1398 2 4 7 247

واکاوی یک سیاست اقتصاد سلامت 1 172 175 2020/03/6 1398/12/16 2020/03/6 1398/12/16 مرضیه زنگنه Marziyeh Zanganeh گروه برنامه ریزی اقتصاد و بیمه سلامت، وزارت بهداشت درمان و آموزش پزشکی، تهران، ایران شهرام توفیقی Shahram Tofighi مرکز ملی تحقیقات بیمه سلامت، سازمان بیمه سلامت ایران، تهران، ایران ## ##

تحلیل روابط سیستماتیک مزیت های یکپارچه سازی بیمه سلامت در ایران Systematic Relationship Analysis of Health Insurance Integration Benefits in Iran 1 1 مقدمه: با توجه به اهمیت سلامت به عنوان سرمایه ای ارزشمند و دستیابی به پوشش همگانی سلامت، برخورداری از مزیت های بیمه های سلامت لازمه دستیابی به سلامت برای همه است و برهمین اساس شناسایی و تحلیل مزیت های تجمیع صندوق های بیمه های سلامت می تواند گامی موثر در این خصوص باشد. مطالعه حاضر با هدف تحلیل روابط سیستماتیک مزیت های یکپارچه سازی بیمه سلامت در ایران به انجام رسید. روش بررسی: مطالعه توصیفی حاضر در دو مرحله شناسایی و تحلیل سیستماتیک مزیت های یکپارچه سازی بیمه سلامت در ایران روی ۶۸ نفر از خبرگان و متخصصان بیمه سلامت انجام گرفت. ابزار گردآوری اطلاعات در مرحله دلفی، پرسشنامه ای ۴۰ سوالی در طیف لیکرت و در مرحله تحلیل سیستماتیک، پرسشنامه مقایسات زوجی بود. تحلیل نتایج فاز دلفی با استفاده از نرم افزار SPSS و آزمون تی تک نمونه ای و وزن دهی مزیت ها با استفاده از تکنیک دیمتل فازی (FUZZY DEMATEL) و با بهره‌گیری از نرم افزار MATLAB انجام گرفت. یافته‌ها: در مجموع ۴۰ مزیت برای تجمیع بیمه سلامت در ایران شناسایی شد که با انجام فاز دلفی، ۲۹ مزیت مورد پذیرش قرار گرفت. نتایج حاصل از تحلیل روابط سیستماتیک نیز نشان داد مزیت تولیت با مختصات (۳۱/۱ و ۳۱/۱) به عنوان تأثیرگذارترین و مزیت فرایند های عملیاتی با مختصات (۹۵۹/۰- و ۹۵۹/۰) به عنوان تأثیرپذیرترین هستند. نتیجه‌گیری: با توجه به اهمیت مزیت های تولیت و تأمین مالی و تأثیرگذاری آنها بر روی سایر مزیت ها، تمرکز بر تقویت این مزیت ها در راستای حرکت به سمت تجمیع صندوق های بیمه ای و فراهم سازی زیرساخت های آن، می تواند گام موثری در این خصوص باشد. همچنین دستیابی به مزیت های بسته پایه خدمتی، پوشش همگانی جمعیت، تأمین مالی و فرایندهای عملیاتی می تواند در قالب برنامه های میان مدت و بلندمدت محقق شود. 2 Introduction: Given the importance of health as a valuable asset and achieving universal health coverage, Enjoyment the benefits of health insurance are essential to achieving health for all. So identifying and analyzing the benefits of integrating health insurance funds can be an effective step in this regard. This study aimed to analyze the Systematic Relationship of Health Insurance Integration Benefits in Iran. Methods: This descriptive study was conducted on 68 health insurance experts in two stages of systematic identification and analysis of the benefits of health insurance integration in Iran. Data collection tool was a 40-item Likert-type questionnaire in the Delphi phase and a paired comparisons questionnaire in the systematic analysis stage. Delphi phase analysis was performed using SPSS software and one-sample t-test and factor weighting were performed using FUZZY DEMATEL technique using MATLAB software. Results: In total, 40 benefits were identified for integration of health insurance in Iran, and 29 benefits were accepted through Delphi phase. The results of Systematic Relationship Analysis also showed that the component of Stewardship with coordinates (1.31 and 1.31) as the most influential component and the component of operational processes with coordinates (0.959 and -0.959) as the most influential component. Conclusion: Considering the importance of the Stewardship component, cost control and improving the efficiency of the health system in the current conditions of the country can be considered through the implementation of infrastructure reforms in the Stewardship. Also, achieving service-based benefits, general population coverage, financing, and operational processes can be achieved through medium-term and long-term plans. 176 183 2020/03/62019/12/7 1398/9/16 2020/03/62019/12/23 1398/10/2 مجید اکبری Majid Akbari گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و علوم اجتماعی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران m_akbari14@yahoo.com خلیل علی محمدزاده Khalil Alimohamadzadeh گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و علوم اجتماعی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران dr-khalil-amz@yahoo.com علی ماهر Ali Maher گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و علوم اجتماعی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران dralimaher@gmail.com سید مجتبی حسینی Seyed Mojtaba Hosseini گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و علوم اجتماعی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران hosseinisch@yahoo.com محمدکریم بهادری Mohammadkarim Bahadori مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه الله، تهران، ایران bahadori_57@yahoo.com Health Insurance Integration Iran Dematel بیمه سلامت تجمیع ایران تکنیک دیمتل ## ##

شناسایی و تحلیل عوامل اقتصادی، اجتماعی و فرهنگی مؤثر بر نرخ سزارین در تهران Identifying and Analyzing the Economic, Social and Cultural Factors Affecting the Rate of Cesarean in Tehran 1 1 مقدمه: برای انتخاب جراحی سزارین، علاوه بر الزامات و محدودیت‌های علمی و توصیه‌های پزشکی، مؤلفه‌های تأثیرگذار دیگری ازجمله عوامل اقتصادی، اجتماعی و فرهنگی نیز نقش دارند. با توجه به معایبی که زایمان به روش سزارین برای فرد و جامعه دارد و در راستای نیل به نرخ استاندارد سزارین و طبیعتاً رسیدن به جامعه سالم، هدف این مطالعه، درک و تحلیل دلایل انتخاب سزارین، به خصوص شناسایی عوامل اقتصادی و اجتماعی مؤثر بر انتخاب سزارین به عنوان شیوه وضع حمل است. محققان با توجه به ضرورت پژوهش، علاوه بر عوامل اقتصادی و اجتماعی، عوامل فرهنگی که بر انتخاب جراحی سزارین مؤثر است را نیز مورد کنکاش قرار می‌دهد. روش بررسی: داده‌ها و اطلاعات مورد نیاز به صورت پرسشنامه‌ای و مقطعی در نمونه‌ای ۶۰۰ عددی در سال ۱۳۹۷ و در شهر تهران جمع‌آوری شده اند. انتخاب تعداد بهینه نمونه از روش کوکران بوده و در مسیر انجام پژوهش از اطلاعات پایگاه‌های آماری معتبر و مقالات مرتبط نیز استفاده شده است. با توجه به صفر یا یک بودن متغیر وابسته روش وضع حمل (زایمان طبیعی یا سزارین)، روش تحلیل داده‌ها با کمک مدل‌های اقتصادسنجی گسسته لاجیت و نرم افزار STATA۱۴ بود. یافته‌ها: یافته های پژوهش نشان می دهد بهبود شرایط اقتصادی خانوار، احتمال انتخاب سزارین را به عنوان روش زایمان افزایش می دهد. همچنین از بین تمامی متغیرهای مورد بررسی در پژوهش، متغیر توصیه اطرافیان به زایمان سزارین با مقدار عددی (۰.۱۹)، بیشترین اثر نهایی را بر احتمال انتخاب و افزایش نرخ سزارین داشته و طبق یافته‌های پژوهش، کمترین اثر نهایی معنا‌دار بر احتمال انتخاب سزارین نیز به متغیر تعداد ساعات شرکت در دوره‌های پیش از زایمان با مقدار عددی (۰.۰۰۳-) اختصاص دارد. نتیجه‌گیری: به صورت کلی و به عنوان نتیجه نهایی، می توان عنوان کرد که نرخ سزارین در میان بانوان، تحت تأثیر شمار زیادی از متغیرهای فردی، اقتصادی، اجتماعی، فرهنگی و پزشکی و بالینی است که هر کدام، اثر افزایشی یا کاهشی کوچکی بر احتمال انتخاب سزارین دارند؛ اما وجود همه آنها در کنار هم، مجموعه بزرگی را می سازد که می‌تواند نرخ سزارین را از حد استاندارد بین المللی فراتر برد. 2 Introduction: In addition to the scientific requirements and limitations and medical advice, other influential factors are involved in choosing cesarean section, including economic, social and cultural factors. Given the disadvantages of cesarean delivery for the individual and society and in order to achieve a standard rate of cesarean section and naturally reach a healthy population, the aim of this study is to understand, and analyze the reasons for cesarean delivery, especially identifying the economic and social factors affecting cesarean delivery. It is a way of giving birth. In addition to the economic and social factors, the researchers also consider the cultural factors that influence the choice of cesarean section in addition to the necessity of research. Methods: The required data and information were collected by questionnaire and cross-sectional in a sample of 600 in Tehran in 2019-2018. Cochran method was used to select the optimal number of samples and valid statistical databases and related articles were also used in the research. Given the zero or one dependent variable of delivery method (natural delivery or cesarean section), data analysis was performed using Logit discrete econometric models and STATA14 software. Results: Research findings show that improving household economic conditions increases the probability of choosing cesarean delivery method. Also, among all the variables under study, cesarean delivery recommendation variable with numerical value (0.19) had the most final effect on probability of choosing and increasing cesarean rate. The least significant marginal effect on the likelihood of cesarean delivery belonged to variable “the number of hours of participation in prenatal periods” with a numerical value of - 0.003. Conclusion: Overall, and as a final result, it can be concluded that the rate of cesarean section among women is influenced by a large number of individual, economic, social, cultural, medical and clinical variables, each of which has a small or incremental effect on the probability of cesarean delivery. But they all come together to form a large collection that can push the rate of cesarean beyond the international standard. 184 197 2020/03/62019/12/72019/11/27 1398/9/6 2020/03/62019/12/232020/01/4 1398/10/14 لطفعلی عاقلی Lotfali Agheli aghelik@modares.ac.ir عباس عصاری Abbas Assari assari_a@modares.ac.ir علیرضا ناصری Alireza Nasseri nasseri@modares.ac.ir علی اصغر اسدی Ali Asghar Asadi aliasadi202004@gmail.com Cesarean Rate Logit Econometric Model Economic Variables Social Variables Cultural Variables Medical-Clinical Variables نرخ سزارین مدل اقتصادسنجی لاجیت متغیرهای اقتصادی متغیرهای اجتماعی متغیرهای فرهنگی متغیرهای پزشکی-   بالینی 1. Hajjian, K. 2002, The Assessment of Trend Changes in Cesarean Delivery Rate in Private Medical Centers in Babol City at 1996-2000. Research in Medicine Jornal. Shahid beheshti University of Medical Science 2002;26(3): 175-179. [Full Text in Persian]##2. Khashani zadeh, N. 2002, Frequency and Causes of Cesarean section in Baqiyatallah Hospital in 1999, Kosar Medical Journal, Volume 7, Number 3, pp. 243-239##3. Besharati, F., Hazavehei, S. M. M., Moeini, B., & Moghimbeigi, A. 2011. Effect of educational interventions based on theory of planned behavior (TPB) in selecting delivery mode among pregnant women referred to Rasht health centers. ZUMS Journal, 19(77), 94-106.