1399 3 2 9 147

بررسی روند پیشرفت کشورهای منتخب موفق در راستای دستیابی به پوشش همگانی سلامت در سال 2017 و ارائه راه کار های مناسب برای کشور ایران؛ یک مطالعه مروری Assessing the Progress of Successful Selected Countries in Achieving Universal Health Coverage in 2017 and Providing Appropriate Solutions for Iran: A Review Study 1 1 مقدمه: در هر کشور با توجه به شرایط فرهنگی، اجتماعی، اقتصادی و منابع موجود و زیر ساخت های توسعه یافتگی کشور، دستیابی و نحوه رسیدن به پوشش همگانی سلامت متفاوت می باشد. در کشور ایران طی چند دهه گذشته برای دستیابی به پوشش همگانی سلامت تلاش های متعددی صورت گرفته است، هدف پژوهش حاضر دستیابی به تجارب موفق کشورهایی نظیر مالزی، تایلند، شیلی، کاستاریکا، کوبا، سوئد و سایر کشورهایی در قاره های مختلف با سیستم های بهداشتی و درمانی مختلف است که به پوشش همگانی سلامت دست یافته اند می باشد. روش بررسی: پژوهش حاضر از نوع مطالعه مروری می باشد، در این پژوهش بخش بسیار عمده داده های مورد مطالعه، مستندات مرتبط با موضوع شامل گزارش های رسمی انتشار یافته و مقالات، کتب، آیین نامه ها و خبرنامه هایی می باشد که با جست و جو کلید واژه هایی همچون بیمه (Insurance)، پوشش همگانی سلامت (Universal Health Coverage)، سلامتی (Health)، نظام سلامت (Health System)، منابع مالی (Financial Resources) و عملکرد نظام سلامت (Health System Performance) در پایگاه های داده ای خارجی مانند Google Scholar،Web of Science  و وبسایت هایی مانند بانک جهانی، سازمان جهانی بهداشت و همچنین استفاده از برخی پایگاه های داخلی مانند Iranmedex و برگزاری جلسه با ذی نفعان وزارت بهداشت در ایران به دست آمده است. کلیه داده ها با بهره گیری از روش تحلیل محتوایی مورد مرور و تحلیل و بررسی قرار گرفته است. یافته ها: امروزه الگوی جهانی واحدی برای طراحی نظامهای بیمه سلامت وجود ندارد. کشور ها ازنظر اولویتهای مورد نظرخود، جمعیت تحت پوشش، درجه توسعه یافتگی، نوع سیستم حکومتی و دیگر عوامل متفاوت اند و هر کدام نقاط قوت و ضعف خود را دارند وکشورها بایستی این نقاط ضعف و قوت را با اولویتها و نیازها و همچنین محدودیتهای اقتصادی و سیاسی و ظرفیتهای اجرایی خود ارزیابی و نسبت به انتخاب بهترین نظام اقدام بنمایند. نتیجه گیری: کلیه کشورهای موفق در زمینه پوشش همگانی سلامت از تعهدات سیاسی و مالی دولت نیز بهره مند بوده اند و بخش خصوصی به عنوان یک مکمل در کنار بخش عمومی نیز فعالیت داشته است. شناخت نیاز های بهداشتی وجود یک سیستم ارجاع منظم و هماهنگ از دلایل بهبود در زمینه پوشش همگانی سلامت می باشد. پوشش همگانی سلامت پروسه ای زمان بر است که کشور ایران در چند سال گذشته با اجرای طرح تحول سلامت به این هدف بزرگ بسیار نزدیک شده است. 2 Introduction: Achieving the universal health coverage in each country is different according to cultural, social, economic conditions, available resources and development infrastructure, which in Iran over the past few decades, several efforts have been made in this field. The aim of this study is to gain successful experiences of countries such as Malaysia, Thailand, Chile, Costa Rica, Cuba, Sweden and some countries in different continents with different health care systems that have achieved universal health coverage. Methods: This study is a review study. The bulk of the data studied is related documentation, including official published reports, articles, books, regulations, and newsletters that search for keywords such as insurance, universal health coverage, and health. Health, Health System, Financial Resources and Health System Performance in external databases such as Google Scholar, Web of Science and websites such as World Bank, World Health Organization, Also, the use of some internal databases such as Iranmedex and holding meetings with the beneficiaries of the Ministry of Health in Iran has been obtained. All data were analyzed by using content analysis method. Results: Today, there is no single global model for designing health insurance systems. Countries differ in terms of priorities, population covered, degree of development, type of government system and other factors, and each has its strengths and weaknesses. Countries must evaluate these strengths and weaknesses with their economic, political, and executive priorities, needs, and constraints, and select the best system. Conclusion: Successful countries in the field of universal health coverage have also benefited from the political and financial commitments of their government and the private sector has acted as a complement to the public sector. Recognizing the health needs for a regular and coordinated referral system is one of the reasons for improving public health coverage. Universal health coverage is a time-consuming process that Iran has come very close to this great goal in the past few years with the implementation of the Health Transformation Plan. 68 81 2020/03/16 1398/12/26 2020/09/19 1399/6/29 سارا امامقلی پور Sara ٍٍEmamgholipour گروه علوم مدیریت و اقتصاد سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران مبارکه علی پناه دولت آباد Mobarakeh Alipanah Dolatabad گروه مدیریت خدمات بهداشتی و درمانی، دانشکده پیراپزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران پدرام نوری‌زاده طهرانی Pedram Nourizadeh Tehrani گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران Hospital Deductions Reimbursement Medical Records Hospital Income بیمه پوشش همگانی سلامت سلامتی نظام سلامت منابع مالی عملکرد نظام سلامت 1. Callahan D. The WHO definition of'health'. Hastings Center Studies. 