیب بیشترین تأثیر را بر متغیر کانونی سلامت داشتند. براساس ضرایب استاندارد، مشخص شد اعتماد بین فردی، بیشترین تأثیر را بر سلامت دارد و اعتماد نهادی، شبکه های اجتماعی، مشارکت مدنی و اجتماعی و روابط شخصی و خانوادگی به عنوان عناصر سرمایۀ اجتماعی، در اولویت های بعدی تأثیر بر سلامت قرار گرفتند. نتیجه گیری: سرمایۀ اجتماعی نقش مهمی بر درک عوامل تعیین کنندۀ سلامت دارد و توجه ویژه به آن ازسوی سیاست گذاران به منظور رفع نابرابری های سلامت، گریزناپذیر است. برهمین اساس در روند سیاست گذاری های سلامت ایران که همچنان با چالش های متعدد مواجه است، افزون بر توجه به راهبردهای سخت افزاری و درمان محور، می توان و باید اهمیت ویژه ای برای سرمایۀ اجتماعی به عنوان یکی از مهم ترین عوامل تعیین کنندۀ سلامت، قائل شد. 2 Introduction: Health, as an inherent value for humans, plays an important role in improving the happiness of society and the prosperity of individuals, and is often considered as a key component of human capital that leads to greater economic growth. The concept of social capital shows how the social structure of a group can act as a valuable resource for its people to achieve their goals at a lower cost. Considering health as an asset means the decentralization of policies from risk factors to a more comprehensive perspective based on social factors, including social capital, and the upcoming research was conducted on this basis. Methods: This research was descriptive and correlational. Data analysis was performed through canonical correlation and multiple regression using secondary data collected by Legatum Institute in 2021 and data related to Iran in the period from 2007 to 2020, with the 24th edition of SPSS software. Results: According to the significance of Pillais and Wilkes tests at a significance level of 5%, the correlation coefficient of social capital and health was determined to be 0.89. According to the structural coefficients, elements of longevity, physical health, mental health, care systems, preventive interventions, and high-risk behavioral factors had the greatest impact on the canonical variable of health, respectively. Based on the standard coefficients, it was found that interpersonal trust has the greatest impact on health, and institutional trust, social networks, civil and social participation, and personal and family relationships as elements of social capital, were placed in the next priorities of impact on health. Conclusion: Social capital plays an important role in understanding the determinants of health, and it is inevitable to pay special attention to it by policymakers in order to eliminate health inequalities. This is the basis in Iran’s health policy process, which is still facing many challenges, in addition to paying attention to hardware and treatment-oriented strategies, social capital can and should be given special importance as one of the most important determinants of health. 143 154 2022/07/252022/03/12022/03/162022/04/52022/06/252022/05/22022/07/15 1401/4/24 2022/09/32022/07/62022/07/242022/07/262022/08/212022/07/252022/07/25 1401/5/3 امین فغفوری آذر Amin Faghfouri Azar گروه مدیریت صنعتی، دانشکدۀ مدیریت و اقتصاد، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران amin.faghfouri@gmail.com فاطمه باکوئی Fatemeh Bakouie گروه مدلسازی کارکردهای عالی شناختی، پژوهشکدۀ 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 amin2.faghfouri@gmail.com رضا رادفر Reza Radfar گروه مدیریت صنعتی، دانشکدۀ مدیریت و اقتصاد، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران amin3.faghfouri@gmail.com محمدعلی افشار کاظمی Mohammad Ali Afshar Kazemi گروه مدیریت صنعتی، دانشکدۀ مدیریت و اقتصاد، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران amin4.faghfouri@gmail.com Social Capital Health Health system Legatum Prosperity Index Canonical Correlation Analysis سرمایۀ اجتماعی سلامت شاخص رفاه لگاتوم نظام سلامت تحلیل همبستگی کانونی 1. