National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Marginal Cost of Public Fund Effects on Social Costs and Public Health 242 255 FA Jahanara Mamikhani Department of Economics, Islamic Azad University, Khomeyni Shahr Branch, Khomeyni Shahr, Iran Yousef Mahmoodi Petroleum Industry Research Institute, Science and Research Branch, Islamic Azad University, Tehran, Iran Shahram Tofighi National Center for Health Insurance Research, Tehran, Iran Mohammad Javad Kabir National Center for Health Insurance Research, Tehran, Iran The marginal cost of public funding (MCPF) is a key factor in resource allocation. It's also an important measure of financial stability, especially in public health. The MCPF shows how much one more unit of public spending (including taxation) changes household spending. It also shows how much it affects society's welfare and security. We can restructure the tax system to rely less on aggressive taxes. We can also add progressive taxes. These changes could reduce the MCPF and spread the tax burden across income deciles. This research, describing the many sides of this cost, talks about its impact on social costs and public health, which are less discussed. We investigated the impact of this cost on health care services. It also affects fairness in health and social costs. Researchers have proposed different methods to calculate MCPF. Osher suggested the simplest. It uses the average and median national income of countries. The cost factor is a number greater than 1. Since health projects are financed through taxes, it is necessary to multiply the project cost by MCPF. This applies to health care projects and economic evaluations. Considering the final cost can provide a more accurate estimate of budget and costs.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 A Hybrid Fuzzy QFD Approach to Evaluating the Financing Policies of Universal Health Coverage in Iran 256 265 FA Saed Salehi Department of Finance, Faculty of Economics and Accounting, South Tehran Branch, Islamic Azad University, Tehran, Iran Norouz Nourollahzadeh Department of Finance, Faculty of Economics and Accounting, South Tehran Branch, Islamic Azad University, Tehran, Iran Seyedeh Mahboubeh Jafari Department of Finance, Faculty of Economics and Accounting, South Tehran Branch, Islamic Azad University, Tehran, Iran Introduction: One of the fundamental challenges faced by various societies is the easy and affordable access to healthcare services. In this context, a plan known as Universal Health Coverage was proposed by the World Health Organization, prompting diverse countries to implement various measures in response. A critical need for the execution of this plan is the availability of sufficient financial resources. Therefore, this research aims to identify and evaluate financing policies for Universal Health Coverage. Methods: This study first reviews recent research literature, followed by conducting focused group interviews with research experts. After identifying stakeholders' needs and various policies, the policies were weighted and prioritized using a Fuzzy Quality Function Deployment (QFD) approach. To enrich the data for the Fuzzy QFD questionnaire, insights from 18 experts with at least five years of experience in insurance and macroeconomic policies were utilized. Results: The research findings indicate that the number of insured individuals and the percentage of services covered by insurance are the most critical needs of the system's stakeholders. Accordingly, reducing the insurance service copayment rate, stratifying the number of insured individuals, and allocating a portion of the base insurance share to private insurance companies are prioritized in the identified policies. Conclusion: Based on the study's findings, it is concluded that for the government to provide sustainable health services to the public, the private sector should also be involved to bear the service provision costs in exchange for appropriate revenue. Health services should be stratified to meet varied needs effectively.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Identifying the Legal Principles Governing the Regulation of the Electronic Health System's Stakeholders Communication in Iran; With Emphasis on Service Providers 266 279 FA Sepideh Mirmajidi Department of Cultural Studies and Communication, Institute for Humanities and Cultural Studies, Tehran, Iran Davood Mehrabi Department of Cultural Studies and Communication, Institute for Humanities and Cultural Studies, Tehran, Iran Irvan Masoudi Asl National Center for Health Insurance Research, Tehran, Iran Introduction: The implementation of the electronic health system on a global scale continues to face various challenges, including legal challenges, after two decades. This research aims to identify the legal principles governing the regulation of the Electronic Health System's Stakeholders Communication in Iran, with emphasis on service providers. Methods: This qualitative research was conducted using thematic analysis method. Data collected in interviews with 27 experts. Interviewees were selected based on their familiarity with the electronic health system, expertise in legal issues related to it, and communication within this system. Data were analyzed using MAXQDA version 20 software. Results: Data thematic analysis led to the identification of four global themes and ten organizing themes. Legal challenges of the electronic health system and the legal principles governing the regulation of stakeholders' communication are two organizing themes discussed in this article. Conclusion: Managing conflict of interest, redesigning the architecture of the electronic health system, mandating contracts for physicians with basic and complementary insurances, and utilizing the potential capacities and capabilities of private sector are among the recommendations of this research.