1973:77-87.##2. Garrett L, Chowdhury AMR, Pablos-Méndez A. All for universal health coverage. The Lancet. 2009;374(9697):1294-9.##3. Mills A, Ataguba JE, Akazili J, Borghi J, Garshong B, Makawia S, et al. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. The Lancet. 2012;380(9837):126-33.##4. Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. The Lancet. 2012;380(9845):924-32.##5. Mahler H, editor The meaning of health for all by the year 2000. World Health Forum; 1981.##6. Doshmangir L RA, Bazyar M . Universal Health Coverage in Thailand: Achievement and##Experiences Learned. Hakim Health Sys Res 2015. 2015;18 ( 3 ):217 - 32.##7. Campbell J, Buchan J, Cometto G, David B, Dussault G, Fogstad H, et al. Human resources for health and universal health coverage: fostering equity and effective coverage. Bulletin of the World Health Organization. 2013;91:853-63.##8. Christopher Dye JCRaRFT. Research for Universal Health Coverage. Science Translational Medicine. 2013;5(199).##9. Anell A GA, Merkur SM. Sweden:. Health system review. Health systems in transition. 2012;14(5):1-59.##10. Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J. Monitoring and evaluating progress towards universal health coverage in Thailand. PLoS Medicine. 2014;11(9):e1001726.##11.najafi B, et al . A Review of Financing Policies on the Way to Achieve Public Health Coverage in Iran. Journal of Epidemiology in Iran. 2017;12(5):74-84.##12. Rashidian A, Karimi-Shahanjarini A, Khosravi A, Elahi E, Beheshtian M, Shakibazadeh E, et al. Iran's multiple indicator demographic and health survey-2010: Study protocol. International journal of preventive medicine. 2014;5(5):632.##13. 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).##14. HUSSEY. Special Issues With Single-Payer Health Insurance Systems. 2004.##15. Evans TG, Chowdhury A, Evans D, Fidler A, Lindelow M, Mills A, et al. Thailand’s universal coverage scheme: achievements and challenges: an independent assessment of the first 10 years (2001–2010). Health Insurance System Research Office: Nonthaburi. 2012.##16. annual r. information of thailand. who. 2015.##17. Hanvoravongchai P. Health financing reform in Thailand: toward universal coverage under fiscal constraints. 2013.##18. Pramualratana P, Wibulpolprasert S. Health insurance systems in Thailand: Health Systems Research Institute; 2002.##19. V. T. Introduction to Thai health systems.##A Conference at Ministry of Health and Medical Education,##Tehran. 2014.##20. Health sector reform in Thailand, with an emphasis on universal coverage plan policies. 2017##21. Transition HSi. The kingdom of Thiland Heath System Review. 2015.##22. Limwattananon S, Tangcharoensathien V, Tisayaticom K, Boonyapaisarncharoen T, Prakongsai P, editors. Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care? BMC Public Health; 2012: BioMed Central.##23. Sakunphanit T. Universal health care coverage through pluralistic approaches: experience from Thailand. Bangkok, ILO Subregional Office for East Asia. 2006.##24. Atun R, De Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. The Lancet. 2015;385(9974):1230-47.##25. Dow WH, Schmeer KK. Health insurance and child mortality in Costa Rica. Social science & medicine. 2003;57(6):975-86.##26. CarmeloMesa-Lago. Health care in Costa Rica: Boom and crisis. siencedirect. 1985;21(1):13-21.##27. Vargas JR, Muiser J. Promoting universal financial protection: a policy analysis of universal health coverage in Costa Rica (1940–2000). Health research policy and systems. 2013;11(1):28.##28 . bank w. health system review. report. 2012.##29. Mohammad Bazyar AR, Sumit Kane, Mohammad Reza Vaez Mahdavi, Ali Akbari Sari, and Leila Doshmangir Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran. health policy and managment. 2016.##30.kanmanesh N. Health and insurance system in selected countries. 2016.##31. Bali AS, Asher MG. Coordinating healthcare and pension policies: an exploratory study. 2012.##32. S. Jaafar KMNae. Malaysia Health System Review,” Asia Pacific Observatory on Health Systems and Policies. 2013.##33. Chua HT, Cheah JCH, editors. Financing universal coverage in Malaysia: a case study. BMC Public Health; 2012: BioMed Central.##34. Mossialos E, Wenzl M, Osborn R, Sarnak D. 2015 international profiles of health care systems: Canadian Agency for Drugs and Technologies in Health; 2016.##35. Dresang LT, Brebrick L, Murray D, Shallue A, Sullivan-Vedder L. Family medicine in Cuba: community-oriented primary care and complementary and alternative medicine. The Journal of the American Board of Family Practice. 