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization.##2. McKeown T (1979). The role of medicine: dream, mirage, or nemesis? Princeton NJ, Princeton University Press.##3. Marmot M et al. (2012). Building of the global movement for health equity: from Santiago to Rio and beyond. The Lancet, 379(9811):181–188.##4. Rose G (1985). Sick individuals and sick populations. International Journal of Epidemiology, 14(1):32–38.##5. Rosen G (1993). A history of public health. Baltimore, Johns Hopkins University Press.##6. Whitehead M (1992). The concepts and principles of equity and health. International Journal of Health Services, 22(3):429–445.##7. Ståhl T et al., eds. (2006). Health in All Policies: prospects and potentials. Helsinki, Ministry of Social Affairs and Health.##8. Ollila E et al. (2006). Health in All Policies in the European :union: and its member states. Policy brief. Brussels, European Commission DG Health and Consumer Protection (http://ec.europa.eu/health/ph_projects/2005/action1/docs/2005_1_18_frep_a4_en.pdf, accessed 4 April 2013).##9. WHO (2006). World Health Organization: basic documents. Constitution of the World Health Organization. Geneva (http://apps.who.int/gb/bd/, accessed 12 March 2013):2.##10. United Nations (1966). International covenant on economic, social and cultural rights. Geneva (http://www.ohchr.org/EN/ProfessionalInterest/ Pages/CESCR.aspx, accessed 1 February 2013).##11. Ståhl T et al., eds. (2006). Health in All Policies: prospects and potentials. Helsinki, Ministry of Social Affairs and Health.##12. WHO (2008). Health equity through intersectoral action: an analysis of 18 country case studies. Ottawa, Public Health Agency of Canada.##13. Kickbusch I, Buckett K, eds. (2010). Implementing Health in All Policies: Adelaide 2010. Adelaide, Department of Health, Government of South Australia.##14. Shankardass K et al. (2011). Getting started with Health in All Policies: a resource pack. Toronto, Centre for Research on Inner City Health (CRICH), St Michael’s Hospital.##15. Allende S (2006). Chile’s medical-social reality– 1939 (excerpts). Social Medicine, 1(3):151–155.##16. Buckett K, ed. (2010). Editorial. International Meeting on Health in All Policies, Adelaide 12–15 April 2010. Adelaide, Government of South Australia.##17. Krech R, Buckett K (2010). The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Health Promotion International, 25(2):258–260.##18. Pritchett L, Summers L (1996). Wealthier is healthier. Journal of Human Resources, 31(4):841–868.##19. Bloom DE, Canning D (2000). The health and wealth of nations. Science, 287(5456):1207–1209.##20. Commission on Macroeconomics and Health (2001). Macroeconomics and health: investing in health for economic development. Geneva, World Health Organization.##21. López-Casasnovas G, Rivera B, Currais L (2005). Health and economic growth: findings and policy implications. Boston, The MIT Press.##22. Deaton A (2004). Health in an age of globalization. Washington DC, Brookings Trade Forum:83–130.##23. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization.##24. Marmot M (2006). Health in an unequal world: social circumstances, biology and disease. Clinical Medicine, 6(6):559–572.##25. Raphael D (2006). Social determinants of health: present status, unanswered questions, and future directions. International Journal of Health Services, 36(4):651–677.##26. Diderichsen F, Evans T, Whitehead M (2001). The social basis of disparities in health. In: Evans T et al., eds. Challenging inequities in health: from ethics to action. New York, Oxford University Press:12–23.##27. Dahlgren G, Whitehead M (1991). Policies and strategies to promote social equity in health. Stockholm, Institute for Futures Studies.##28. McKeown T (1976). The role of medicine: dream, mirage, or nemesis? London, Nuffield Provincial Hospitals Trust.