##4. Amidi Mazaheri, M. Amiri, M. Khorsandi, M. Hassanzadeh, A. Taheri, Z. 2015, Can Pregnant Women Can be Reduced by Cesarean Section? Monitor, 14, No. 5, pp. 586-577##5. Mould, T. A. J., Chong, S., Spencer, J. A. D., & Gallivan, S. 1996. Women's involvement with the decision preceding their caesarean section and their degree of satisfaction. BJOG: An International Journal of Obstetrics & Gynaecology, 103(11), 1074-1077.##6. James D.K., Steer P.J. High risk pregnancy. 2nd Edition. Harcourt Brace and Company. 1999.##7. Azizi, M. Salari, P. 2009, Ethical Approach to Cesarean Delivery by Mother's Request, Journal of Medical Ethics and History, Volume 2, Number 2, pp. 65-55##8. Ghooshchian S, Dehghani M. Khorsandi M, Farzad V. 2011, The role of fear of pain and related psychological variables in prediction of cesarean labor. Arak Medical University Journal. 2011:14:45-54 Persian)##9. Javaheri, F. Hashemi Khah, Z. 2016, Selective Cesarean Section Analysis of the Experience of a Sample of Women in Tehran, Journal of the Social and Cultural Council of Women and Family, Volume 18, Number 71, pp. 30-7##10. Stalburg CM. Doctor, 2009, I want a c-section. How should you respond?, http://www.obgmanagement.com/pdf/2005/2005OBGM_Article1.pdf (accessed on Feb 2009)##11. Word health organization. 2008, Appropriate technology of birth. Lancet 2008; 45: 7-436##12. Liu S, Listov RM, Joseph KS, et al. 2007, Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176(4): 60-455##13. Garmaroodi, Gh. 2000, Prevalence and Some Factors Affecting Cesarean Section in Pregnant Women in Maternity Hospital of Tehran, Institute of Health Sciences (Internal Approved Plans Report), Maternal and Child Health Research Group##14. Paterson-Brown, S., Amu, O., Rajendran, S., & Bolaji, I. I. (1998). Should doctors perform an elective caesarean section on request? Yes, as long as the woman is fully informedMaternal choice alone should not determine method of delivery. Bmj, 317(7156), 462-465.##15. Shariat, M. (2002). Rate of cesarean and factors related to that in Maternity of Tehran. Payesh Journal, 3, 1.##16. World Health Organization. 1985. Appropriate technology for birth. Lancet 1985; 2 (8452): 436-7##17. Wagner M. 2001, Fish can't see water: the need to humanize birth. Int J Gynaecol Obstet 2001; 75 Suppl 1: S25-S37.##18. Sachs BP, Castro MA. 2003, The risk of lowering cesarean-delivery rate. N Engl J Med 2003; 340:54-57.##19. Rahmani, Z. Jafari, B. Dehghan Doin, A. Hatami, M. Vaezi, A. Ghorbani, M. 2012, Experience and Function Report Evaluating the Effect of Some Interventions on Elective Cesarean Section Reduction in Imam Khomeini Hospital in Shirvan 2010, Trade Conference and Desired Functions of Primary Health Care System, Poster##20. Gibbons Luz, Belizán José M., Lauer Jeremy A, Betrán Ana P, Merialdi Mario, Althabe Fernando, 2010, The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage, World Health Report, Background Paper, No 30##21. Ramadanzadeh, F. 2007, Cesarean section is not for money, Hamshahri, Monday 18 July##22. Jacquemyn Y, Ahankour F, Martens G. Flemish, 2003, obstetricians` personal preference regarding mode of delivery and attitude towards caesarean section on demand. Eur J Obstet Gynecol Reprod Biol 2003; 111(2): 6-146##23. Hasanpoor S. Bani S. (2008), The preferred method of delivery and maternal factors affecting the choice of perspective, referring to Tabriz Al-Zahra Hospital Medicine. Journal of Nursing and Midwifery, Tabriz. vol, 10:51-6 Persian##24. Alimohammadian, M., Shariat, M., Mahmmodi, M., & Ramezanzadeh, F. (2003). Investigation of the effect of pregnant women’s request on the rate of elective caesarean delivery, 43-137.##25. Ghafourzadeh, M. Nasirzadeh, N. 2000, Cesarean section and its causes in hospitals of Shahid Sadoughi University of Medical Sciences, Journal of Shahid Sadoughi University of Medical Sciences, Volume 8, Number 4, pp. 10-6##26. Faramarzi, M. Bakhtiari, A. Nazari, T. 2000, Prevalence and Causes of Cesarean Section in Babol, Journal of Babol University of Medical Sciences, Volume 2, Number 1 (Special Letter)##27. Mossadegh Rad, A. Malekiha, Z. 2005, Frequency of natural delivery, cesarean section and its causes in Isfahan University Hospitals, 2002, Iranian Journal of Medical Sciences Organization, Volume 23, Number 2, p. 169-161##28. Maghareh Abed, L. Goharian, V. Adibi, P. Goharian, A. Ghanee, M. 2000, Prevalence of Cesarean section and its Causes in the Islamic Republic of Iran in 1998, Hakim, Volume 3, Number 2, pp. 150-147##29. Judithi, A. Yavari Kia, P. 2000, Statistical Study of Cesarean Rate and Incidence in East Azarbaijan Province in 1997, Medical Journal of Tabriz University of Medical Sciences, Volume 34, Number 46, pp. 24-19##30. Nikandesh, R. Ebrahimi, A. Khalegi, A. 2005, Training of Health System Personnel and Management of Managed Care Can Reduce Cesarean Delivery, Journal of Kerman University of Medical Sciences, Volume 5, Number 14, (Special Issue) 7th National Conference on Medical Education)##31. Arab, M. 2001, Comparison of Costs and Complications of Postpartum Natural Cesarean and Repetitive Cesarean, Ibn Sina Clinical Medicine Journal (Scientific Journal of Hamadan University of Medical Sciences and Health Services), Volume 8, Number 2, pp. 33-29##32. Maroufizadeh, S. Bagheri Lankarani, N. Almashi Hashiani, A. Amini, P. Esmaeilzadeh, A. Navid, B. Mohammadi, M. Omani Samani, R. 2016, Journal of Isfahan Medical School 35, Number 3, pp. 310-303##33. Johari, S. Bayati, S. Pour Asad Kheirabadi, F. Moradi, E. 2014, Evaluation of Cesarean Section and its Causes in Fasa 2011, Journal of Fasa University of Medical Sciences, Vol. 4, No. 3, pp. 300-295##34. Mohammad Tabar, Sh. Rahnama, P. Mohammad, Kh. 2014, Selecting Cesarean Based on Maternal Appeal: Prevalence and Factors Affecting it, Journal of Mazandaran University of Medical Sciences, Volume 24, Number 114, pp. 82-74##35. Tavassoli, A. Kalari, F. Zafari Dizaji, A. 2014, Social Factors Affecting Cesarean Tendency in Pregnant Women, Journal of Medical Ethics, Volume 7, Number 29, pp. 170-145##36. Siavashi, E. Shojaei, P. Zakeri, M. 2016, Identification of Factors Affecting Cesarean Section in Pregnant Women Based on the Transcendental Approach, Journal of Zanjan University of Medical Sciences, Volume 24, Number 6, pp. 41-30##37. Badiee Aval, S. Ravanshad, Y. Azarfar, A. Dastfan, F. Babaei, S. Mirzaei, N. 2013, Survey of Cesarean Delivery and Their Causes in Hospitals Affiliated to Mashhad University of Medical Sciences in 2011, Journal of Obstetrics and Gynecology, Volume 16 , No. 66, pp. 10–17##38. Reza Soltani, P. Hossein Jani, A. Etebari, S. 2012, Causes of Cesarean Section in a Training Center in Rasht, Iran Nursing and Midwifery, Volume 22, Number 67, pp 22-16##39. Dehghani, S L. Mehrolhassani, N. Rostad, H. Alsadat Ebrahimi, M. Motamed Jahromi, M. 2012, Investigating the Causes of Cesarean Section in Women Referred to Gynecology and Pregnancy Clinic of Mahdieh Bam Maternity Hospital, Journal of Health and Development No. 1, , Pp. 243-237##40. Shakeri, M. Mazloomzadeh, S. Mohammadian, F. 2012, Investigation of Factors Affecting Cesarean Rate in Zanjan Maternity Hospitals in 2008, Zanjan University of Medical Sciences Journal, Volume 20, Number 80, pp. 104-98##41. Aghtagai, M. Noahi, E. 2011, Imagination of Pain and Cesarean Section and Pregnancy in Pregnant Women Referred to Clinics of Kerman University of Medical Sciences, Iranian Journal of Obstetrics and Infertility, Volume 14, Number 7, Pages 50 -44##42. Ghasemi, F. 2011, Frequency and Causes of Cesarean Section in Yazd Province, 2009, Journal of Shahid Sadoughi University of Medical Sciences, Volume 20, Number 2, pp. 236-229##43. Schulkind, L. Shapiro Teny, M. 2014, What a difference a day makes: Quantifying the effects of birth timing manipulation on infant health, Journal of Health Economics 33, 139– 158##44. Ali Mohammadzadeh, Kh. Persons Asroghani, P. 2015, Determinants of Cesarean Section (Case Study: Pregnant Women in Tehran), Women in Development and Politics, Volume 13, Number 3, pp. 376-357##45. Akbarzadeh, F. Talaei, A. Tavassoli, F. Jalaliani, S. Talebi, M. Modaresi Gharavi, M. Akhlaqi, S. 2016, Investigation of Psychological Characteristics in Women with Normal Delivery, Elective Cesarean Section and Emergency, Journal of Mashhad University of Medical Sciences, Vol. 1, No. 2, pp. 619-611##46. Grant, D. 2009, Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project, Journal of Health Economics, Volume 28, Issue 1, January 2009, Pages 244-250##47. Dadipour, S. Madani, A. Alavi, A. Roozbeh, N. Safari, A. Moradabadi, 2016, Investigating the Growing Trend of Cesarean Section in Iran and the World: A Review Article, Iranian Journal of Midwifery and Infertility, Volume 19, Number 27, Pages 17 -8##48. Kiani Azabir, A. Heidari, M. Rahnama, P. Mohammadi Tabar, Sh. 2014, A Survey of Midwives' Attitude toward Elective Cesarean Section and Related Factors in Tehran, Paeesh Journal, Volume 13, Number 3, pp. 338-331##49. Sadat Asadi, Z. Salhi, M. Taghdisi, M. Moghaddam Hosseini, V. Javan, R. Hashemian, M. 2014, The Effect of Educational Intervention Based on Logical Practice Theory on Pregnancy Selection in Pregnant Women Demanding Elective Cesarean Section, Journal of Midwifery and Infertility , Volume 17, Number 901, pp. 8-1##50. Lotfi, R. Ramezani Tehrani, F. Turkestanie, F. Rostami, M. Abedini, M. Sajdinejad, S. 2014, Management of Health System and Elective Cesarean Section in Iran: A Qualitative Study, Payesh Journal, Volume 14, Number 1, pp. 71-59##51. Vecino-Ortiz AI, Bardey D, Castano-Yepes RA, 2011, Multilevel Analysis To Measure Hospital Variation: The Cace Of Cesarean Delivery, Value in health, 14, A1-A214## ##