2005;18(4):297-303.##36. Cohn M. uman Rights Hypocrisy: US Criticizes Cuba. 2016.##37. Pol De Vos CaC, Patrick Van der Stuyft. contrasting models in Latin America's health sector reformWim De Ceukelaire. TMIH. 21 September 2006.##38. Werner D. Health care in Cuba: a model service or a means of social control--or both? 1983.##39. Savedoff WD. Governing mandatory health insurance: concepts, framework, and cases. Governing mandatory health insurance: learning from experience Washington, DC, World Bank. 2008:13-48.##40. Bastías G, Pantoja T, Leisewitz T, Zárate V. Health care reform in Chile. Canadian Medical Association Journal. 2008;179(12):1289-92.##41. Correa-Burrows P. Out-of-pocket health care spending by the chronically Ill in Chile. Procedia Economics and Finance. 2012;1:88-97.##42. Aguilera X, Castillo-Laborde C, Najera-De Ferrari M, Delgado I, Ibañez C. Monitoring and evaluating progress towards universal health coverage in Chile. PLoS medicine. 2014;11(9):e1001676.##43. Savedoff WD, Smith AL. Achieving universal health coverage: learning from Chile, Japan, Malaysia and Sweden. Washington, DC: Results for Development Institute. 2011.##44. Anell A, Glenngard AH, Merkur SM. Sweden: Health system review. Health systems in transition. 2012;14(5):1-159.##45. Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. The Lancet. 2012;379(9818):833-42.##46. Patcharanarumol W, Tangcharoensathien V, Wibulpolprasert S, Suthiwisesak P. Universal Health Coverage for Inclusive and Sustainable Development: Country Summary Report for Thailand. 2014.##47. Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I, et al. Universal health coverage in Turkey: enhancement of equity. The Lancet. 2013;382(9886):65-99.##48. Preker AS, Lindner ME, Chernichovsky D, Schellekens OP. Scaling up affordable health insurance: staying the course: World Bank Publications; 2013.##49. Mulupi S, Kirigia D, Chuma J. Community perceptions of health insurance and their preferred design features: implications for the design of universal health coverage reforms in Kenya. BMC health services research. 2013;13(1):474.##50. Aran M, Ozceli EA. Universal Health Coverage for Inclusive and Sustainable Development: Country Summary Report for Turkey. 2014.##51.Chun C, Kim S, Lee J, Lee S. Republic of Korea. Health system review. Health systems in transition. 2009;11(7).##52. Liang L, Langenbrunner JC. The long march to universal coverage: lessons from China. 2013.##53. Menon R, Mollahaliloglu S, Postolovska I. Toward Universal Coverage: Turkey’s Green Card Program for the Poor. 2013.##54. Sakunphanit T. Thailand: universal health care coverage through pluralistic approaches. Social Security Extension Initiatives in East Asia ILO sub-regional office for East Asia Bangkok: International Labour Organization. 2006.##55. Knaul FM, González-Pier E, Gómez-Dantés O, García-Junco D, Arreola-Ornelas H, Barraza-Lloréns M, et al. The quest for universal health coverage: achieving social protection for all in Mexico. The Lancet. 2012;380(9849):1259-79.##56. Marten R, McIntyre D, Travassos C, Shishkin S, Longde W, Reddy S, et al. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The Lancet. 2014;384(9960):2164-71.##57. Temkin LS. Universal health coverage: Solution or siren? Some preliminary thoughts. Journal of Applied Philosophy. 2014;31(1):1-2.2##1. Callahan D. The WHO definition of'health'. Hastings Center Studies. 1973:77-87.##2. Garrett L, Chowdhury AMR, Pablos-Méndez A. All for universal health coverage. The Lancet. 2009;374(9697):1294-9.##3. Mills A, Ataguba JE, Akazili J, Borghi J, Garshong B, Makawia S, et al. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. The Lancet. 2012;380(9837):126-33.##4. Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. The Lancet. 2012;380(9845):924-32.##5. Mahler H, editor The meaning of health for all by the year 2000. World Health Forum; 1981.##6. Doshmangir L RA, Bazyar M . Universal Health Coverage in Thailand: Achievement and##Experiences Learned. Hakim Health Sys Res 2015. 2015;18 ( 3 ):217 - 32.##7. Campbell J, Buchan J, Cometto G, David B, Dussault G, Fogstad H, et al. Human resources for health and universal health coverage: fostering equity and effective coverage. Bulletin of the World Health Organization. 2013;91:853-63.##8. Christopher Dye JCRaRFT. Research for Universal Health Coverage. Science Translational Medicine. 2013;5(199).##9. Anell A GA, Merkur SM. Sweden:. Health system review. Health systems in transition. 2012;14(5):1-59.##10. Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J. Monitoring and evaluating progress towards universal health coverage in Thailand. PLoS Medicine. 2014;11(9):e1001726.##11.najafi B, et al . A Review of Financing Policies on the Way to Achieve Public Health Coverage in Iran. Journal of Epidemiology in Iran. 2017;12(5):74-84.