##29. Fogel RW (1986). Nutrition and the decline in mortality since 1700: some preliminary findings. In: Engerman SL, Gallman RE, eds. (1986). Longterm factors in American economic growth. Chicago, University of Chicago Press:439–556.##30. Schultz TP, Strauss J, eds. (2008). Handbook of development economics. Volume 4. Oxford, North-Holland (Handbooks in Economics 9).##31. Caldwell JC (1979). Education as a factor in mortality decline: an examination of Nigerian data. Population Studies, 33(3):395–413.##32. Schultz TP (1985). Studying the impact of household economic and community variables on child mortality. Population and Development Review, 10(suppl.):215–235.##33. Breierova L, Duflo E (2004). The impact of education on fertility and child mortality: do fathers really matter less than mothers? Cambridge MA, National Bureau of Economic Research (NBER Working Paper No. 10513).##34. Bicego GT, Boerma JT (1991). Maternal education and child survival: a comparative analysis of DHS data. Columbia MD, IRD/Macro International Inc.##35. Kawachi I, Kennedy BP (1999). Income inequality and health: pathways and mechanisms. Health Services Research, 34(1 Pt 2):215–227.##36. Deaton A (2003). Health, inequality, and economic development. Journal of Economic Literature, 41(1):113–158.##37. Wilkinson RG (1996). Unhealthy societies: the afflictions of inequality. London, Routledge.##38. Wilkinson R, Pickett K (2009). The spirit level: why equality is better for everyone. London, Penguin.##39. Legatum Institute, “Legatum prosperity index”, 2021.##40. Lock, john. Two treaties of Governments: With A Supplement, Patriarcha, by Robert Filmer. No. 2. Simon and Schuster, 1947.##41. De Tocqueille, Alexis. Democracy in America. Vol 10. Regency Publishing, 2003.##42. Galtung, Johan. “Violence, peace, and peace research.” Journal of peace research 6, no 3 (1969): 167-191.##43. Paul Dolan, Tessa Peasgood, and Mathew White. “Do we really know what makes us happy? A review of the economic literature on the factors associated with subjective wellbeing,”Journal of economic psychology 29, no. 1 (2008): 94-122.##44. Ahmad Al-Windi. “The relations between symptoms, somatic and psychiatric conditions, life satisfaction and perceived health. A primary care based study,” Health and quality of life outcomes 3, no. 1 (2005): 28.##45. Robert J. Barro. “Health and economic growth,” Annals of Economics and Finance 14, no. 2 (2013): 329-366.##46. WHO Commission on Macroeconomics and Health, Working Group 1 & World Health Organization. “Health, economic growth and poverty reduction,” World Health Organization, 2002.##47. Coleman, J. (1990), Foundations of Social Theory, Cambridge: Harvard University Press.##48. Putnam Robert D. Simon and Schuster; New York, NY: 2000. Bowling Alone: the Collapse and Revival of American Community. ##49. Durkheim Emile. Free Press; New York: 1951. Suicide: A Study in Sociology, Translated by John Spaulding and George Simpson.[1897] ##50. Rodgers Justin, Valuev Anna V., Hswen Yulin, Subramanian S.V. Social capital and physical health: an updated review of the literature for 2007–2018. Soc. Sci. Med. 2019;236:112360. doi: 10.1016/j.socscimed.2019.112360. ##51. Fukuyama, Francis. “Francis Fukuyama Article on Social Capital: Global Trends and US Civil Society.” (1997).##52. Putnam, Robert D. 2000. Bowling Alone : The Collapse and Revival of American Community. New York: Simon & Schuster.##53. Putnam, Robert D., Robert Leonardi, and Raffaella Y. Nanetti. Making democracy work: Civic traditions in modern Italy. Princeton university press, 1994.##54. Uphoff, Eleonora P., Kate E. Pickett, Baltica Cabieses, Neil Small, and John Wright. “A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities.” International journal for equity in health 12, no. 1 (2013): 54.