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Identifying of Pattern Outpatient visit of insured person with Data Mining Techniques: Case Study of Health Insurance in Bushehr Province 280 287 FA Rajabali Daroudi National Center for Health Insurance Research, Tehran, Iran Ebrahim Jaafaripooyan Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Houshang Golzar National Center for Health Insurance Research, Tehran, Iran Introduction: In recent decades, the field of health insurance has emerged as one of the vital components of the healthcare system, propelled by continuous advancements in technology and the increasing complexity of medical services and technologies. With the advent of new challenges in this industry, there has been a heightened effort to find innovative solutions to enhance service quality, optimize resource management, and increase the satisfaction of insured individuals. One significant approach in improving this domain involves the application of data mining techniques to identify behavioral patterns among health insurance policyholders during outpatient visits to diagnostic and treatment facilities. Methods: The present study is a descriptive cross-sectional study. The claim data of health insurance in Bushehr province of Iran was used. After data preparation, analysis was performed using SPSS Clementine12.0 software. The values of insurance start time, number of visits, and the value of the type of insurance were used to model the K-means algorithm in two modes including demographic mode and Recency-frequency-monetary (RFM). Sampling was done by census method. The statistical population includes the information of all outpatient referrals of the insured covered by health insurance of Bushehr province to 1,420,579 referrals to diagnostic and medical centers in 2018, which has been prepared by the researcher’s direct referral to the database of medical records. Results: The root mean square deviation values for RFM-based clustering and demographics are 21 and 21.65, respectively. And the Dunn’s Index confirmed the better RFM-based clustering. The RFM-based K-Means algorithm classified the data into four clusters, with 44% of the insured in Cluster One, 4% in Cluster Two, 22% in Cluster Three, and 30% in Cluster Four. Based on this, cluster 2 insured, including women with insurance of other classes with 4% of the population, were identified as the most referred, and cluster 3, including women with rural insurance, with 22% of the population, were identified as the least referred insured. Conclusion: The obtained model divided the insured into 4 clusters. This model allows the organization to predict the referral patterns of each insurer based on their age, gender, and type of insurance and provide appropriate services for different clusters. By using these models and technique in decision making process, the insurers satisfaction will be improved.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Economic Evaluation of Molnopyravir, Paxlovid and Fluvoxamine in Treatment of COVID-19 Patients in Iran 288 299 FA Pedram Nourizadeh Tehrani Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mobarakeh Alipanah Dolatabad Department of Health Services Management, School of Management and Health Informatics, Iran University of Medical Sciences, Tehran, Iran Rajabali Daroudi Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Introduction: Various medications for the treatment of coronavirus disease 2019 (COVID-19) have been introduced in outpatient and inpatient wards. Three of the referees are Nirmatrelvir/ritonavir (Paxlovid), Molnupiravir and Fluvoxamine. The aim of this study was to investigate the cost-effectiveness of these drugs in treatment of patients with mild to moderate COVID-19 in Iran. Methods: The present study was an economic evaluation study with the aim of investigating the cost-effectiveness of drugs. A two-part decision analysis model of decision tree model and Markov model was used to investigate cost-effectiveness. The study parameters included hospitalization, death rate, drugs, quality of life and treatment costs in 2012. Results: The results showed that standard treatment had higher cost and lower average outcome (QALY) compared to the average fluvoxamine. Molnopyravir had a higher average cost (202.205.422 vs. 155.243.881) and lower QALY (4.352 vs. 4.363). The average cost of Paxlovid was higher (133.712.604 Rials vs. 3.328.029) and the average QALY (0.969 vs. 0.966). The cost-effectiveness ratio of pexelloids compared with fluvoxamine was 302.781.040.50 Rials. If the cost of the course of treatment with pexelloids is less than 2.108.425 Rials, this drug will be cost-effective. Conclusion: It can be concluded that the use of paxlovid and molnopyravir in the treatment of COVID-19 patients in the mild to moderate stage who are at high risk for disease progression is not cost-effective at current prices. In the case of fluvoxamine, although the drug is cost-effective based on the available evidence, there is a lot of uncertainty about its effectiveness.