##12. Rashidian A, Karimi-Shahanjarini A, Khosravi A, Elahi E, Beheshtian M, Shakibazadeh E, et al. Iran's multiple indicator demographic and health survey-2010: Study protocol. International journal of preventive medicine. 2014;5(5):632.##13. 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).##14. HUSSEY. Special Issues With Single-Payer Health Insurance Systems. 2004.##15. Evans TG, Chowdhury A, Evans D, Fidler A, Lindelow M, Mills A, et al. Thailand’s universal coverage scheme: achievements and challenges: an independent assessment of the first 10 years (2001–2010). Health Insurance System Research Office: Nonthaburi. 2012.##16. annual r. information of thailand. who. 2015.##17. Hanvoravongchai P. Health financing reform in Thailand: toward universal coverage under fiscal constraints. 2013.##18. Pramualratana P, Wibulpolprasert S. Health insurance systems in Thailand: Health Systems Research Institute; 2002.##19. V. T. Introduction to Thai health systems.##A Conference at Ministry of Health and Medical Education,##Tehran. 2014.##20. Health sector reform in Thailand, with an emphasis on universal coverage plan policies. 2017##21. Transition HSi. The kingdom of Thiland Heath System Review. 2015.##22. Limwattananon S, Tangcharoensathien V, Tisayaticom K, Boonyapaisarncharoen T, Prakongsai P, editors. Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care? BMC Public Health; 2012: BioMed Central.##23. Sakunphanit T. Universal health care coverage through pluralistic approaches: experience from Thailand. Bangkok, ILO Subregional Office for East Asia. 2006.##24. Atun R, De Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. The Lancet. 2015;385(9974):1230-47.##25. Dow WH, Schmeer KK. Health insurance and child mortality in Costa Rica. Social science & medicine. 2003;57(6):975-86.##26. CarmeloMesa-Lago. Health care in Costa Rica: Boom and crisis. siencedirect. 1985;21(1):13-21.##27. Vargas JR, Muiser J. Promoting universal financial protection: a policy analysis of universal health coverage in Costa Rica (1940–2000). Health research policy and systems. 2013;11(1):28.##28 . bank w. health system review. report. 2012.##29. Mohammad Bazyar AR, Sumit Kane, Mohammad Reza Vaez Mahdavi, Ali Akbari Sari, and Leila Doshmangir Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran. health policy and managment. 2016.##30.kanmanesh N. Health and insurance system in selected countries. 2016.##31. Bali AS, Asher MG. Coordinating healthcare and pension policies: an exploratory study. 2012.##32. S. Jaafar KMNae. Malaysia Health System Review,” Asia Pacific Observatory on Health Systems and Policies. 2013.##33. Chua HT, Cheah JCH, editors. Financing universal coverage in Malaysia: a case study. BMC Public Health; 2012: BioMed Central.##34. Mossialos E, Wenzl M, Osborn R, Sarnak D. 2015 international profiles of health care systems: Canadian Agency for Drugs and Technologies in Health; 2016.##35. Dresang LT, Brebrick L, Murray D, Shallue A, Sullivan-Vedder L. Family medicine in Cuba: community-oriented primary care and complementary and alternative medicine. The Journal of the American Board of Family Practice. 2005;18(4):297-303.##36. Cohn M. uman Rights Hypocrisy: US Criticizes Cuba. 2016.##37. Pol De Vos CaC, Patrick Van der Stuyft. contrasting models in Latin America's health sector reformWim De Ceukelaire. TMIH. 21 September 2006.##38. Werner D. Health care in Cuba: a model service or a means of social control--or both? 1983.##39. Savedoff WD. Governing mandatory health insurance: concepts, framework, and cases. Governing mandatory health insurance: learning from experience Washington, DC, World Bank. 2008:13-48.##40. Bastías G, Pantoja T, Leisewitz T, Zárate V. Health care reform in Chile. Canadian Medical Association Journal. 2008;179(12):1289-92.##41. Correa-Burrows P. Out-of-pocket health care spending by the chronically Ill in Chile. Procedia Economics and Finance. 2012;1:88-97.##42. Aguilera X, Castillo-Laborde C, Najera-De Ferrari M, Delgado I, Ibañez C. Monitoring and evaluating progress towards universal health coverage in Chile. PLoS medicine. 2014;11(9):e1001676.##43. Savedoff WD, Smith AL. Achieving universal health coverage: learning from Chile, Japan, Malaysia and Sweden. Washington, DC: Results for Development Institute. 2011.##44. Anell A, Glenngard AH, Merkur SM. Sweden: Health system review. Health systems in transition. 2012;14(5):1-159.##45. Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. The Lancet. 2012;379(9818):833-42.##46. Patcharanarumol W, Tangcharoensathien V, Wibulpolprasert S, Suthiwisesak P. Universal Health Coverage for Inclusive and Sustainable Development: Country Summary Report for Thailand. 2014.##47. Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I, et al. Universal health coverage in Turkey: enhancement of equity. The Lancet. 2013;382(9886):65-99.##48. Preker AS, Lindner ME, Chernichovsky D, Schellekens OP. Scaling up affordable health insurance: staying the course: World Bank Publications; 2013.##49. Mulupi S, Kirigia D, Chuma J. Community perceptions of health insurance and their preferred design features: implications for the design of universal health coverage reforms in Kenya. BMC health services research. 2013;13(1):474.##50. Aran M, Ozceli EA. Universal Health Coverage for Inclusive and Sustainable Development: Country Summary Report for Turkey. 2014.##51.Chun C, Kim S, Lee J, Lee S. Republic of Korea. Health system review. Health systems in transition. 2009;11(7).##52. Liang L, Langenbrunner JC. The long march to universal coverage: lessons from China. 2013.##53. Menon R, Mollahaliloglu S, Postolovska I. Toward Universal Coverage: Turkey’s Green Card Program for the Poor. 2013.##54. Sakunphanit T. Thailand: universal health care coverage through pluralistic approaches. Social Security Extension Initiatives in East Asia ILO sub-regional office for East Asia Bangkok: International Labour Organization. 2006.##55. Knaul FM, González-Pier E, Gómez-Dantés O, García-Junco D, Arreola-Ornelas H, Barraza-Lloréns M, et al. The quest for universal health coverage: achieving social protection for all in Mexico. The Lancet. 2012;380(9849):1259-79.##56. Marten R, McIntyre D, Travassos C, Shishkin S, Longde W, Reddy S, et al. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The Lancet. 2014;384(9960):2164-71.##57. Temkin LS. Universal health coverage: Solution or siren? Some preliminary thoughts. Journal of Applied Philosophy. 2014;31(1):1-2.2 ##

نقش توسعه اقتصاد پایدار بر صنعت بیمه و سلامت The Role of Sustainable Economy Development on the Insurance Industry and Health 1 1 پژوهش حاضر، نقش توسعه اقتصاد پایدار بر صنعت بیمه و سلامت با مطالعه موردی بیمه سلامت دولتی و خصوصی در نظام حقوقی ایران را مورد تبیین و بررسی قرار داده؛ همچنین، توجه صرف به موضوع بیمه سلامت نموده و از ورود به سایر جنبه های تأمین و رفاه اجتماعی اجتناب میکند و در نظر دارد، معیارهای مناسب برای اجرای بیمه پایه سلامت را در جهت رسیدن به پوشش همگانی بیمه بررسی و بر اساس اولویت مورد سنجش قرار دهد. توجه به این عرصه ها به ویژه در کشورهای در حال توسعه که با محدودیت وسیع منابع از یکسو و نیازهای گسترده بهداشتی و درمانی از سوی دیگر مواجه هستند، میتواند به نوعی، خردگرایی سازمانی و برنامه ریزی را تقویت نموده و بهرهمندی بیشتر از منابع را تحقق بخشد. نتایج پژوهش حاضر، حاکی از آن است که همکاری بین نهادهای تأثیرگذار، اهمیت بالایی در تحقق برنامه های حوزه سلامت دارد. یکی دیگر از نمونه های تأثیر نهادها بر سلامت، برنامه پوشش بیمهای بینالمللی است؛ یکی دیگر از راهها، جذب سرمایهگذاران بخش خصوصی به حوزه سلامت است. در ایران، اجرای طرح تحول سلامت، به شرط تدوین منابع مالی پایدار، ضمن افزایش رضایت بیماران از خدمات بیمارستانهای دولتی، میتواند موجب ارتقای کیفیت خدمات سلامت گردد. 2 The present study explains and examines the role of sustainable economy development on the insurance industry and health with a case study of public and private health insurance in the Iranian legal system; Also, it pays attention only to the issue of health insurance and avoids entering into other aspects of social security and welfare, and intends to review the appropriate criteria for the implementation of basic health insurance in order to achieve universal insurance coverage and be assessed on the basis of priority. Paying attention to these areas, especially in developing countries, which face widespread resource constraints on the one hand and widespread health needs on the other, can strengthen organizational rationalism and planning and achieve greater resource utilization. The results of the present study indicate that cooperation between influential institutions is of great importance in the implementation of health programs. Another example of the impact of institutions on health is the international insurance coverage program. Another way is to attract private sector investors to the health sector. In Iran, the implementation of the Health Transformation Plan, if sustainable financial resources are developed, in addition to increasing patient satisfaction with public hospital services, can improve the quality of health services. 82 91 2020/03/162020/07/6 1399/4/16 2020/09/192020/07/6 1399/4/16 بیت اله جعفری Beitollah Jafari گروه حقوق عمومی، واحد قشم، دانشگاه آزاد اسلامی، قشم، ایران jafarib48@gmail.com خیراله پروین Kheirollah Parvin گروه حقوق عمومی، دانشکده حقوق و علوم سیاسی دانشگاه تهران، تهران، ایران khparvin@ut.ac.ir محمد صادقی Mohammad Sadeghi گروه حقوق اقتصادی تطبیقی، مرکز مطالعات و تحقیقات هرمز (پژوهشکده هرمز)، دانشگاه هرمزگان، بندرعباس، ایران mrs4272@yahoo.com Insurance Health Public Private Hospital Development Sustainable بیمه سلامت درمان ‌تأمین اجتماعی توسعه اقتصادی پایدار ## ##

