National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 R&D Networks are an Inevitable Necessity for Economics Studies and Health Insurance of Iran 102 105 FA Mohammad Reza Rohoullahi Cancer Research Center, Tehran, Iran Shahram Tofighi National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 106 116 FA Ali Akhavan Behbahani Department of Health Services Management, South Tehran Branch, Islamic Azad University, Tehran, Iran Irvan Masoudi Asl Department of Health, Islamic Parliament Research Center of The I.R.I, Tehran, Iran Somayeh Hessam Department of Health Services Management, South Tehran Branch, Islamic Azad University, Tehran, Iran Mohsen Najafikhah National Center of Health law Research, Ministry of Health and Medical Education, Tehran, Iran Introduction: Parliaments are the embodiment of democratic political systems. Each legislative assembly is a complex organization usually with several hundred members. The two main tools for organizing legislative assemblies are political parties and internal parliamentary committees. On the other hand, governments' involvement and interference in health is often achieved through legislation. Legislation in a complex, highly specialized, sensitive and challenging environment such as health requires a great deal of care and attention. Therefore, the role of committees in organizing health approvals is crucial. Methods: This research is a comparative study. The research environment consists of legislative assemblies in ten selected countries that were selected and evaluated by 4 criteria of legal system, executive regime, efficiency and success in legislation and type of health system through targeted search. The level of duties and responsibilities of the commissions varied across the countries studied. Results: The legislatures of the studied countries use different models with different levels of authority to legislate in the health sector. There were various active legislative commissions in all 10 countries studied. In 6 countries (Japan, Turkey, South Africa, USA, Egypt and Iran) there was an Commission on Health Affairs and in 4 other countries such commission were not seen. Conclusion: In the Iranian Parliament, the Independent Commission on Health Care is considered to have a wide range of functions and responsibilities and can easily interact with stakeholder's.Provides expert and specialized work in the field of health that should be considered.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 The Organizational Ecosystem for Insurer-Hospital Interaction 117 124 FA Jahan Ara Mamikhani Lecturer and Consultant in Management Systems, Managing Director of Behin Pouyan Hooten Institute, Tehran, Iran Seyed Moosa Tabatabaie Expert in Economics and Health Insurance, Advisor to the Deputy Minis ter of Health and Medical Education, Ministry of Health, Tehran, Iran Marziyeh Zangeneh Head of Department of Economics and Health Insurance Planning, Minis try of Health and Medical Education, Tehran, Iran Introduction: Health insurance organizations are the main purchasers in Iran health system. Ordinarily, financial documents are delivered to the health insurers by the hospitals. It is possible there be other processes according to circumstances. Both these offices protect their own organizations' benefits, so there may occur some conflicts, which may harm patients. This study was conducted with a systemic approach employing organizational ecosystem technique for demonstrating the space of decisions and behaviors much better, in order to achieve better management in the interaction between hospitals and insurers. Methods: This is a model building study, conducted in four phases. Initially a literature review study was performed for gathering higher national and institutional level documents, and for situational analysis of processes and functions. Then an FGD was performed according to Harris framework of ecosystems, the elements were identified under four domains, i.e. community, public policy, organizational, and interpersonal. In the third phase employing tables of program evaluation model of CDC, revealed the key stakeholders of the interaction, continued by explaining their functions and roles in the interaction. In the last phase, graphical model showing the direct effects among the elements of interaction was depicted and in the last step finalized by the experts in an FGD. Results: In the insurer-hospital interaction ecosystem there were 30 elements identified in domains of community, public policy, organizational, and interpersonal; containing 11, 8, 4 and 7 elements respectively. The key stakeholder analysis for the interaction program, revealed the number of stakeholders which were dropped in these distinctive groups: who are affected by the program, who perform the program, and who benefit the results of the program, 2, 6, and 7 respectively. The graphical model was drawn using these findings. Conclusion: In the organizational ecosystem of insurer-hospital interaction more than 63 percent of elements belong to community and public policy domains; less than 23 percent are related to organizational and interpersonal domains. This emphasizes that insurer-hospital interaction is more affected by community and public policy rather internal factors of insure organizations and hospitals.