مدل بندی زمان بستری بیماران در بخش مراقبت های ویژه کودکان در بیمارستان های دولتی شهر مشهد در سال 1397 با استفاده از توزیع های مرکب وایبول معکوس Modeling the Time of Hospitalization in Pediatric Intensive Care Unit in Mashhad Hospitals in 2018 with Inverse Weibull Composite Distributions 1 1 مقدمه: یکی از عوامل موثر در تعیین هزینه های بیماران بستری در بخش های بیمارستانی، مدت زمان اقامت بیماران در بیمارستان و یکی از بخش‌های پرهزینه نیز، بخش مراقبت‌های ویژه کودکان (PICU) است. اطلاع از مدت زمان بستری بودن بیماران در مدیریت تخت‌های بیمارستانی می تواند موثر باشد. هدف از این مطالعه ارائه مناسب‌ترین توزیع آماری برای زمان اقامت بیماران در بخش‌های PICU بوده تا با استفاده از آن، بتوان زمان بستری بودن بیماران در بخش را پیش‌بینی کرد. روش بررسی: در این مطالعه علاوه بر بررسی تشخیص‌های ارائه شده برای بیماران بستری در بخش PICU، سعی شد با استفاده از توزیع های آماری پرکاربرد در مطالعات بقا مانند خانواده توزیع های وایبول معکوس یا ترکیبات آن، بهترین مدل آماری را برای زمان بستری در بخش مراقبت های ویژه کودکان سه بیمارستان در شهر مشهد در سال ۱۳۹۷مشخص کرد. برای تجزیه و تحلیل اطلاعات و ارائه مدل های آماری از نرم افزار R ویرایش ۳.۵.۲ و برای تشخیص مدل مناسب، از معیارهای آماری ماکزیمم درست نمایی، معیار آکائیک (AIC) و معیار اطلاع بیزی(BIC) استفاده شده است. یافته ها: بر اساس داده‌های بررسی شده بیمارستان ها، توزیع های آماری هندسی وایبول معکوس، سری‌لگاریتمی وایبول معکوس، هندسی وایبول معکوس تعمیم‌یافته و سری‌لگاریتمی ‌وایبول ‌معکوس تعمیم‌یافته برای داده‌های بقا روی زمان ماندگاری بیماران در بخش‌های PICU مورد بررسی برازش داده شدند. پس از برآورد پارامترهای توزیع‌ها، شاخص‌های میانه، چارک‌های اول و سوم برای توزیع ها گزارش شده است. نتیجه گیری: با توجه به نتایج برازش توزیع‌های آماری بر مدت زمان بستری بیماران در بخش PICU،توزیع‌های سری لگاریتمی وایبول معکوس تعمیم یافته و هندسی وایبول معکوس در مقایسه با سایر توزیع‌ها برازش بهتری ارائه دادند. 2 Introduction: Length of stay in hospital is one of the effective factors in determining the cost of hospitalized patients and one of the high-cost departments is the pediatric intensive care unit (PICU). Knowing how long patients stay in hospital beds can be effective. The purpose of this study was to provide the most appropriate statistical distribution of patients 'stay in PICU wards to predict patients' hospital stay. Methods: In this paper, in addition to investigating the diagnoses presented to patients admitted to the PICU ward, it has been attempted to use the best statistical models in survival studies such as the inverse Weibull distribution family or its combinations to determine the best statistical model for pediatric hospitalization. To determine the pediatric intensive care unit of three hospitals in Mashhad in 2018 based on these distributions, the first, second and third quartiles of survival time are identified and the best statistical distribution is determined for patients' residence time. R statistical software version 3.5.2 was also used for data analysis and statistical modeling of the population. Finally, maximum likelihood, Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) were used to identify the appropriate model. Results: Based on the data from these three hospitals, several statistical distributions suitable for survival data were fitted to patients' survival times in the PICU wards studied, and the distribution parameters along with intermediate indices and first and third quartiles were reported. After fitting the composite statistical Weibull and Generalized Reverse Weibull statistical distributions to the length of hospital stay in the PICU ward, the best distribution was the logistic regression Weibull series distribution with the highest likelihood. Conclusion: Generalized inverse Weibull logarithmic series and Inverse Weibull Geometric distribution had a good fit for patients’ bed time in PICU department of reviewed hospitals. 198 205 2020/03/62019/12/72019/11/272019/11/9 1398/8/18 2020/03/62019/12/232020/01/42020/02/26 1398/12/7 امیرعباس آذریان Amir Abbas Azarian گروه آمار، دانشگاه پیام نور، تهران، ایران azarianaa1@gmail.com پرویز نصیری Parviz Nasiri گروه آمار، دانشگاه پیام نور، تهران، ایران pnasiri@pnu.ac.ir Survival Time Inverse Weibull Distribution Bed-Time Pediatric Intensive Care Unit Statistical Criteria زمان بقا توزیع وایبول معکوس اقامت بیمارستانی بخش مراقبتهای ویژه کودکان معیارهای آماری 1. Ajalloueian M, Kazemi H, Samar G, Feyzzadeh A. Study on nosocomial infections in an intensive care unit and the related factors. J Gorgan Univ Med Sci. 2007; 9 (2) :24-28##2. Alwash AMS., Habibzade, M, Shafa, A. A Comparative Study of Hospital Cost of Patients in Internal Medicine and Surgical Wards in Pediatric Intensive Care Unit in Imam Hussein Hospital. Depiction of Health 2018; 9(3): 186-194##3. Arab M, Zareei A, Rahimi A, Rezaeian F, Akbari F. Analysis of Factors Affecting Length of stay in Public Hospitals in Lorestan Province, Iran . Hakim Health Sys Res. 2010; 12 (4) :27-32##4. Chakrabarty, J. B. and S. Chowdhury. "Compounded inverse Weibull distributions: Properties, inference and applications." 2018. Communications in Statistics-Simulation and Computation: 1-22.##5. Ebrahimipour H, Vajaee A, nouri G, Esmaeili H, Jamili S. Studying Waiting Time of Patient during Discharge Process in Clinical Departments of Imam Reza Hospital affiliated with Mashhad University Of Medical Science In 2014. jhosp. 2015; 14 (1) :117-125##6. Gusmão, R.S. Ortega, M.M, The generalized inverse Weibull distribution, Stat Papers (2011) 52:591-619##7. Kandi Kele M, Kadivar M, Zeraati H, Ahmadnezhad E, Holakoui Naini K. Length of Stay in NICU Admitted Infants and Its Effective Factors at Children's Hospital Medical Center Using Survival Analysis. irje. 2014; 10 (1) :25-32##8. Liu Y, Phillips M, Codde J. Factors influencing patients' length of stay. Australian Health Review. 2001; 24: 63-70.##9. Mennis, J., Stahler, G.J., El Magd, S.A., Baron, D.A. How long does it take to complete outpatient substance use disorder treatment? Disparities among Blacks, Hispanics, and Whites in the US (2019) Addictive Behaviors, 93, pp. 158-165.##10. M'Hallah, R., Visintin, F. A stochastic model for scheduling elective surgeries in a cyclic Master Surgical Schedule (2019) Computers and Industrial Engineering, 129, pp. 156-168.##11. Moosavi, A., Ebrahimnejad, S. Scheduling of elective patients considering upstream and downstream units and emergency demand using robust optimization (2018) Computers and Industrial Engineering, 120, pp. 216-233.##12. Moosavi, Amirhossein. Ebrahimnejad, Sadoullah. Scheduling of elective patients considering upstream and downstream units and emergency demand using robust optimization. Computers & Industrial Engineering 120 (2018) 216–233.##13. Oueida, S., Kadry, S., Char, P.A., Ionescu, S. Improving emergency department services using simulation: Case study of Kuwait hospital (2018) 2017 9th IEEE-GCC Conference and Exhibition, GCCCE 2017, art. no. 8448175, ##14. Oueida, S., Kadry, S., Char, P.A., Ionescu, S.Improving emergency department services using simulation: Case study of Kuwait hospital (2018) 2017 9th IEEE-GCC Conference and Exhibition, GCCCE 2017, art. no. 8448175, .##15. Sokoreli, I., Cleland, J.G., Pauws, S.C., Steyerberg, E.W., de Vries, J.J.G., Riistama, J.M., Dobbs, K.,Bulemfu, J., Clark, A.L. Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure: An analysis from OPERA-HF (2019) International Journal of Cardiology, 278, pp. 167-172.##16. The length of hospital stay in ICU is between3 and 5 days. Available at: https://www.palna.ir/p/1h06. Accessed Feb 24, 2020##17. Weibull, W. "A statistical distribution function of wide applicability." Journal of applied mechanics (1951). 18(3): 293-297.##1. Kandi Kele M, Kadivar M, Zeraati H, Ahmadnezhad E, Holakoui Naini K. Length of Stay in NICU Admitted Infants and Its Effective Factors at Children's Hospital Medical Center Using Survival Analysis. irje. 2014; 10 (1) :25-32##2. Ajalloueian M, Kazemi H, Samar G, Feyzzadeh A. Study on nosocomial infections in an intensive care unit and the related factors. J Gorgan Univ Med Sci. 2007; 9 (2) :24-28##3. Arab M, Zareei A, Rahimi A, Rezaeian F, Akbari F. Analysis of Factors Affecting Length of stay in Public Hospitals in Lorestan Province, Iran . Hakim Health Sys Res. 2010; 12 (4) :27-32##4. Ebrahimipour H, Vajaee A, nouri G, Esmaeili H, Jamili S. Studying Waiting Time of Patient during Discharge Process in Clinical Departments of Imam Reza Hospital affiliated with Mashhad University Of Medical Science In 2014. jhosp. 2015; 14 (1) :117-125##5. Alwash AMS., Habibzade, M, Shafa, A. A Comparative Study of Hospital Cost of Patients in Internal Medicine and Surgical Wards in Pediatric Intensive Care Unit in Imam Hussein Hospital. Depiction of Health 2018; 9(3): 186-194##6. Mennis, J., Stahler, G.J., El Magd, S.A., Baron, D.A. How long does it take to complete outpatient substance use disorder treatment? Disparities among Blacks, Hispanics, and Whites in the US (2019) Addictive Behaviors, 93, pp. 158-165.##7. M'Hallah, R., Visintin, F. A stochastic model for scheduling elective surgeries in a cyclic Master Surgical Schedule (2019) Computers and Industrial Engineering, 129, pp. 156-168.##8. Sokoreli, I., Cleland, J.G., Pauws, S.C., Steyerberg, E.W., de Vries, J.J.G., Riistama, J.M., Dobbs, K.,Bulemfu, J., Clark, A.L. Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure: An analysis from OPERA-HF (2019) International Journal of Cardiology, 278, pp. 167-172.##9. Moosavi, A., Ebrahimnejad, S. Scheduling of elective patients considering upstream and downstream units and emergency demand using robust optimization (2018) Computers and Industrial Engineering, 120, pp. 216-233.##10. Oueida, S., Kadry, S., Char, P.A., Ionescu, S.Improving emergency department services using simulation: Case study of Kuwait hospital (2018) 2017 9th IEEE-GCC Conference and Exhibition, GCCCE 2017, art. no. 8448175.##11. Weibull, W. "A statistical distribution function of wide applicability." Journal of applied mechanics (1951). 18(3): 293-297.##12. Chakrabarty, J. B. and S. Chowdhury. "Compounded inverse Weibull distributions: Properties, inference and applications." 2018. Communications in Statistics-Simulation and Computation: 1-22.##13. Gusmão, R.S. Ortega, M.M, The generalized inverse Weibull distribution, Stat Papers (2011) 52:591-619##14. The length of hospital stay in ICU is between3 and 5 days. Available at: https://www.palna.ir/p/1h06. Accessed Feb 24, 2020##15. Liu Y, Phillips M, Codde J. Factors influencing patients' length of stay. Aust Health Rev. 2001; 24(2):63-70.##16. Ayyoubzadeh SM, Ghazisaeedi M, Rostam Niakan Kalhori S, Hassaniazad M, Baniasadi T, Maghooli K, Kahnouji K. A study of factors related to patients' length of stay using data mining techniques in a general hospital in southern Iran. Health Inf Sci Syst. 2020; 8(1):9##17. Liu Y, Phillips M, Codde J. Factors influencing patients' length of stay. Australian Health Review. 2001; 24: 63-70. ##

تحلیل روند متغیرهای اصلی اقتصاد کلان ایران و تاثیر آن بر شاخص های سلامت Trend Analysis of Iran's Macroeconomics Main Variables and its Impact on Health Indicators 1 1 مقدمه: بررسی اثر متغیرهای کلان اقتصادی بر متغیرهای سطح سلامت می تواند علاوه بر آگاهی سیاست گذاران نظام سلامت از میزان تأثیر متغیرهای اقتصادی بر سطح سلامت، امکان پیش بینی اثر نوسانات اقتصادی را بر سطح سلامت فراهم کند. هدف از مطالعه حاضر، تحلیل روند متغیرهای اصلی اقتصاد کلان ایران و بررسی تأثیر آنها بر شاخص های سلامت بود. روش بررسی: پژوهش حاضر یک مطالعه توصیفی تحلیلی بود. در این مطالعه به منظور شناسایی تأثیر نوسانات اقتصادی بر سلامت عمومی، روند ۴ دهه تغییرات (۱۳۵۰-۱۳۹۰) در شاخص های کلان اقتصادی و شاخص های سلامت عمومی مورد بررسی قرار گرفت. شاخص های سلامت از بانک جهانی و شاخص های مرتبط با اقتصاد کلان از بانک مرکزی جمهوری اسلامی ایران و مرکز آمار ایران جمع آوری شد. برای شناسایی ارتباط بین متغیرها از برازش مدل رگرسیونی الگوی خودتوضیح برداری (VAR model) و آزمون علّیت گرنجر (Granger causality test) استفاده شد. تخمین مدل های رگرسیونی و آزمون های آماری مرتبط با استفاده از نرم افزار اقتصادسنجی eviews ۷ انجام شد. یافته ها: رشد درآمد سرانه، نابرابری درآمد، و نرخ بیکاری، تأثیر آماری معناداری بر شاخص های امید به زندگی و مرگ و میر کودکان زیر ۵سال داشتند (P<۰.۰۵) و آزمون علّیت گرانجر نیز جهت تأثیر را تأیید می کرد. اختلالات نرخ ارز اگرچه تأثیر آماری معناداری بر امید به زندگی داشت(P<۰.۰۵)، اما اثر آن بر مرگ و میر کودکان زیر ۵ سال معنادار نبود (P>۰.۰۵). از میان متغیرهای کلان اقتصادی تأثیر متغیر نابرابری درآمدی بر شاخص های سلامت بیشتر از سایر متغیرها بود. نتیجه گیری: از بین متغیرهای کلان اقتصادی، تأثیر نابرابری درآمدی بیشتر و طولانی مدت تر از سایر متغیرها بود و برهمین اساس دولت می تواند با اتخاذ سیاست های بازتوزیع درآمد، از طریق کاهش نابرابری درآمدی آثار سوء نوسانات اقتصادی را بر سطح سلامت جامعه کنترل کند. 2 Introduction: Investigating the effect of macroeconomic variables on health indicators can provide the ability to predict the effect of economic fluctuations on health in addition to health policy makers' awareness of the impact of economic variables on health level. The purpose of this study was to analyze the trend of the main variables of Iran's macroeconomics and their impact on Iran's health indicators. Methods: The present study was a descriptive-analytical study. In this study, in order to identify the impact of economic fluctuations on public health, the trend of 4 decades (19712011-) fluctuation of macroeconomic and public health indices were analyzed. Health indicators were collected from the World Bank database and macroeconomic indicators from the Central Bank of the Islamic Republic of Iran and the Iranian Statistics Center. To identify the relationship between variables, the VAR model estimated and the Granger causality test used. Regression models and statistical tests run by using eviews7 econometrics software. Results: The growth of "per capita income", "income inequality", and "unemployment rate" had statistically significant effect on life expectancy and mortality in children under 5 years (P <0.05) and Granger causality test also confirmed the effect. Although the "exchange rate disorder" had a statistically significant effect on life expectancy (P <0.05), its effect on mortality of children under 5 years was not significant (P> 0.05). Among macroeconomic variables, the effect of income inequality on health indicators was more than other variables. Conclusion: Among macroeconomic variables, the effect of income inequality is larger and long lasting than other variables. By adopting income redistribution policies, the government can control the effects of economic fluctuations on the society's health through reducing income inequality. 206 215 2020/03/62019/12/72019/11/272019/11/92019/11/24 1398/9/3 2020/03/62019/12/232020/01/42020/02/262020/02/25 1398/12/6 محمد مسکرپور امیری Mohammad Meskarpour-Amiri مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه ا...(عج)، تهران، ایران mailer.amiri@gmail.com پریسا مهدی زاده Parisa Mahdizadeh مرکز تحقیقات مدیریت سلامت، دانشگاه علوم پزشکی بقیه ا...(عج)، تهران، ایران hmrc1391@gmail.com Health Economics Economic Fluctuations Health Macroeconomic Health Indicators اقتصاد سلامت نوسانات اقتصادی سلامت اقتصاد کلان شاخص های سلامت 1. Iran Cbo. Economic time series database Tehran,Iran: Central bank of Iran; 1392. Available from: http://tsd.cbi.ir/Display/Content.aspx.##2. Raghfar H KM, Vaez Mahdavi Z, Sangesari Mohazab K,. Impact of Health Insurance Inefficiency on Poverty among Iranian Households. Hakim Research Journal 2013;16(1):9-19.##3. Lashkari M. social welfare indexes. journal of Political-Economic Informations. 1998 1998/05/01;12(6):214-24. fa.##4. Heydarniya MA, Ghaemiyan T, Abadi A, Fathiyan S, Montazeri A. The relationship between deprivation (poverty) and health-related quality of life. Payesh Journal. 2012;4.##5. Subramanian SV, Belli P, Kawachi I. The macroeconomic determinants of health. Annual Review of Public Health. 2002;23(1):287-302. PubMed PMID: 11910064.##6. Fayissa* B, Gutema P. Estimating a health production function for Sub-Saharan Africa (SSA). Applied Economics. 2005;37(2):155-64.##7. Ram R. Income inequality, poverty, and population health: evidence from recent data for the United States. Social science & medicine. 2005;61(12):2568-76.##8. Drakopoulos SA. Economic policies, political considerations and overall health. Economic Analysis and Policy. 2011;41(3):273.##9. Wilkinson RG, Pickett KE. Income inequality and population health: a review and explanation of the evidence. Social science & medicine. 2006;62(7):1768-84.##10. Hosseinpoor AR, Mohammad K, Majdzadeh R, Naghavi M, Abolhassani F, Sousa A, et al. Socioeconomic inequality in infant mortality in Iran and across its provinces. Bulletin of the World Health Organization. 2005;83:837-44.##11. Ruhm CJ. Healthy living in hard times. Journal of health economics. 2005;24(2):341-63.##12. Baker DB. The study of stress at work. Annual review of public health. 1985;6(1):367-81.##13. Karasek R. Healthy work: stress, productivity, and the reconstruction of working life: Basic books; 1992.##14. Mehrara M, Nasibparast S. Determinants of health status in developing countries: a Bayesian econometric approach. International Journal of Social Science Tomorrow. 2012;1(6):1-7.##15. Evans W, Graham JD. Traffic safety and the business cycle. Alcohol, Drugs, and Driving. 1988;4(1):31-8.##16. Ruhm CJ, Black WE. Does drinking really decrease in bad times? Journal of Health Economics. 2002;21(4):659-78.##17. Amini Anabad H, Meskarpour Amiri M. Financial Accessibility of Iranian Households to Health Care Services during 1983-2008. Hakim Research Journal. 2013;16(1):1-8. eng %@ 1561-252X %[ 2013.##18. Zare H, Trujillo AJ, Driessen J, Ghasemi M, Gallego G. Health inequalities and development plans in Iran; an analysis of the past three decades (1984–2010). International journal for equity in health. 2014;13(1):42.## ##