بررسی میزان و علل کسورات بیمارستانی و تعیین راهکارهای کاهش آن در بیمارستان های کشور Investigating the Rate and Causes of Hospital Deductions and Determining its Reduction Strategies in Iranian Hospitals 1 1 مقدمه: کسور بیمارستانی عمدتاً به مبالغی اطلاق می‌گردد که توسط بیمارستان هزینه شده‌اند اما از جایی تأمین مالی و بازپرداخت نمی‌شوند. کسور اعمال‌شده در واحدهای ارائه‌دهنده خدمت نشان‌دهنده میزان ۳۰-۱۰ درصدی از رقم درآمد بیمارستان‌ها می‌باشد که بیشتر از ۲۰ درصد از این کسورات از طریق خود بیمارستان‌ها بر اسناد اعمال می‌گردد. هدف از انجام این پژوهش بررسی کسورات اعمال شده از سوی سازمان های بیمه گر و بیمارستان ها و همچنین شناسایی علل این کسورات و ارائه راهکارهای کاربردی جهت کاهش میزان کسور می‌باشد. روش بررسی: مطالعه حاضر از انواع مطالعات توصیفی- تحلیلی بوده، که به‌صورت گذشته‌نگر و ترکیبی از روش‌های کمی و کیفی به بررسی و تحلیل میزان و علل کسور بیمارستانی پرداخته است. جامعه آماری پژوهش شامل مجموعه بیمارستان‌های ارائه‌دهنده خدمات سلامت در کشور بودند. تعداد بیمارستان‌های نمونه ۱۴ واحد بود. تعداد پرونده های پزشکی جهت بررسی کسور بیمه، با استفاده از روش کوکران، ۱۷۱۵ پرونده برآورد گردید. تحلیل داده ها متناسب با هریک از سطوح سنجش کسور، از روش های توصیفی و تحلیلی بهره گرفته شد و در انتهای تحلیل در هر سطح، میزان کسور به ازا هر پرونده استخراج گردید. یافته‌ها: به‌طور متوسط (میانگین هندسی) احتمال ۸۷% عدم ثبت حداقل یک خدمت در پرونده پزشکی وجود دارد. بیشترین بار مالی ایجادشده ناشی از عدم ثبت خدمت در HIS، در بیمارستان‌های خصوصی به میزان ۵۵۸۲۴۱ ریال به ازای هر یک پرونده رخ می‌دهد. بین نوع بیمارستان و مجموعه عوامل بررسی‌شده در مورد علل ایجاد کسور در حسابرسی توسط کارشناسان درآمد بیمارستان ارتباط معنادار آماری وجود داشت (p<۰.۰۰۱). کای بیهوشی/ شرح عمل/ مشاوره (۱۵.۲۷%)، بیشترین علت اعمال کسور توسط سازمان‌های بیمه‌گر می‌باشد. میزان میانگین هزینه کسور اعمال‌شده به یک پرونده در بیمارستان‌های نمونه ۳,۸۷۳,۷۲۳ ریال می‌باشد که این میزان، ۵/۵ درصد هزینه کل پرونده را شامل می‌شود. نتیجه‌گیری: تحلیل یافته‌ها نشان می‌دهند که مبلغ بالایی از هزینه‌های ایجادشده از طرف بیمارستان که صرف ارائه خدمت به بیماران می‌شود، به بیمارستان بازپرداخت نمی‌شود. وجود این چالش به عوامل زیادی بستگی دارد و در این امر نه‌تنها سازمان‌های بیمه‌گر، بلکه بیمارستان و متولیان ارائه خدمت، ثبت و آماده‌سازی پرونده‌های پزشکی، افراد متصدی ثبت خدمت در HIS و تنظیم‌کننده‌های صورتحساب‌های مالی پرونده تأثیر بسزایی دارند. 2 Introduction: Hospital deductions are predominantly costs that are spent by the hospital, but are not funded and reimbursed. The deductions are 10-30% of the hospital income, of which more than 20% of these deductions are applied to the documents through the hospitals themselves. The purposes of this research is to examining the deductions imposed by insurance organization and hospitals, as well as identifies the causes of these deductions and provide practical solutions for reducing deductions. Methods: The present study is a descriptive-analytic study that was done retrospectively and a combination of quantitative and qualitative methods. The statistical population consisted of a set of hospitals providing health services in the country. The sampled hospitals were 14 units. The number of medical records in order to examine the insurance deductions, using the Cochran method, was estimated at 1715 cases. Data analysis was performed using descriptive and analytical methods in accordance with each of the levels of subtraction. At each end of the analysis, the amount of deduction was extracted from each case. Results: on average (geometric mean), there is a 87% probability of not registering at least one service in a medical record. The highest financial burden due to the lack of registration of the service at HIS occurs in private hospitals at a rate of 558241 Rials per case. There was a significant correlation between the type of hospital and the set of factors examined about the causes of the deficit in the audit by the hospital income experts (P <0.001). Anesthesiology/ Consultant (15.27%) is the most common cause of the deduction by the insurance companies. The average cost of a deduction applied to a medical record in is 3,873,723 Rials, which accounts for 5.5% of the total cost of each medical record. Conclusion: Analysis of the findings shows that a high cost of hospital-provided services for patients is not reimbursed to the hospital. This challenge depends on many factors, in which not only insurance organizations, but also hospitals and service providers, who are in charge of the service record and financial statements regulators, are affected. 