##55. Knowles, Stephen. Is social capital part of the institutions continuum? No. 05/11. CREDIT Research Paper, 2005.##56. Steven N. Durlauf, Marcel Fafchamps, ‘SOCIAL CAPITAL’ NBER Working Paper 10485, May 2004.##57. Helliwell, John F., and Robert D. Putnam. “The social context of well–being.” Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 359, no. 1449 (2004): 1435-1446.##58. Allen J, Balfour R, Bell R, Marmot M. Social determinants of mental health. Int Rev Psychiatry. 2014;26(4):392–407.##59. Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet. 2012;380:1011–29.##60. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(1_suppl2):19–31.##61. Kawachi I. Social capital and community effects on population and individual health. Ann N Y Acad Sci. 1999;896:120–30.##62. Edward LG, David L, Bruce S. An economic approach to social capital. Econ J. 2002;112(483):437–58.##63. Bourdieu P. The forms of capital. In: Halsey A, Lauder H, Brown P, Wells AS, editors. Education: culture economy, society. Oxford: Oxford University Press; 1997.##64. Putnam RD. Bowling alone: America’s declining social capital. In: Culture and politics. New York: Palgrave Macmillan US; 2000. p. 223–34.##65. Coleman JS. Social Capital in the Creation of human capital. Am J Sociol. 1988;94:S95–120.##66. Sobel J. Can we trust social capital? J Econ Lit. 2013;40(1):139–54.##67. Downward P, Pawlowski T, Rasciute S. Does associational behavior raise social capital? A cross-country analysis of trust. East Econ J. 2014;40(2):150–65.##68. Paxton P. Social capital and democracy: an interdependent relationship. Am Sociol Rev. 2002;67(2):254–77.##69. Cigler A, Joslyn MR. The extensiveness of group membership and social capital: the impact on political tolerance attitudes. Polit Res Q. 2002;55(1):7–25.##70. Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125(5):729–37.##71. Rodríguez-Pose A, von Berlepsch V. Social capital and individual happiness in Europe. J Happiness Stud. 2014;15(2):357–86.##72. Yu G, Sessions JG, Fu Y, Wall M. A multilevel cross-lagged structural equation analysis for reciprocal relationship between social capital and health. Soc Sci Med. 2015;142:1–8.##73. Harpham T. Measuring social capital within health surveys: key issues. Health Policy Plan. 2002;17(1):106–11.##74. Moore S, Kawachi I. Twenty years of social capital and health research: a glossary. J Epidemiol Community Health. 2017;71(5):513–7.##75. Ding N, Berry HL, O’Brien LV. One-year reciprocal relationship between community participation and mental wellbeing in Australia: a panel analysis. Soc Sci Med. 2015;128:246–54.##76. Kawachi I. Commentary: social capital and health: making the connections one step at a time. Int J Epidemiol. 2006;35(4):989–93.##77. Hanlon P, Carlisle S, Hannah M, Reilly D, Lyon A. Making the case for a “fifth wave” in public health. Public Health. 2011;125(1):30–6.##78. Younsi M, Chakroun M. Does social capital determine health? Empirical evidence from MENA countries. Soc Sci J. 2016;53(3):371–9.##79. Liu Y, Croft JB, Anderson LA, Wheaton AG, Presley-Cantrell LR, Ford ES. The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older, 1994-2006. Int J COPD. 2014;9:75–83.##80. Oshio T. The association between individual-level social capital and health: cross-sectional, prospective cohort and fixed-effects models. J Epidemiol Community Health. 2015;70(1):25–30.##81. Rohde N, D’Ambrosio C, Tang KK, Rao P. Estimating the mental health effects of social isolation. Appl Res Qual Life. 2016;11(3):853–69.##82. Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What enables and constrains the inclusion of the social determinants of health inequities in government policy agendas? A narrative review. Int J Heal Policy Manag. 2017;7(2):101–11.