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 Hospital Resource Was tages in Health Transformation Plan (HTP) and Cos t Containment Approaches: Diagnos tic and Therapeutic Services Tariff 125 133 FA Masud Ferdosi Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Reza Rezayatmand Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Maryam Barati Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Introduction: Proper tariff setting of health services in addition to reduction the health sector resources wastages, increases the healthcare providers’ incentives in delivering effective services. The purpose of this study was to identify the waste points of HTP hospital resources, and to offer some solutions in medical tariffs setting. Methods: This is an original applied research conducted employing a content analysis method. In order to identify hospital resources wastages and cost control approaches, PubMed, Irandoc, SID, Google Scholar and Magiran databases were searched with keywords wastage- tariff- Health Transformation- Cost and Cost Control Plan. Related articles were extracted. The nominal group technique was used to classify the wastes, and a focus group discussion with 33 participatants of senior managers and experts of hospitals, insurance organizations and academic members of Isfahan University of Medical Sciences was used to confirm the solutions. Results: The mos t important wastages caused by diagnostic and Therapeutic services tariffs were disparities in the income levels of some specialists, imbalances in the income of various specialist groups, imbalances in physicians’ earnings versus other medical personnel’s, and induced demand. The most important cost containment strategies included tariff review, reconstructing the health sector financial structures, and reinforcing accurate pricing, reducing induced demands, implementing family physician and referral systems, and tracing health services abuse. Conclusion: The Iran HTP and any other reform plan in the health system will have its own costs, so that if the wasted resources are not identified and controlled, the success of the plan would be in danger.  

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 Wagner's Law Tes t on Health Expenditure in Iran 134 141 FA Mahmoud Eisavi Faculty of Economics, Allameh Tabatabai University, Tehran, Iran Salar Ghorbani Health Sciences Management and Economics Center, Iran University of Medical Sciences, Tehran, Iran Ahmad Moiedfar Faculty of Economics, Shiraz University, Shiraz, Iran Maryam Holakoupour Dezful University of Medical Sciences, Dezful, Iran Introduction: Health expenditure and its relationship with Gross Domestic Product (GDP) have always been one of the cases of study in the framework of economic subjects. Wagner's Law is a theory that argues about this relationship and briefly, it says public sector increases when the GDP begins to grow in one country. This article, according to Wagner law, examines the relationship between health spending and GDP in Iran. Methods: In order to investigate the relationship between the two variables, Toda-Yamamoto and Cointegration causality methods were used. The study period included the years 1980 to 2016. The results of Todayamamato causality method showed that there is a statistically causal relationship between the two variables. Results: The Johansson coefficient showed that there was a positive relationship between GDP and health expenditure. Conclusion: In other words, an increase in GDP led to an increase in health spending, so Wagner law was approved for health expenditure in Iran.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 Comparison of Refugees Inpatient Cos ts Before and After Implementation of Basic Health Insurance in University Hospitals of Tehran Province during 2013 -2017 142 150 FA Seyyedeh Fatemeh Sagha Abolfazl Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Sara Emamgholipour Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mehdi Yaseri Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Arab Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Introduction: To achievement Universal Health Coverage, one of the target groups is refugees that have been provided basic health insurance for this population. The purpose of the present study was to compare the inpatient costs, in drugs, surgery, laboratory and other paraclinic, imaging, and resource allocation of inpatient costs and burden of inpatient in the two years before and after basic health insurance. Methods: This study is a descriptive-analytic and applied type. The research environment was the university hospitals of Tehran province and the statistical population of the refugee hospitalization records during two years before and after the implementation of insurance. Cluster sampling was performed in two stages. At first, 55 hospitals of the province, 15 hospitals and then 1575 samples in each period, were randomly selected. Data were analyzed by SPSS. Results: By implementation of basic health insurance, the average share of refugees from inpatient costs was 13.50% (P <0.001), the share of supplementary insurance was 0.04% (P <0.001), the share of hospital discounts was 9.99% (P <0.001). Burden of inpatient increased by 52% (P <0.001). The average share of drug and surgery costs decreased by P = 0.002 and P <0.001, respectively, and imaging services increased by P <0.001. Laboratory and other para clinics did not show a significant difference. Conclusion: Basic health insurance reduced patient share and hospital discounts and increased burden of inpatient. However, given the low population coverage, it seems necessary to reconsider the dimensions of Universal Health Coverage, and especially population coverage.