رابطه پوشش بیمه درمانی و مواجهه خانوارهای ایرانی با هزینه های کمرشکن The Relationship Between Health Insurance Coverage and Catastrophic Health Expenditure Among Iranian Households 1 1 مقدمه: محدودیت های مالی و اقتصادی یکی از مهم ترین موانع دسترسی به خدمات مراقبت های سلامت به شمار می روند و  بنابراین، حفاظت مالی از گیرندگان خدمات در برابر هزینه‌های سلامت، با استفاده از مکانیسم بیمه، یکی از راهکارهای اصلی دستیابی به پوشش همگانی سلامت، در جوامع شناخته می شود. برهمین اساس پژوهش حاضر نیز با هدف تبیین وضعیت پوشش بیمه درمانی و تأثیر آن بر هزینه‌های کمرشکن بین خانوارهای ایرانی طراحی و اجرا شد. روش بررسی: مطالعه حاضر به صورت مقطعی در دوره مطالعاتی ۱۳۹۴تا ۱۳۹۶ و با استفاده از داده های پیمایش هزینه  -   درآمد خانوار مرکز آمار ایران انجام شد. پس از استخراج و پالایش داده های خام، به منظور دستیابی به هدف مطالعه، داده های مربوط به ۱۱۴هزار و ۳۷۵ خانوار وارد مطالعه شدند. سنجش شـاخص هزینـه هـای کمرشـکن سلامت در مطالعه حاضر براساس تعریف سازمان جهانی بهداشت انجام شد. استخراج داده ها با استفاده از نرم افزارهای کاربردی MSAccess۲۰۱۳ و MSExcel۲۰۱۳ و تحلیل داده ها به کمک نرم افزارSTATA v.۱۴.۱ براساس تکنیک رگرسیونی لاجیت انجام شد. یافته ها: نتایج مطالعه حاضر نشان داد که پوشش بیمه ای در مناطق روستایی (۶۶/۷۷ درصد) بیشتر از مناطق شهری (۷۱درصد) بود. در مناطق روستایی، شهری و کل کشور به ترتیب بیمه سلامت، تأمین اجتماعی و خدمات درمانی بیشترین جامعه را تحت پوشش قرار می دادند. تأثیر مثبت پوشش بیمه  ای بر پیشگیری از احتمال مواجهه خانوارها با هزینه های کمرشکن سلامت مشاهده نشد. عواملی مانند افزایش تعداد سالمندان در خانوارها، نداشتن منزل شخصی، ساکن مناطق روستا بودن، درآمد پایین خانوار، تعداد شاغل کمتر در خانوار به عنوان عوامل موثر بر افزایش احتمال ابتلا به هزینه های کمرشکن سلامت شناسایی شدند. نتیجه گیری: طبق نتایج مطالعه حاضر به نظر می رسد بیمه های درمانی پایه نتوانسته اند از ابتلای خانوارهای ایرانی به هزینه های کمرشکن سلامت جلوگیری کنند. با وجود اینکه عوامل اجتماعی و اقتصادی دیگری نیز در مواجهه با هزینه های کمرشکن ممکن است دخیل باشند، اما آنچه به طور واضح به نظر می رسد، این است که خانوارهای ایرانی دارای بیمه درمانی از خطر مواجهه با هزینه های کمرشکن سلامت در امان نبوده‌اند. بنابراین در کنار اصلاحات سیاست های بیمه ای لازم است به سایر عوامل اجتماعی و اقتصادی موثر بر اقتصاد سلامت خانوار نیز توجه شود. 2 Introduction: Financial and economic constraints are among the most important barriers to accessing health care services. Therefore, protecting the recipients of health services against the cost of health by using the insurance mechanism is one of the main strategies for achieving universal health coverage in societies; accordingly, the present study was designed and implemented to explain the status of health insurance coverage and its effect on catastrophic health expenditure among Iranian households. Methods: This cross-sectional study was conducted in 2015-2018 using the Household Expenditure Survey data by Statistics Center of Iran. After data extraction and data cleaning, data on 37962 households were included in the study. Catastrophic health expenditure index was calculated based on WHO definition. Data were extracted by MSAccess2013 and MSExcel2013 and analyzed using Logit regression technique with STATA v.14.1. Result: The results of this study showed that insurance coverage in rural areas (77.66%) was more than urban areas (71%). In rural areas, urban and countrywide, respectively, health insurance, social security and health insurance covered the most of the population. There was no positive effect of insurance coverage on probability of households facing catastrophic health expenditures. Factors such as increasing number of elderly in households, being rented, being rural, income, unemployed were identified as contributing factors to the increased probability of facing catastrophic health expenditures. Conclusion: According to the results of the present study, it seems that health insurance has not been able to prevent Iranian households with catastrophic health expenditures. While other socioeconomic factors may also be contributing to catastrophic health expenditures, what seems to be clear is that Iranian households with health insurance have not been exposed to the risk of being exposed to catastrophic health expenditures. Therefore, along with insurance policy reforms, other socioeconomic factors affecting the health of the household should also be considered. 216 227 2020/03/62019/12/72019/11/272019/11/92019/11/242019/12/13 1398/9/22 2020/03/62019/12/232020/01/42020/02/262020/02/252020/02/22 1398/12/3 فاروق نعمانی Faroogh Na'emani گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران farooghnamani93@gmail.com جعفر یحیوی دیزج Jafar Yahyavi Dizaj گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران jafar.economic@yahoo.com Iranian Households CHE OOP Health Insurance Coverage خانوار ایرانی هزینه کمرشکن پرداخت مستقیم از جیب پوشش بیمه درمانی منابع:##1. Frenk J, De Ferranti D. Universal health coverage: good health, good economics. The Lancet. 2012;380(9845):862-4.##2. Chen M, Zhao Y, Si L. Who pays for health care in China? The case of Heilongjiang province. PLoS One. 2014;9(10):e108867.##3. Rad EH, Khodaparast M. Inequity in health care financing in Iran: progressive or regressive mechanism? The Eurasian journal of medicine. 2016;48(2):112.##4. Castaño R, Bitrán R, Giedion U. Monitoring and evaluating hospital autonomization and its effects on priority health services. 2004.##5. Preker AS, Harding A. Innovations in health service delivery: the corporatization of public hospitals: The World Bank; 2003.##6. Mir Hosein Mousavi, Hosein Raghfar, Zahra Fazel. Analysis Equity in Financing of Household’s Health in Development Programs of Iran. Hakim Health Systems Research Journal. 2018;21(1):1-12.##7. Pouragha B, poor Reza A, Hosseinzadeh H. Proportion of public and private tariffs for visiting general practitioners with the insured's household budget. Teb va tazkiye journal. 2017;21(1):14-21(persian).##8. Mehrolhassani M, Najafi B, Yazdi Feyzabadi V, Haghdoost A, Abolhallaje M, Ansari M, et al. Total health expenditures and proportion of out-of-pocket payments in Iranian provinces; 2008-2014. Iranian Journal of Epidemiology. 2017;12(5Special Issue):1-12.##9. Emamgholipour S, Akbari Sari A, Geravandi S, Mazrae H. Estimation of out-of-pocket and catastrophic expenditures among patients with cardiovascular diseases in Khuzestan. Journal of Payavard Salamat. 2017;11(3):297-307.##10. SAVOJIPOUR S, ASSARI AA, AGHELI L, HASSANZADEH A. Modeling Healthcare Expenditure among Iranian Households. 2018.##11. Ahmadi A, Nikravan A, Naseri A, Asari A. Effective determinants in household out of packet payments in health system of Iran, using two part regression model. Journal of Health Administration (JHA). 2014;17(56).##12. Organization WH. Global tuberculosis report 2013: World Health Organization; 2013.##13. Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, Bryson-Cahn C, Barofsky J, Maguire R, et al. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. The Lancet. 2006;368(9549):1828-41.##14. Gutiérrez JP, García-Saisó S, Dolci GF, Ávila MH. Effective access to health care in Mexico. BMC health services research. 2014;14(1):186.##15. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A. Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program. Health policy and planning. 2019.##16. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. The lancet. 2003;362(9378):111-7.##17. Organization WH. Tracking universal health coverage: first global monitoring report: World Health Organization; 2015.##18. Yazdi Feyzabadi V, Bahrampour M, Rashidian A, Haghdoost A, Abolhallaje M, Najafi B, et al. Incidence and intensity of catastrophic health expenditures in Iranian provinces; 2008-2014. Iranian Journal of Epidemiology. 2017;12:40-54.##19. Kavosi Z, Rashidian A, Pourmalek F, Majdzadeh R, Pourreza A, Mohammad K, et al. Measuring household exposure to catastrophic health care expenditures: a Longitudinal study in Zone 17 of Tehran. Hakim Research Journal. 2009;12(2):38-47.##20. Piroozi B, Moradi G, Nouri B, Bolbanabad AM, Safari H. Catastrophic health expenditure after the implementation of health sector evolution plan: a case study in the west of Iran. International journal of health policy and management. 2016;5(7):417.##21. Anbari Z, Mohammadbeigi A, Mohammadsalehi N, Ebrazeh A. Health expenditure and catastrophic costs for inpatient-and out-patient care in Iran. International journal of preventive medicine. 2014;5(8):1023.##22. Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Health CoSDo. Closing the gap in a generation: health equity through action on the social determinants of health. The lancet. 2008;372(9650):1661-9.##23. Moghaddasi H, Hosseini A, Asadi F, Esmaeili M. Problems of health insurance systems and the need for implementation of a reform approach. Journal of Health Administration (JHA). 2011;14(44).##24. Ghaderi S. The Impact of medical Insurances on out-of-pocket payments among urban households in Iran: A Double-Sample selection Model. Journal of Health Administration. 2019;22(2):41-54.##25. Mohamadi E, Zaraei G. Investigating the effect of health care improvement plan on the payment of the insured in Iranian health insurance organization (case study: hospitalized patients in collegiate hospitals of Ilam city in december 2013 and 2014). 2017.##26. Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health affairs. 2009;28(3):w467-w78.##27. Limwattananon S, Tangcharoensathien V, Prakongsai P. Equity in financing healthcare: impact of universal access to healthcare in Thailand. 2008.##28. Ekman B. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. Health policy. 2007;83(2-3):304-13.##29. Wagstaff A, Lindelow M. Can insurance increase financial risk?: The curious case of health insurance in China. Journal of health economics. 2008;27(4):990-1005.##30. Ghiasvand H, Hadian M, Maleki M, Shabaninejad H. Determinants of catastrophic medical payments in hospitals affiliated to Iran University of Medical Sciences 2009. Hakim Research Journal. 2010;13(3):145-54.##31. Nekoeimoghadam M, Akbari-Javar M, Amiresmaili M, Baneshi M, Ganjavai S. Households exposure to catastrophic health expenditures and the affecting factors in Kerman province. Iran J Manage Med Inform Sch. 2014;1(2):74-85.##32. O’donnell O, Van Doorslaer E, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, et al. Who pays for health care in Asia? Journal of health economics. 2008;27(2):460-75.##33. Yahyavi Dizaj J, Emamgholipour S, Pourreza A, Nommani F, Molemi S. Effect of Aging on Catastrophic Health Expenditure in Iran During the Period 2007-2016. Journal of School of Public Health and Institute of Public Health Research. 2018;16(3):216-27.##34. Ghiasi A, Baghi A, Rezapour A, Alipour V, Ahadinezhad B, Mahmoudi M, et al. Health insurance, medicine expenses and catastrophic health expenditures. Journal of Health Administration. 2016;18(62):64-74.