##83. WHO. Noncommunicable Diseases Country Profiles 2018: World Health Organization; 2018. https://www.who.int/nmh/publications/ncd-profiles-2018/en/.##1. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization.##2. McKeown T (1979). The role of medicine: dream, mirage, or nemesis? Princeton NJ, Princeton University Press.##3. Marmot M et al. (2012). Building of the global movement for health equity: from Santiago to Rio and beyond. The Lancet, 379(9811):181–188.##4. Rose G (1985). Sick individuals and sick populations. International Journal of Epidemiology, 14(1):32–38.##5. Rosen G (1993). A history of public health. Baltimore, Johns Hopkins University Press.##6. Whitehead M (1992). The concepts and principles of equity and health. International Journal of Health Services, 22(3):429–445.##7. Ståhl T et al., eds. (2006). Health in All Policies: prospects and potentials. Helsinki, Ministry of Social Affairs and Health.##8. Ollila E et al. (2006). Health in All Policies in the European :union: and its member states. Policy brief. Brussels, European Commission DG Health and Consumer Protection (http://ec.europa.eu/health/ph_projects/2005/action1/docs/2005_1_18_frep_a4_en.pdf, accessed 4 April 2013).##9. WHO (2006). World Health Organization: basic documents. Constitution of the World Health Organization. Geneva (http://apps.who.int/gb/bd/, accessed 12 March 2013):2.##10. United Nations (1966). International covenant on economic, social and cultural rights. Geneva (http://www.ohchr.org/EN/ProfessionalInterest/ Pages/CESCR.aspx, accessed 1 February 2013).##11. Ståhl T et al., eds. (2006). Health in All Policies: prospects and potentials. Helsinki, Ministry of Social Affairs and Health.##12. WHO (2008). Health equity through intersectoral action: an analysis of 18 country case studies. Ottawa, Public Health Agency of Canada.##13. Kickbusch I, Buckett K, eds. (2010). Implementing Health in All Policies: Adelaide 2010. Adelaide, Department of Health, Government of South Australia.##14. Shankardass K et al. (2011). Getting started with Health in All Policies: a resource pack. Toronto, Centre for Research on Inner City Health (CRICH), St Michael’s Hospital.##15. Allende S (2006). Chile’s medical-social reality– 1939 (excerpts). Social Medicine, 1(3):151–155.##16. Buckett K, ed. (2010). Editorial. International Meeting on Health in All Policies, Adelaide 12–15 April 2010. Adelaide, Government of South Australia.##17. Krech R, Buckett K (2010). The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Health Promotion International, 25(2):258–260.##18. Pritchett L, Summers L (1996). Wealthier is healthier. Journal of Human Resources, 31(4):841–868.##19. Bloom DE, Canning D (2000). The health and wealth of nations. Science, 287(5456):1207–1209.##20. Commission on Macroeconomics and Health (2001). Macroeconomics and health: investing in health for economic development. Geneva, World Health Organization.##21. López-Casasnovas G, Rivera B, Currais L (2005). Health and economic growth: findings and policy implications. Boston, The MIT Press.##22. Deaton A (2004). Health in an age of globalization. Washington DC, Brookings Trade Forum:83–130.##23. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization.##24. Marmot M (2006). Health in an unequal world: social circumstances, biology and disease. Clinical Medicine, 6(6):559–572.##25. Raphael D (2006). Social determinants of health: present status, unanswered questions, and future directions. International Journal of Health Services, 36(4):651–677.##26. Diderichsen F, Evans T, Whitehead M (2001). The social basis of disparities in health. In: Evans T et al., eds. Challenging inequities in health: from ethics to action. New York, Oxford University Press:12–23.##27. Dahlgren G, Whitehead M (1991). Policies and strategies to promote social equity in health. Stockholm, Institute for Futures Studies.