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 Registration of Anesthesia Time in Surgical Operation and its Costs in the Hospitals of East Azarbayjan 151 161 FA Zahra Najafi Hospital Experts Group, Department of Medical Documents, Health Insurance General Directorate of Eas t Azerbaijan, Iran Health Insurance Organization, Tabriz, Iran Vahid Majidi Health Insurance General Directorate of East Azerbaijan, Iran Health Insurance Organization, Tabriz, Iran Naser Safaie Faculty of Medicine, Department of Cardiovascular Surgery, Tabriz University of Medical Science, Tabriz, Iran Negar Nezhadabyaz Hospital Experts Group, Department of Medical Documents, Health Insurance General Directorate of Eas t Azerbaijan, Iran Health Insurance Organization, Tabriz, Iran Introduction: With the introduction of the book Relative Value, anesthesia has increased, and as prolonged anesthesia time, along with the risks and adverse effects, impose a financial burden on the patient and the hospital, it is essential to review the costs required by this department and to monitor the maintenance of the insurance organization's resources and reduce payments from the insured's pockets. The aim of this study was to determine the incidence of unrealistic anesthesia registrations and their impact on costing in East Azerbaijan. Methods: This descriptive study was performed by extracting data from 8 selected hospitals by purposeful stratified method based on criteria and indicators (including 182 surgical records). Descriptive statistics and one-way ANOVA and variance test were used to classify the data. Results: Most of the surgeries were related to health insurance funds (48%). The average unit of anesthesia time elapsed for each operation was similar in different surgeries in different hospitals. The time taken for global action was longer than the average time recorded for each operation in private hospitals and public hospitals. In clinical records, overlap of anesthesia was extracted according to available documentation based on calculation of duration of each physician's activity and concurrent anesthesia management of two patients by physician during office hours. The average overwriting in public hospitals was 26.6% and in private hospitals 54%. In 19% of the time the anesthesia was started before the patient entered the operating room and in 36% of the cases the end of the anesthesia was recorded after the patient had left the operating room and 43% of the total requested hospital units were surplus. Since P-Value<0.05 was considered statistically significant in this study, the result of claiming a significant difference between the average amount of anesthesia for similar operations in private and public hospitals was rejected (p = 0.793).  Conclusion: The amount requested for anesthesia times in both public and private hospitals is higher than the actual amount. Therefore, the cost can be controlled by applying the calculation method of unrealistic registration cases. Also, the unit of anesthesia time considered in the Global Time List is higher than the average unit recorded for each operation in the studied hospitals. Therefore, a review of the list of times of global actions seems necessary.  

National Center for Health Insurance Research Iranian Journal of Health Insurance 2645-8225 2 3 2019 12 1 Drug prescribing in family physician program involved health care centers and hospital of Hashtrood (Iran) in 2017 162 171 FA Javad Babaie Faculty of Medical Management and Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Safa Elmi Hashtrood Imam Hussein Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Introduction: Drugs are one of the essential components in diseases treatment process. Their to-the-point prescription in terms of quality and quantity and their cost are important issues that should be focused by health providing authorities. The present study aims at evaluating the average of prescribed items and their costs in family physician program involved health centers and hospital in 2017 Hashtrood, Iran.   Methods: In this cross-sectional study, the data on prescriptions, items and their averages costs were collected from Hashtrood healthcare centers and hospital. The data were processed by Microsoft Excel. Then, the Mean and Pearson correlation was analyzed by SPSS20   Results: Totally 72806 prescriptions were issued in 2017. The average of prescribed drugs was 2.79 ± 0/36 for each prescription and the average price was 116123 ± 12486/09 IRL. The highest number of prescribed drugs was for Hashtrood hospital, but the highest price was for the health center No 1.   Conclusion: The average of prescribed drugs in Family physician program in Hashtrood was less than the national average and the averages mentioned in other published literature. It shows the relative success to control the number of prescribed drugs; however some health centers need more attention and assessments.