##35. Naghdi S, Azami SR, Naghdi A, Faghi Solouk F, Ghiasvand H. The Inequity of Expenditure Ratios on Health and Food among Different Deciles of Iranian Households. 2013.##36. center s. https://www.amar.org.ir/english 2010 [##37. Kruk ME, Freedman LP. Assessing health system performance in developing countries: a review of the literature. Health policy. 2008;85(3):263-76.##38. Gotsadze G, Zoidze A, Rukhadze N. Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC health services research. 2009;9(1):69.##39. Rashidian A, Soofi M. Methodology of the Assessment of Financial Protection Against Health Costs. Iranian Journal of Epidemiology. 2015;11(1):82-93.##40. Safaei Pour M, Maveddat E. Assessment of areas with an emphasis on social indicators - economic and human development indicators in combination with the use of GIS techniques and TOPSIS. Scientific Journal Management System. 2013;1(3):11-27.##41. Panahi H, Falahi F, Mohammadzadeh P, Janati A, Narimani M, Sabaghizadeh L. Factors influencing the out-of-pocket payments by patients in the hospital in Tabriz-Iran. Health Inf Manage. 2014;11:199-207.##42. Nekoeimoghadam M, Akbari-Javar M, Amiresmaili M, Baneshi M, Ganjavai S. Households exposure to catastrophic health expenditures and the affecting factors in Kerman province. Iran J Manage Med Inform Sch. 2014;1:74-85.##43. Hajizadeh M, Connelly LB. Equity of health care financing in Iran: the effect of extending health insurance to the uninsured. Oxford Development Studies. 2010;38(4):461-76.##44. Pourasghari H, Jafari M, Bakhtiari M, Keliddar I, Irani A, Afshari M. Analysis of equality in Iranian household healthcare payments during Iran’s fourth development program. Electronic physician. 2016;8(7):2645.##45. Yazdi-Feyzabadi V, Bahrampour M, Rashidian A, Haghdoost A-A, Javar MA, Mehrolhassani MH. Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey. International journal for equity in health. 2018;17(1):44.##46. Kavosi Z, Keshtkaran A, Hayati R, Ravangard R, Khammarnia M. Household financial contribution to the health System in Shiraz, Iran in 2012. International journal of health policy and management. 2014;3(5):243.##47. Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bulletin of the World Health Organization. 2006;84:21-7.##48. Hajizadeh M, Nghiem HS. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? International journal of health care finance and economics. 2011;11(4):267.##49. Pal R. Analysing catastrophic OOP health expenditure in India: Concepts, determinants and policy implications. 2012.##50. Merlis M, Gould D, Mahato B, Fund C. Rising out-of-pocket spending for medical care: a growing strain on family budgets: Citeseer; 2006.##51. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health affairs. 2007;26(4):972-83.##52. Wyszewianski L. Families with catastrophic health care expenditures. Health services research. 1986;21(5):617.##منابع:##1. Frenk J, De Ferranti D. Universal health coverage: good health, good economics. The Lancet. 2012;380(9845):862-4.##2. Chen M, Zhao Y, Si L. Who pays for health care in China? The case of Heilongjiang province. PLoS One. 2014;9(10):e108867.##3. Rad EH, Khodaparast M. Inequity in health care financing in Iran: progressive or regressive mechanism? The Eurasian journal of medicine. 2016;48(2):112.##4. Castaño R, Bitrán R, Giedion U. Monitoring and evaluating hospital autonomization and its effects on priority health services. 2004.##5. Preker AS, Harding A. Innovations in health service delivery: the corporatization of public hospitals: The World Bank; 2003.##6. Mir Hosein Mousavi, Hosein Raghfar, Zahra Fazel. Analysis Equity in Financing of Household’s Health in Development Programs of Iran. Hakim Health Systems Research Journal. 2018;21(1):1-12.##7. Pouragha B, poor Reza A, Hosseinzadeh H. Proportion of public and private tariffs for visiting general practitioners with the insured's household budget. Teb va tazkiye journal. 2017;21(1):14-21(persian).##8. Mehrolhassani M, Najafi B, Yazdi Feyzabadi V, Haghdoost A, Abolhallaje M, Ansari M, et al. Total health expenditures and proportion of out-of-pocket payments in Iranian provinces; 2008-2014. Iranian Journal of Epidemiology. 2017;12(5Special Issue):1-12.##9. Emamgholipour S, Akbari Sari A, Geravandi S, Mazrae H. Estimation of out-of-pocket and catastrophic expenditures among patients with cardiovascular diseases in Khuzestan. Journal of Payavard Salamat. 2017;11(3):297-307.##10. SAVOJIPOUR S, ASSARI AA, AGHELI L, HASSANZADEH A. Modeling Healthcare Expenditure among Iranian Households. 2018.##11. Ahmadi A, Nikravan A, Naseri A, Asari A. Effective determinants in household out of packet payments in health system of Iran, using two part regression model. Journal of Health Administration (JHA). 2014;17(56).##12. Organization WH. Global tuberculosis report 2013: World Health Organization; 2013.##13. Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, Bryson-Cahn C, Barofsky J, Maguire R, et al. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. The Lancet. 2006;368(9549):1828-41.##14. Gutiérrez JP, García-Saisó S, Dolci GF, Ávila MH. Effective access to health care in Mexico. BMC health services research. 2014;14(1):186.##15. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A. Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program. Health policy and planning. 2019.##16. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. The lancet. 2003;362(9378):111-7.##17. Organization WH. Tracking universal health coverage: first global monitoring report: World Health Organization; 2015.##18. Yazdi Feyzabadi V, Bahrampour M, Rashidian A, Haghdoost A, Abolhallaje M, Najafi B, et al. Incidence and intensity of catastrophic health expenditures in Iranian provinces; 2008-2014. Iranian Journal of Epidemiology. 2017;12:40-54.##19. Kavosi Z, Rashidian A, Pourmalek F, Majdzadeh R, Pourreza A, Mohammad K, et al. Measuring household exposure to catastrophic health care expenditures: a Longitudinal study in Zone 17 of Tehran. Hakim Research Journal. 2009;12(2):38-47.##20. Piroozi B, Moradi G, Nouri B, Bolbanabad AM, Safari H. Catastrophic health expenditure after the implementation of health sector evolution plan: a case study in the west of Iran. International journal of health policy and management. 2016;5(7):417.##21. Anbari Z, Mohammadbeigi A, Mohammadsalehi N, Ebrazeh A. Health expenditure and catastrophic costs for inpatient-and out-patient care in Iran. International journal of preventive medicine. 2014;5(8):1023.##22. Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Health CoSDo. Closing the gap in a generation: health equity through action on the social determinants of health. The lancet. 2008;372(9650):1661-9.##23. Moghaddasi H, Hosseini A, Asadi F, Esmaeili M. Problems of health insurance systems and the need for implementation of a reform approach. Journal of Health Administration (JHA). 2011;14(44).##24. Ghaderi S. The Impact of medical Insurances on out-of-pocket payments among urban households in Iran: A Double-Sample selection Model. Journal of Health Administration. 2019;22(2):41-54.##25. Mohamadi E, Zaraei G. Investigating the effect of health care improvement plan on the payment of the insured in Iranian health insurance organization (case study: hospitalized patients in collegiate hospitals of Ilam city in december 2013 and 2014). 2017.##26. Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health affairs. 2009;28(3):w467-w78.##27. Limwattananon S, Tangcharoensathien V, Prakongsai P. Equity in financing healthcare: impact of universal access to healthcare in Thailand. 2008.##28. Ekman B. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. Health policy. 2007;83(2-3):304-13.##29. Wagstaff A, Lindelow M. Can insurance increase financial risk?: The curious case of health insurance in China. Journal of health economics. 2008;27(4):990-1005.##30. Ghiasvand H, Hadian M, Maleki M, Shabaninejad H. Determinants of catastrophic medical payments in hospitals affiliated to Iran University of Medical Sciences 2009. Hakim Research Journal. 2010;13(3):145-54.##31. Nekoeimoghadam M, Akbari-Javar M, Amiresmaili M, Baneshi M, Ganjavai S. Households exposure to catastrophic health expenditures and the affecting factors in Kerman province. Iran J Manage Med Inform Sch. 2014;1(2):74-85.##32. O’donnell O, Van Doorslaer E, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, et al. Who pays for health care in Asia? Journal of health economics. 2008;27(2):460-75.##33. Yahyavi Dizaj J, Emamgholipour S, Pourreza A, Nommani F, Molemi S. Effect of Aging on Catastrophic Health Expenditure in Iran During the Period 2007-2016. Journal of School of Public Health and Institute of Public Health Research. 2018;16(3):216-27.##34. Ghiasi A, Baghi A, Rezapour A, Alipour V, Ahadinezhad B, Mahmoudi M, et al. Health insurance, medicine expenses and catastrophic health expenditures. Journal of Health Administration. 2016;18(62):64-74.##35. Naghdi S, Azami SR, Naghdi A, Faghi Solouk F, Ghiasvand H. The Inequity of Expenditure Ratios on Health and Food among Different Deciles of Iranian Households. 2013.##36. center s. https://www.amar.org.ir/english 2010 [##37. Kruk ME, Freedman LP. Assessing health system performance in developing countries: a review of the literature. Health policy. 2008;85(3):263-76.##38. Gotsadze G, Zoidze A, Rukhadze N. Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC health services research. 2009;9(1):69.##39. Rashidian A, Soofi M. Methodology of the Assessment of Financial Protection Against Health Costs. Iranian Journal of Epidemiology. 2015;11(1):82-93.##40. Safaei Pour M, Maveddat E. Assessment of areas with an emphasis on social indicators - economic and human development indicators in combination with the use of GIS techniques and TOPSIS. Scientific Journal Management System. 