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Analysis of Factors Affecting the Optimal Management of Hospitals: A Qualitative Study 300 315 FA Nasim Nabipour Jafarabad Department of Health Services Management, Semnan Branch, Islamic Azad University, Semnan, Iran Ali Maher Department of Management, Economics and Health Policy, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amin Ghasem Begloo Department of Health Services Management, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran Ali Fakhr-Movahedi Maternity and Children Health Nursing Department, School of Nursing and Allied Health, Semnan University of Medical Sciences, Semnan, Iran Introduction: The rapid growth of technology, demographic changes, increasing patients’ demand, and changes in the nature of diseases, increased competition among hospitals and healthcare providers, and constraints in budget allocation necessitate adopting a novel approach to the management of medical centers based on international standards. Methods: This qualitative study was conducted in two stages by a content analysis approach in the year 2022 in teaching hospitals affiliated with the Islamic Azad University nationwide. The statistical population in the first stage included all studies addressing various aspects of the factors affecting the optimal management of hospitals. In the second stage, it included 10 executive managers of hospitals purposively selected as experts until reaching data saturation. The validity and reliability of the interviews were confirmed using the Lincoln and Guba methods. The data analysis method involved a comprehensive review of studies to identify factors affecting the optimal management of hospitals and a contractual content analysis to identify, analyze, and report themes. Results: In the first stage, a comprehensive review of studies was conducted, encompassing a total of 96 research papers, including 36 in Persian and 60 in English. Following the examination of the titles and abstracts of these research papers and aligning them with the predefined inclusion and exclusion criteria, a total of 18 studies were selected for final analysis, comprising 11 in Persian and 7 in English. After identifying the factors affecting the optimal management of hospitals, three main dimensions were extracted, including strategic planning (12 components), reengineering (8 components), and supply chain engineering (14 components) for the optimal management of hospitals affiliated with the Islamic Azad University using the content analysis method. Conclusion: Managers should implement each of the identified components of strategic planning, reengineering, and supply chain engineering for the optimal management of hospitals in line with the hospitals’ structure. By examining the excellence and efficiency of hospitals over time, as well as evaluating the trends of each of them, they should take steps towards adopting reform policies and their experiences should be utilized in other hospitals.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Futures Study of Corporate Governance With the Scenario Planning Approach Focusing on Healthcare Companies 316 327 FA Rohollah Esmaeili Department of Accounting, Qom Branch, Islamic Azad University, Qom, Iran Mohammad Hasan Maleki Department of Management, University of Qom, Qom, Iran Reza Gholami Jamkarani Department of Accounting, Qom Branch, Islamic Azad University, Qom, Iran Azadeh Maddahi Department of Accounting, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran Introduction: The current study seeks to identify drivers and future scenarios of corporate governance in health companies. Methods: The current research is practical in terms of orientation and its methodology is mixed. The theoretical community of the research are active experts in the capital market and corporate governance. The sampling method was done in a judgmental manner according to the expertise. The number of samples was equal to 10 people. The drivers of the research were obtained through literature review and interviews with experts. Screening and prioritization of drivers was done using two questionnaires, expert assessment and prioritization. These questionnaires were analyzed with two methods, fuzzy Delphi and Marcus. Results: 24 drivers were obtained through literature review and 7 drivers were obtained through interviews with experts. Among the drivers of the research, 10 drivers had a diffusion number higher than 0.7 and were selected for the final ranking. The degree of priority of drivers screened with Marcus and considering three indicators of experts' expertise, severity of importance and degree of certainty was determined. The drivers, policies of governments regarding economic corruption and monitoring regulations of the TSE were respectively the most important drivers and were used to formulate research scenarios. To strengthen the research scenarios, the components of the root definition tool were used. The scenarios were: glass room, weak mechanisms, scattered world and dark room. Conclusion: The practical proposals of the research were presented according to the ideal scenario (glass room). In this context, suggestions such as improving the organizational culture, strengthening the administrative organization, developing decision support systems for ranking health companies and continuously revising the corporate governance rules according to the necessities of business will help to improve corporate governance in the long term.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 6 4 2024 3 1 Waiting for the new Parliament to Support the Increase of Domestic Production Capacity and Decrease the Dependency of Pharmaceutical Currency 328 329 FA Faramarz Ekhteraei Chairman of the Board of Directors of the Syndicate of Pharmaceutical, Chemical and Pharmaceutical Packaging Manufacturers, Tehran, Iran