92 103 2020/03/162020/07/62020/04/4 1399/1/16 2020/09/192020/07/62020/08/3 1399/5/13 عفت محمدی Efat Mohamadi مرکز تحقیقات عدالت در سلامت، دانشگاه علوم پزشکی تهران، تهران، ایران efat.mohamadi@gmail.com> علیرضا اولیایی منش Alireza Oliaeemanesh مرکز تحقیقات عدالت در سلامت، دانشگاه علوم پزشکی تهران، تهران، ایران arolyaee@gmail.com مرضیه زنگنه Marziyeh Zanganeh معاونت درمان، وزارت بهداشت درمان و آموزش پزشکی، تهران، ایران m.zan1976@gmail.com فرانک ندرخانی Faranak Nadarkhani معاونت درمان، وزارت بهداشت درمان و آموزش پزشکی، تهران، ایران farnadar@yahoo.com الناز قناتی Enaz Ghanati معاونت درمان، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی تبریز، ایران ghanati.elnaz@gmail.com ترانه یوسفی نژادی Taraneh Yousefinezhadi مرکز تحقیقات ارتقای ایمنی و پیشگیری از مصدومیت ها، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران t.yousefinezhadi@gmail.com موسی طباطبایی Mousa Tabatabaei معاونت توسعه مدیریت، منابع و برنامه ریزی، وزارت بهداشت درمان و آموزش پزشکی، تهران، ایران drsm_taba@yahoo.com Hospital deductions reimbursement medical records hospital income کسورات بیمارستانی بازپرداخت پرونده پزشکی درآمد بیمارستان 1. Karagas MR, Choi AL, Oken E, Horvat M, Schoeny R, Kamai E, Cowell W, Grandjean P, Korrick S. Evidence on the human health effects of low-level methylmercury exposure. Environmental health perspectives. 2012; 120(6):799-806.##2. Lesch WC, Brinkmann J. Consumer insurance fraud/abuse as co-creation and co-responsibility: A new paradigm. Journal of business ethics. 2011; 103(1):17-32.##3. Bolancé C, Ayuso M, Guillén M. A nonparametric approach to analyzing operational risk with an application to insurance fraud. The Journal of Operational Risk. 2012; 7(1):57.##4. Siciliani L. Hospital Economics: The Effect of Competition, Tariffs and Non-profit Status on Quality. InHealth Econometrics 2018 May 30 (pp. 263-283). Emerald Publishing Limited.##5. Seaman BA, Young DR, editors. Handbook of research on nonprofit economics and management. Edward Elgar Publishing; 2018 Jun 29.##6. Hussein RA, Mahmoud RA, Al-Hamadi NQ, Majeed AA, Saihoud SA. Assessment of the documentation completeness level of the medical records in Basrah General Hospital. The Medical Journal of Basrah University. 2018; 36(2):50-9.##7. Safarani S, Ravaghi H, Raeissi P, Maleki M. Financial challenges of teaching hospitals and providing solutions. Journal of Education and Health Promotion. 2018; 7.##8. Wahed MA, Kady KW, Saleh N. Automated Management System for Accreditation of Clinical Engineering Department in Hospitals. Journal of Clinical Engineering. 2019; 44(1):47-52.##9. Law of the Fifth Economic, Social and Cultural Islamic Republic of Iran. Formulated on 2010. Available from: URL: http://just1.persianblog.ir/post/246 [Cited 2019 Feb 7]##10. Sodzi-Tettey S, Aikins M, Awoonor-Williams J, Agyepong I. Challenges in provider payment under the Ghana National Health Insurance Scheme: a case study of claims management in two districts. Ghana medical journal. 2012;46(4):189.##11. Ranson MK. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bulletin of the World Health Organization. 2002;80(8):613-21.##12. Blanchfield BB, Heffernan JL, Osgood B, Sheehan RR, Meyer GS. Saving billions of dollars—and physicians’ time—by streamlining billing practices. Health Affairs. 2010:10.1377/hlthaff. 2009.0075.##13. Sinha T, Ranson MK, Chatterjee M, Acharya A, Mills AJ. Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat. Health policy and planning. 2006;21(2):132-42.##14. HIAA (Health Insurance Association of America). Results from an HIAA Survey on Claims Payment Processes. March 2003.##15. Zadeh YM, Soleymanzadeh M, Nosratnejad S. Exploring the Rate and Causes of Inpatient Records Deductions Covered by Iran Health Insurance: The Case of a Public Hospital in Tabriz. Taṣvīr-i salāmat. 2017; 8(2):119-25.##16. Karami M, Safdari R, Moeini M.Investigating the Effect of deductions applying by Social Security Insurance on Patients' Financial Rights in Kashan University of Medical Sciences Patients. Journal of Urmia Nursing and Midwifery Faculty .2010; 8(4):220-228.##17. America’s Health Insurance Plans (AHIP). Centre for Policy and Research, An Updated Survey of Health Care Claims Receipt and Processing Times. May 2006.##18. Busse R, Riesberg A. Health care systems in transition: Germany. 2004.##19. Safdari RE, Sharifian RO, Ghazi Saeedi M, Masoori NI, Azad Manjir ZS. The amount and causes deductions of bills in Tehran university of medical sciences hospitals. Journal of Payavard Salamat. 2011; 5(2):61-70.##20. Safdari R, Ghazi Saeedi M, Sheykhotayefe M, Jebraeily M, Farajolah S, Sedigheh S, Maserat E, Laki Tabrizi R. The Study of Insurance Deductions from Point of Insurance Professionals in Educational Hospitals of Mashhad University of Medical Sciences. Journal of Payavard Salamat. 2017; 11(1):10-9.##21. Norooz Sarvestani E, Pour Mohammadi K, Kavoosi Z, Yousefi AR. The amount and causes insurance deductions of Shohada-e Sarvestan hospital and ways to reduce it by using the techniques of problem solving, 2012. J Manage Med Inform Sci. 2015; 2(2):122-32.##22. Karimi S, Vesal S, Saeedfar S, Rezayatmand M. The Study Deductions of Insurance Bills andPresenting Suggestions Approaches in Seyed Alshohada Hospital. Health Information Management 2011; 7##(Special Issue): 600.