2013;1(3):11-27.##41. Panahi H, Falahi F, Mohammadzadeh P, Janati A, Narimani M, Sabaghizadeh L. Factors influencing the out-of-pocket payments by patients in the hospital in Tabriz-Iran. Health Inf Manage. 2014;11:199-207.##42. Nekoeimoghadam M, Akbari-Javar M, Amiresmaili M, Baneshi M, Ganjavai S. Households exposure to catastrophic health expenditures and the affecting factors in Kerman province. Iran J Manage Med Inform Sch. 2014;1:74-85.##43. Hajizadeh M, Connelly LB. Equity of health care financing in Iran: the effect of extending health insurance to the uninsured. Oxford Development Studies. 2010;38(4):461-76.##44. Pourasghari H, Jafari M, Bakhtiari M, Keliddar I, Irani A, Afshari M. Analysis of equality in Iranian household healthcare payments during Iran’s fourth development program. Electronic physician. 2016;8(7):2645.##45. Yazdi-Feyzabadi V, Bahrampour M, Rashidian A, Haghdoost A-A, Javar MA, Mehrolhassani MH. Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey. International journal for equity in health. 2018;17(1):44.##46. Kavosi Z, Keshtkaran A, Hayati R, Ravangard R, Khammarnia M. Household financial contribution to the health System in Shiraz, Iran in 2012. International journal of health policy and management. 2014;3(5):243.##47. Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bulletin of the World Health Organization. 2006;84:21-7.##48. Hajizadeh M, Nghiem HS. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? International journal of health care finance and economics. 2011;11(4):267.##49. Pal R. Analysing catastrophic OOP health expenditure in India: Concepts, determinants and policy implications. 2012.##50. Merlis M, Gould D, Mahato B, Fund C. Rising out-of-pocket spending for medical care: a growing strain on family budgets: Citeseer; 2006.##51. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health affairs. 2007;26(4):972-83.##52. Wyszewianski L. Families with catastrophic health care expenditures. Health services research. 1986;21(5):617. ##

عوامل موثر بر ارتقای عدالت در سلامت با محوریت سازمان بیمه سلامت Factors Contributing to Development of Justice the Centrality Health Insurance Organization 1 1 مقدمه: تغییر در سیاست یکی از حوزه‌های پرطرفدار رشته سیاست گذاری عمومی است و در این میان، ایجاد عدالت و ارتقای آن در بخش سلامت یکی از اهداف مهم و اصلی دولت‌ها و سیاست گذاران فعال در این رشته محسوب می شود. پژوهش حاضر نیز با هدف تبیین عوامل موثر بر ارتقای عدالت در سلامت با محوریت سازمان بیمه سلامت ایران انجام شده است. روش بررسی: پژوهش حاضر از نظر نوع هدف، کاربردی و از نظر روش، در دو بخش کیفی و کمّی در سال ۱۳۹۷ اجرا شده است. در بخش کیفی پس از مرور متون از روش دلفی و پانل خبرگان استفاده شد. به کمک ۶ نفر از خبرگان که به روش ترکیبی نمونه گیری در دسترس و گلوله برفی در این مطالعه شرکت کردند، موضوع هدف ارزیابی شد و ساختار مدل مفهومی تحقیق با ۴ سازه و ۲۰ متغیر ساخته شد. پس از بررسی روایی صوری و محتوایی، ۱۶ سوال با طیف لیکرت ۵ گزینه ای برای بررسی در بخش کمّی نهایی شدند. در بخش کمّی، روایی سازه توسط تحلیل عاملی تأییدی و پایایی توسط آلفای کرونباخ ارزیابی شد. در این مرحله از تحقیق به روش نمونه گیری در دسترس ۱۹۰ نفر از اعضای جامعه هدف که در زمینه موضوع تحقیق اطلاعات کافی داشتند شرکت کردند. برای تحلیل داده ها از نرم افزارهای SPSS و AMOS نسخه ۲۲ استفاده شد. یافته‌ها: در این مطالعه ۷/۶۵ درصد از شرکت کنندگان مرد و ۳/۴۳ درصد زن بودند. ۳/۵۷ درصد از آنها استخدام رسمی بوده و ۵۷ درصد نیز بیش از ۲۰ سال سابقه کار دارند. بیش از ۵۶ درصد از شرکت کنندگان دارای مدرک تحصیلی کارشناسی ارشد و دکترا بودند. پایایی پرسشنامه نهایی شده در این مطالعه ۸۳/۰ به دست آمد. تمامی ۴ سازه پرسشنامه در این مطالعه، مقدار پایایی بیش از ۷/۰ داشت. روایی به ۳ روش صوری، محتوایی و سازه ارزیابی و تأیید شد. نتایج این مطالعه نشان داد که ساختار عملکردی در بالاترین اولویت و تأمین منابع مالی در پایین ترین اولویت عدالت در سلامت با محوریت بیمه سلامت بوده است. نتیجه گیری: کارشناسان و مسئولان بیمه سلامت به طور روزمره دغدغه تأمین مالی دارند و به همین دلیل، صاحب نظران و مسئولان بیمه سلامت ایران بیش از اینکه به قرار گرفتن در جایگاه مناسب و نقش آفرینی موثر در بهسازی و افزایش کارایی و اثربخشی نظام سلامت کشور، همچنین سیاست گذاری و ساختارسازی استراتژیک و بلندمدت که منشأ اکثر ناکامی ها و مشکلات بیمه سلامت هستند بیاندیشند، دل مشغول تأمین مالی هستند. این گرفتاری ذهنی و عملی روزمره مانع کنار گذاشتن تفکر صندوق و حاکم کردن تفکر نظام بیمه سلامت می شود. 2 Introduction: Policy change is one of the most popular areas in public policy, and the establishment of justice in the health sector is one of the most important goals of government - oriented governments in this field. Accordingly, the present study aimed to explain the effective factors in promoting justice in health with centrality of Iran health insurance organization. Methods: the present study is applied in terms of the practical purpose and the method is implemented in two qualitative and quantitative sectors in 1397. in the qualitative section after reviewing the literature, the delphi method and expert panel were used with the help of six experts who participated in the mixed sampling method and the snowball sampling in this study, the objective was evaluated and the conceptual model structure was constructed with four constructs and 20 variables. After examining the formal validity and content validity, 16 questions were finalised with a five - point Likert scale to examine in the quantitative section. in the quantitative part, structural validity was evaluated by cronbach's alpha by factor analysis and reliability. at this stage of the research, 190 members of the target community who had sufficient information on the subject of research were conducted. SPSS and excel software were used for data analysis. Results: In this study, 65.7 percrent of male participants were male and 43.3 percent female. 57.3 percent of them are official employment and 57 percent have more than 20 years of work experience. More than 56 percent of the participants have master degrees and doctorate degrees. Reliability of the questionnaire proved to be 83 percent in this study. Validity was assessed and confirmed (Face validity, Content validity and Construct validity). All four constructs in this study were the reliability of over 70 percent. Confirmatory factor analysis also showed that construct validity was approved by the whole questionnaire. Conclusion: The results of this study indicate that the Iranian health insurance organization has a key role in health with the support provided by the government and the adoption of reason Influence in the study to satisfy the people of the society and ultimately in health. 228 237 2020/03/62019/12/72019/11/272019/11/92019/11/242019/12/132020/01/1 1398/10/11 2020/03/62019/12/232020/01/42020/02/262020/02/252020/02/222020/02/3 1398/11/14 مصطفی پیری Mostafa Piri دانشکده علوم سیاسی، واحد تهران مرکز، دانشگاه آزاد اسلامی، تهران، ایران piri.mostafa1351@gmail .com رضا جلالی Reza Jalali دانشکده علوم سیاسی، واحد تهران مرکز، دانشگاه آزاد اسلامی، تهران، ایران Dr_rezajalali@y علی اکبر امینی Ali Akbar Amini دانشکده علوم سیاسی، واحد تهران مرکز، دانشگاه آزاد اسلامی، تهران، ایران ali akbaramini@ymail.com Justice in Health Health Insurance Health Care Service Leveling Expansive Testing عدالت در سلامت بیمه سلامت خدمات درمانی سطح بندی خدمات آزمون وسع 1. Moyson S. Cognition and policy change: the consistency of policy learning in the advocacy coalition framework. Policy Soc. 2017;36(2):320-44.##2-World Health Organization (2000). The world health report , health systems : Improving performance. Geneva : World Health Organization . 2000: 1.##3-World Health Organization (2012). The world health report , health systems : Improving performance. Geneva : World Health Organization . 2012 : 1##4-World Health Organization (2018). The world health report , health systems : Improving performance. Geneva : World Health Organization . 2018 : 1.##5- Ganate A،golezadh M،partoe I،Alidocte s، Comparative health systems comparing health systems in the countries of the worl(2017) .Tahran .Gngal (2017)25-130page##6 - Karimi I, Salarian A, Anbari Z. A comparative study on equity in access to health services in developed countries and designing a model for Iran. Journal of Arak University of Medical Sciences. 2010;12(4):92-104.##7- Shahri S, Tabibi SJ, Nasiripour AA, Ghaffari F. Effect Functions on Goals of Health System in Iran. Journal of Payavard Salamat. 2017;11(3):247-58.##8- Buse K, Mays N, Walt G. Making health policy: McGraw-Hill Education (UK); 2012.M.5 1-288Page##9 - Marmot M. The health gap: the challenge of an unequal world. The Lancet. 2015;386(10011):2442##10- Ghasemi E, Barooni M, Dehnavieh R, Jafari Sirizi M, Mehrolhassani M. Assessment of the Performance of Health Insurance Organizations using the DEA Approach; 2014. Iranian Journal of Epidemiology. 2017;12:13-9.##11- Wagstaff A, Lindelow M. Can insurance increase financial risk?: The curious case of health insurance in China. Journal of health economics. 2008;27(4):990-1005.##12- Doshmangir L, Doshmangir P, Abbasi M, Rashidian A. Infrastructures for Implementation of Urban Family Medicine in Iran: Infrastructures for Implementation of Urban Family Medicine in Iran. Hakim Research Journal. 2015;18(1):1-13.## ##