##28. McKeown T (1976). The role of medicine: dream, mirage, or nemesis? London, Nuffield Provincial Hospitals Trust.##29. Fogel RW (1986). Nutrition and the decline in mortality since 1700: some preliminary findings. In: Engerman SL, Gallman RE, eds. (1986). Longterm factors in American economic growth. Chicago, University of Chicago Press:439–556.##30. Schultz TP, Strauss J, eds. (2008). Handbook of development economics. Volume 4. Oxford, North-Holland (Handbooks in Economics 9).##31. Caldwell JC (1979). Education as a factor in mortality decline: an examination of Nigerian data. Population Studies, 33(3):395–413.##32. Schultz TP (1985). Studying the impact of household economic and community variables on child mortality. Population and Development Review, 10(suppl.):215–235.##33. Breierova L, Duflo E (2004). The impact of education on fertility and child mortality: do fathers really matter less than mothers? Cambridge MA, National Bureau of Economic Research (NBER Working Paper No. 10513).##34. Bicego GT, Boerma JT (1991). Maternal education and child survival: a comparative analysis of DHS data. Columbia MD, IRD/Macro International Inc.##35. Kawachi I, Kennedy BP (1999). Income inequality and health: pathways and mechanisms. Health Services Research, 34(1 Pt 2):215–227.##36. Deaton A (2003). Health, inequality, and economic development. Journal of Economic Literature, 41(1):113–158.##37. Wilkinson RG (1996). Unhealthy societies: the afflictions of inequality. London, Routledge.##38. Wilkinson R, Pickett K (2009). The spirit level: why equality is better for everyone. London, Penguin.##39. Legatum Institute, “Legatum prosperity index”, 2021.##40. Lock, john. Two treaties of Governments: With A Supplement, Patriarcha, by Robert Filmer. No. 2. Simon and Schuster, 1947.##41. De Tocqueille, Alexis. Democracy in America. Vol 10. Regency Publishing, 2003.##42. Galtung, Johan. “Violence, peace, and peace research.” Journal of peace research 6, no 3 (1969): 167-191.##43. Paul Dolan, Tessa Peasgood, and Mathew White. “Do we really know what makes us happy? A review of the economic literature on the factors associated with subjective wellbeing,”Journal of economic psychology 29, no. 1 (2008): 94-122.##44. Ahmad Al-Windi. “The relations between symptoms, somatic and psychiatric conditions, life satisfaction and perceived health. A primary care based study,” Health and quality of life outcomes 3, no. 1 (2005): 28.##45. Robert J. Barro. “Health and economic growth,” Annals of Economics and Finance 14, no. 2 (2013): 329-366.##46. WHO Commission on Macroeconomics and Health, Working Group 1 & World Health Organization. “Health, economic growth and poverty reduction,” World Health Organization, 2002.##47. Coleman, J. (1990), Foundations of Social Theory, Cambridge: Harvard University Press.##48. Putnam Robert D. Simon and Schuster; New York, NY: 2000. Bowling Alone: the Collapse and Revival of American Community. ##49. Durkheim Emile. Free Press; New York: 1951. Suicide: A Study in Sociology, Translated by John Spaulding and George Simpson.[1897] ##50. Rodgers Justin, Valuev Anna V., Hswen Yulin, Subramanian S.V. Social capital and physical health: an updated review of the literature for 2007–2018. Soc. Sci. Med. 2019;236:112360. doi: 10.1016/j.socscimed.2019.112360. ##51. Fukuyama, Francis. “Francis Fukuyama Article on Social Capital: Global Trends and US Civil Society.” (1997).##52. Putnam, Robert D. 2000. Bowling Alone : The Collapse and Revival of American Community. New York: Simon & Schuster.##53. Putnam, Robert D., Robert Leonardi, and Raffaella Y. Nanetti. Making democracy work: Civic traditions in modern Italy. Princeton university press, 1994.