بررسی شیوه های نوین درآمدزایی در سازمان بیمه سلامت از دیدگاه متخصصان مالی Financial Analysis of New Monetization Methods in Iran Health Insurance Organization 1 1 مقدمه: سازمان بیمه سلامت به‌عنوان یکی از بزرگ‌ترین سازمان‌های فعال در حوزه بیمه درمان ایران است که به دلیل شرایط اقتصادی حاکم بر کشور، ازجمله فشارهای اقتصادی ناشی از تحریم‌ها و روند پیر شدن جامعه، نیاز به درآمدزایی برای برابری منابع با مصارف خود دارد. این سازمان باید اقدامات مناسبی در راستای تأمین منابع مالی به منظور تحت پوشش قرار دادن بیمه درمان برای تمامی آحاد جمعیت کشور، مطابق با قوانین جاری انجام دهد. هدف از این مطالعه ارائه شیوه‌های نوین درآمدزایی در سازمان بیمه سلامت ایرانیان است. روش بررسی: در این پژوهش ابتدا براساس روش داده بنیاد و با استفاده از نظر متخصصان این حوزه نسبت به استخراج شیوه‌های نوین درآمدزایی اقدام شد. با توجه به کمبود متخصصان تأمین مالی در حوزه بیمه درمان، جامعه آماری پژوهش شامل ۲۱ نفر از خبرگان دانشگاهی و دستگاه‌های اجرای در حوزه اقتصاد سلامت و بیمه درمان انتخاب شدند. در نهایت با فرآیند سلسله‌مراتب تحلیلی، عوامل شناسایی شده مورد تحلیل و رتبه بندی قرار گرفت. یافته‌ها: از میان ۹ مؤلفه اصلی در تأمین درآمد سازمان بیمه سلامت که مورد مقایسه براساس گزینه‌های سرعت جذب، میزان یا حجم درآمد، پایداری و درون‌زایی درآمد قرار گرفت، با توجه به ماتریس زوجی به‌دست‌آمده مشخص شد درآمدزایی از افراد با وزن ۰.۳۱۴ در رتبه نخست  اهمیت، درآمدزایی داخلی سازمان با وزن ۰.۲۶۴ در رتبه ۲، کسب درآمد از شرکت‌های زیرمجموعه با وزن ۰.۲۲۱ در رتبه ۳، انجام فعالیت‌های تجاری و غیر بیمه‌ای با وزن ۰.۲۰۹ در رتبه ۴، درآمدزایی ناشی از آموزش و انتقال تجربیات با وزن ۰.۱۹۹ در رتبه ۵، تأمین منابع مالی از سازمان‌های دیگر با وزن ۰.۱۸۸ در رتبه ۶، وجوه دریافتی از دولت به‌عنوان درآمد با وزن ۰.۱۷۶ در رتبه ۷ و کمک‌های مردمی و سایر اقدامات درآمدزا با اوزان ۰.۱۶۵ و ۰.۱۶۳ در ترتیب اهمیت آخر است. در معیار درآمدزایی فردی مشخص شد، اهمیت اخذ هزینه مستقیم از گیرندگان خدمت نسبت به گزینه‌های فروش بیمه‌نامه‌های متنوع، ورود به عرصه بیمه مکمل و فروش خدمات به مخاطبان منطقه‌ای بسیار فراتر است. نتیجه‌گیری: نتایج نشان داد بار اصلی هزینه‌های بیمه درمان باید برعهده بیمه‌شدگان باشد. دولت و سازمان‌های ذی‌ربط قادر به ادامه تأمین مالی در سازمان بیمه سلامت نیستند. نتایج این پژوهش با آنچه سایر محققان مطرح می‌سازند، مقداری متفاوت است و از نظر خبرگان، تأمین مالی در سازمان بیمه سلامت باید متمرکز بر دریافت‌کنندگان خدمت باشد. در همین راستا سازمان بیمه سلامت ایران می تواند برای جلوگیری از فشار مضاعف به بیمه شدگان، از سایر اقدامات متنوع دیگر که اهمیتی برابر با اخذ هزینه مستقیم از گیرندگان خدمت دارد، استفاده کند. این راهکارها را می توان در گزینه‌های فروش بیمه‌نامه‌های متنوع، ورود به عرصه بیمه مکمل و فروش خدمات به مخاطبان منطقه‌ای به عنوان یک نهاد بیمه ای و سرمایه گذاری مشاهد کرد. 2 Introduction: Having an insured population of 39 million, Iran Health Insurance Organization is one of the largest entities in health insurance sector of Iran. The organization needs to monetize in order to equate its resources with its costs due to economic conditions imposed on the country following sanctions as well as the aging trend of the society. That is, the organization needs to take appropriate measures to finance the coverage of health insurance for every Iranian, for which it is responsible in accordance with current law. This study aims at studying modern monetizing methods in Iran Health Insurance Organization. Methods: First, the new monetizing methods were extracted using grounded theory and employing field’s experts’ opinion. Given the lack of finance experts in health insurance sector, the statistical population was consisted of 21 academic and administrative experts of health and insurance economy. Then the analytic hierarchy process was employed to analyze and rank findings. Results: The nine main monetizing methods for Iran Health Insurance Organization were compared based on absorption rate, and revenue volume, sustainability, and endogeneity. According to the paired comparison matrix, the monetizing from individuals was ranked 1 with a weight of 0.314, internal monetizing was ranked 2 with a weight of 0.264, monetizing from subsidiaries was ranked 3 with a weight of 0.221, business and non-insurance activities was ranked 4 with a weight of 0.209, training and knowledge transfer was ranked 5 with a weight of 0.199, funding from other organizations was ranked 6 with a weight of 0.188, receiving public funds was ranked 7 with a weight of 0.176, and public donations and other monetizing measures were ranked last with weights of 0.165 and 0.163, respectively. For monetizing from individuals, receiving direct payments from recipients of services revealed to be far more significant than other options including selling a variety of insurance policies, introducing complementary insurance, and selling services to regional customers. Conculsions: Results show that the insured need to carry the main burden of health insurance costs. The government and other relevant agencies are no longer able to finance Iran Health Insurance Organization. This is somewhat different from what other researchers suggest. However, experts believe that the Health Insurance Organization should be financed by service recipients. In order to prevent too much pressure on the insured clients, the organization can take various measures, which are of equal significance to receiving direct fees from service recipients. These include selling various insurance policies, introducing supplementary insurance policies, and selling services to regional clients as an insurance and investment organization. 238 247 2020/03/62019/12/72019/11/272019/11/92019/11/242019/12/132020/01/12019/10/19 1398/7/27 2020/03/62019/12/232020/01/42020/02/262020/02/252020/02/222020/02/32020/03/3 1398/12/13 محمدرضا رضائی mohammadreza rezaee گروه مدیریت، دانشکده مدیریت، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران rezaee2526@gmail.com سعید دائی کریم زاده Said Daei-Karimzadeh گروه اقتصاد، دانشکده مدیریت، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران saeedkarimzade@yahoo.com مهدی فدائی Mehdi Fadaei گروه مدیریت، دانشکده مدیریت، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران fadaeemahdi@phd.pnu.ac.ir اکبر اعتباریان Akbar Etbarian گروه مدیریت، دانشکده مدیریت، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران etebarian@khuisf.ac.ir@gmail.com Financing Healthcare Insurance Monetization تأمین مالی درآمدزایی بیمه سلامت References##1. WHO. Health Systems: Improving Performance Geneva: Who 2000.##2.Rezaei M. Evaluation, Causes and Significant Consequences of the Economic Crisis in Iran. Financial Economics Quarterly. 2018;12:227-201.##3. Fattah Zadeh A. 2005. Health System Reforms, Justice and Performance Guidelines. Tehran: First Edition, Ibn Sina Cultural Institute Publications.538 pages.##4.Zare H, el a. A model for private health insurance in Iran. Tab and Teschiyeh Journal. 2011;1:35-54.##5.AkhavanBehbahani A, Alidoost S, MasoudiAsl I, RahbariBonab M. Investigating the Performance of Iran’s Health Insurance Organization and Providing Solutions for Improvement: A Mixed Method Study. Journal of Iran Health Insurance. 2018;1(3):94.##6.Official Journal Collections - Statute of Iran Health Insurance Organization- Chapter Four Financial and Financial Resources- Article 16-Available from:http://www.dastour.ir/Brows/?lid=356748. 2013.##7.AkhavanBehbahani A, Alidoost S, MasoudiAsl I, RahbariBonab M. Investigating the Performance of Iran’s Health Insurance Organization and Providing Solutions for Improvement: A Mixed Method Study. Journal of Iran Health Insurance. 2018;1(3):91.##8. Gottret PE, Schieber G. 2006. health financing revisited: A practitioner's guide. Washington, DC: World Bank Publications.##9. Fernandes Antunes A, Wanert S, Bigdeli M, Eang RC. Summary report of the health financing system assessment in##Cambodia [Online]. [cited 2009]; Available from: URL: www.who.int/health_financing/documents/oasis_e_09-cambodia.pdf##10. Department of Health Systems Financing. User manual for OASIS Organizational assessment for improving and##strengthening [Online]. [cited 2011]; Available from: URL:www.who.int/health_financing/tools/oasis_manual_version_october.pdf##11. World Health Organization. A health financing review of Viet Nam with a focus on social health insurance. Geneva,Switzerland: WHO; 2011.##12. Fernandes Antunes A, Wanert S, Bigdeli M, Eang RC. Summary report of the health financing system assessment in Cambodia [Online]. [cited 2009]; Available from: URL: www.who.int/health_financing/documents/oasis_e_09-cambodia.pdf.##13. Khatib A. 1396. Investigation of Sustainable Financing Strategies in Small Municipalities, Case Study: City of Three Castles. M.Sc. Ferdows Noor Message Center, Payam Noor University, South Khorasan Province.##14. Tajeddin B, Moradi M. 2018. Urban Management Solutions for Realizing Resistance Economy with Emphasis on Income System in Tehran Municipality, First Conference on Challenges and Presentation of New Urban Management Solutions, Tehran, Tehran Municipality Mobilization Organization. Issues 1.1: 1-20.##15. Kiser T.(2005) “Was audit quality of Laventhol and Horwath poor? Journal of Accounting and Public Policy 27,217–237.##16. USAID. The health system assessment approach: A how-to manual [Online]. [cited 2012]; Available from: URL:www.apps.who.int/medicinedocs/documents/s19838en/s19838en.pdf.##17. Hsiao W, Siadat B. 2009. In search of a common conceptual framework for health systems strengthening [Online]. [cited 2009]; Available from: URL:http://siteresources.worldbank.org/INTHSD/Resources /376278-1114111154043/1011834- 1246449110524/ HsiaoSiadatInSearchOfaCommonConceptualFrameworkForHSSDraft62309.pdf.##18. Kulesher R, Forrestal E. 2014. International models of health systems financing. J Hosp Adm, 3(4): 127-39.##19. WHO Regional Office for the Western Pacific. Strategy on health care financing for countries of the Western Pacific and South-East Asia Regions (2006-2010). Geneva, Switzerland: World Health Organization; 2005.##20. Gill A. Healthcare financing: How should Singapore’s ministry of health shift costs from private pockets to the public purse? Bukit Timah, Singapore: Lee Kuan Yew School of Public Policy; 2013.##21.Rųttingen JA, Ottersen T, Ablo A. Shared Responsibilities for Health: A Coherent Global Framework for Health Financing.New York, NY: Seven Bridges Press, LLC; 2014.## ##