##54. Uphoff, Eleonora P., Kate E. Pickett, Baltica Cabieses, Neil Small, and John Wright. “A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities.” International journal for equity in health 12, no. 1 (2013): 54.##55. Knowles, Stephen. Is social capital part of the institutions continuum? No. 05/11. CREDIT Research Paper, 2005.##56. Steven N. Durlauf, Marcel Fafchamps, ‘SOCIAL CAPITAL’ NBER Working Paper 10485, May 2004.##57. Helliwell, John F., and Robert D. Putnam. “The social context of well–being.” Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 359, no. 1449 (2004): 1435-1446.##58. Allen J, Balfour R, Bell R, Marmot M. Social determinants of mental health. Int Rev Psychiatry. 2014;26(4):392–407.##59. Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet. 2012;380:1011–29.##60. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(1_suppl2):19–31.##61. Kawachi I. Social capital and community effects on population and individual health. Ann N Y Acad Sci. 1999;896:120–30.##62. Edward LG, David L, Bruce S. An economic approach to social capital. Econ J. 2002;112(483):437–58.##63. Bourdieu P. The forms of capital. In: Halsey A, Lauder H, Brown P, Wells AS, editors. Education: culture economy, society. Oxford: Oxford University Press; 1997.##64. Putnam RD. Bowling alone: America’s declining social capital. In: Culture and politics. New York: Palgrave Macmillan US; 2000. p. 223–34.##65. Coleman JS. Social Capital in the Creation of human capital. Am J Sociol. 1988;94:S95–120.##66. Sobel J. Can we trust social capital? J Econ Lit. 2013;40(1):139–54.##67. Downward P, Pawlowski T, Rasciute S. Does associational behavior raise social capital? A cross-country analysis of trust. East Econ J. 2014;40(2):150–65.##68. Paxton P. Social capital and democracy: an interdependent relationship. Am Sociol Rev. 2002;67(2):254–77.##69. Cigler A, Joslyn MR. The extensiveness of group membership and social capital: the impact on political tolerance attitudes. Polit Res Q. 2002;55(1):7–25.##70. Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125(5):729–37.##71. Rodríguez-Pose A, von Berlepsch V. Social capital and individual happiness in Europe. J Happiness Stud. 2014;15(2):357–86.##72. Yu G, Sessions JG, Fu Y, Wall M. A multilevel cross-lagged structural equation analysis for reciprocal relationship between social capital and health. Soc Sci Med. 2015;142:1–8.##73. Harpham T. Measuring social capital within health surveys: key issues. Health Policy Plan. 2002;17(1):106–11.##74. Moore S, Kawachi I. Twenty years of social capital and health research: a glossary. J Epidemiol Community Health. 2017;71(5):513–7.##75. Ding N, Berry HL, O’Brien LV. One-year reciprocal relationship between community participation and mental wellbeing in Australia: a panel analysis. Soc Sci Med. 2015;128:246–54.##76. Kawachi I. Commentary: social capital and health: making the connections one step at a time. Int J Epidemiol. 2006;35(4):989–93.##77. Hanlon P, Carlisle S, Hannah M, Reilly D, Lyon A. Making the case for a “fifth wave” in public health. Public Health. 2011;125(1):30–6.##78. Younsi M, Chakroun M. Does social capital determine health? Empirical evidence from MENA countries. Soc Sci J. 2016;53(3):371–9.##79. Liu Y, Croft JB, Anderson LA, Wheaton AG, Presley-Cantrell LR, Ford ES. The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older, 1994-2006. Int J COPD. 2014;9:75–83.##80. Oshio T. The association between individual-level social capital and health: cross-sectional, prospective cohort and fixed-effects models. J Epidemiol Community Health. 2015;70(1):25–30.##81. Rohde N, D’Ambrosio C, Tang KK, Rao P. Estimating the mental health effects of social isolation. Appl Res Qual Life. 2016;11(3):853–69.##82. Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What enables and constrains the inclusion of the social determinants of health inequities in government policy agendas? A narrative review. Int J Heal Policy Manag. 2017;7(2):101–11.##83. WHO. Noncommunicable Diseases Country Profiles 2018: World Health Organization; 2018. https://www.who.int/nmh/publications/ncd-profiles-2018/en/. ##

عوامل مؤثر بر بسته‌های خدمتی بیمه تکمیلی درمان، یک مطالعه کیفی Factors Affecting the Service Packages of Supplementary Health Insurance, a Qualitative Study 1 1 مقدمه: بیمه‌های پایه و مکمل درمان نقش مهمی در دستیابی به پوشش همگانی سلامت دارند. در کشورهای در حال توسعه، بیمه‌های مکمل درمان، مشکلات و نارسایی‌های عدیده ساختاری و سازمانی دارند. پژوهش حاضر با هدف بررسی عوامل موثر بر بسته‌های خدمتی بیمه تکمیلی درمان صورت پذیرفت. روش بررسی: پژوهش حاضر از نوع کیفی با روش تحلیل چارچوبی است که در سال ۱۴۰۰ صورت پذیرفت. ۱۱ نفر از خبرگان سازمان بیمه‌ای و صاحب‌نظران در نظام سلامت، با روش نمونه‌گیری هدفمند به عنوان نمونه‌های پژوهش انتخاب شدند. برای تحلیل داده‌ها از نرم‌افزار MAXQDA استفاده شد. یافته‌ها: ابعاد الگوی بیمه مکمل درمان در ایران بر اساس تحلیل نظرات صاحب‌نظران و خبرگان در ایران شامل ۵ بعد اصلی «قوانین و مقررات، پوشش خدمات، تقویت و ایجاد بازار رقابتی، تدوین استاندارد استفاده از خدمات و گایدلاین‌های درمانی، توسعه بیمه‌های مکمل» بود. نتیجه‌گیری: براساس یافته‌ها تلاش برای تدوین بسته جامع خدمات مکمل درمان در کشور در راستای افزایش دسترسی مردم باید مدنظر سیاست‌گذاران قرار گیرد و ظرفیت مالی برای مدیریت و تامین مالی پوشش همگانی سلامت افزایش یابد. انتظار می‌رود با توسعه علمی بیمه مکمل درمان، کمک شایانی به پوشش همگانی سلامت در کشور انجام شود. 2 Introduction: Basic and supplementary insurances play an important role in achieving universal health coverage. In developing countries, complementary insurances have many structural and organizational problems and inadequacies. The present study was conducted with the aim of investigating the factors affecting the service packages of supplementary medical insurance. Methods: The current research is of a qualitative type with a framework analysis method that was carried out in 1400. 11 experts of the insurance organization and experts in the health system were selected as the research samples by the purposeful sampling method. MAXQDA software was used for data analysis. Results: The dimensions of the complementary insurance model of treatment in Iran based on the analysis of the opinions of experts and experts in Iran include five main dimensions: "laws and regulations, coverage of services, strengthening and creating a competitive market, developing standards for the use of services and treatment guidelines; Development of complementary insurances. Conclusion: Based on the findings, efforts to develop a comprehensive package of complementary treatment services in the country in order to increase people's access should be considered by policy makers and the financial capacity to manage and finance universal health coverage should be increased. It is expected that with the scientific development of supplementary medical insurance, it will contribute greatly to universal health coverage in the country.   155 166 2022/07/252022/03/12022/03/162022/04/52022/06/252022/05/22022/07/152022/06/11 1401/3/21 2022/09/32022/07/62022/07/242022/07/262022/08/212022/07/252022/07/252022/08/17 1401/5/26 شادی حاجی‌خانی Shadi Hajikhani گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران shadi.hajikhani@yahoo.com سمیه حسام Somayeh Hessam گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران somayehh59@yahoo.com ایروان مسعودی‌اصل Irvan Masoudi Asl گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و اطلاع‌رسانی پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران masoudi_1352@yahoo.com علی ماهر Ali Maher گروه مدیریت خدمات بهداشتی درمانی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران dralimaher@gmail.com Service Package Supplementary Insurance Universal Health Coverage بسته خدمت بیمه مکمل پوشش همگانی سلامت ## ##