##1. Karagas MR, Choi AL, Oken E, Horvat M, Schoeny R, Kamai E, Cowell W, Grandjean P, Korrick S. Evidence on the human health effects of low-level methylmercury exposure. Environmental health perspectives. 2012; 120(6):799-806.##2. Lesch WC, Brinkmann J. Consumer insurance fraud/abuse as co-creation and co-responsibility: A new paradigm. Journal of business ethics. 2011; 103(1):17-32.##3. Bolancé C, Ayuso M, Guillén M. A nonparametric approach to analyzing operational risk with an application to insurance fraud. The Journal of Operational Risk. 2012; 7(1):57.##4. Siciliani L. Hospital Economics: The Effect of Competition, Tariffs and Non-profit Status on Quality. InHealth Econometrics 2018 May 30 (pp. 263-283). Emerald Publishing Limited.##5. Seaman BA, Young DR, editors. Handbook of research on nonprofit economics and management. Edward Elgar Publishing; 2018 Jun 29.##6. Hussein RA, Mahmoud RA, Al-Hamadi NQ, Majeed AA, Saihoud SA. Assessment of the documentation completeness level of the medical records in Basrah General Hospital. The Medical Journal of Basrah University. 2018; 36(2):50-9.##7. Safarani S, Ravaghi H, Raeissi P, Maleki M. Financial challenges of teaching hospitals and providing solutions. Journal of Education and Health Promotion. 2018; 7.##8. Wahed MA, Kady KW, Saleh N. Automated Management System for Accreditation of Clinical Engineering Department in Hospitals. Journal of Clinical Engineering. 2019; 44(1):47-52.##9. Law of the Fifth Economic, Social and Cultural Islamic Republic of Iran. Formulated on 2010. Available from: URL: http://just1.persianblog.ir/post/246 [Cited 2019 Feb 7]##10. Sodzi-Tettey S, Aikins M, Awoonor-Williams J, Agyepong I. Challenges in provider payment under the Ghana National Health Insurance Scheme: a case study of claims management in two districts. Ghana medical journal. 2012;46(4):189.##11. Ranson MK. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bulletin of the World Health Organization. 2002;80(8):613-21.##12. Blanchfield BB, Heffernan JL, Osgood B, Sheehan RR, Meyer GS. Saving billions of dollars—and physicians’ time—by streamlining billing practices. Health Affairs. 2010:10.1377/hlthaff. 2009.0075.##13. Sinha T, Ranson MK, Chatterjee M, Acharya A, Mills AJ. Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat. Health policy and planning. 2006;21(2):132-42.##14. HIAA (Health Insurance Association of America). Results from an HIAA Survey on Claims Payment Processes. March 2003.##15. Zadeh YM, Soleymanzadeh M, Nosratnejad S. Exploring the Rate and Causes of Inpatient Records Deductions Covered by Iran Health Insurance: The Case of a Public Hospital in Tabriz. Taṣvīr-i salāmat. 2017; 8(2):119-25.##16. Karami M, Safdari R, Moeini M.Investigating the Effect of deductions applying by Social Security Insurance on Patients' Financial Rights in Kashan University of Medical Sciences Patients. Journal of Urmia Nursing and Midwifery Faculty .2010; 8(4):220-228.##17. America’s Health Insurance Plans (AHIP). Centre for Policy and Research, An Updated Survey of Health Care Claims Receipt and Processing Times. May 2006.##18. Busse R, Riesberg A. Health care systems in transition: Germany. 2004.##19. Safdari RE, Sharifian RO, Ghazi Saeedi M, Masoori NI, Azad Manjir ZS. The amount and causes deductions of bills in Tehran university of medical sciences hospitals. Journal of Payavard Salamat. 2011; 5(2):61-70.##20. Safdari R, Ghazi Saeedi M, Sheykhotayefe M, Jebraeily M, Farajolah S, Sedigheh S, Maserat E, Laki Tabrizi R. The Study of Insurance Deductions from Point of Insurance Professionals in Educational Hospitals of Mashhad University of Medical Sciences. Journal of Payavard Salamat. 2017; 11(1):10-9.##21. Norooz Sarvestani E, Pour Mohammadi K, Kavoosi Z, Yousefi AR. The amount and causes insurance deductions of Shohada-e Sarvestan hospital and ways to reduce it by using the techniques of problem solving, 2012. J Manage Med Inform Sci. 2015; 2(2):122-32.##22. Karimi S, Vesal S, Saeedfar S, Rezayatmand M. The Study Deductions of Insurance Bills andPresenting Suggestions Approaches in Seyed Alshohada Hospital. Health Information Management 2011; 7##(Special Issue): 600. ##

بررسی تأثیر سیاست‌های اصلاحات مالی بر توسعه بیمه درمان در کشورهای ‌درحال‌توسعه Investigating the Effect of Financial Reform Policies on Health ‎Insurance Development in Developing Countries 1 1 مقدمه: بیمه درمان از الزامات حوزه سلامت محسوب می‌شود که در اکثر کشورهای توسعه‌یافته و درحال‌توسعه مورد توجه دولت‌ها است. ازآنجاکه صنعت بیمه یکی از اجزای مهم سیستم مالی کشورها به حساب می‌آید، بررسی تأثیر سیاست‌های اصلاح و دگرگونی نظام مالی بر توسعه این صنعت و به خصوص گسترش بیمه درمان از اهمیت بسیاری برخوردار است. روش بررسی: این پژوهش یک تحقیق کاربردی و کمی است که با استفاده از تخمین پانل پویا به روش گشتاورهای تعمیم‌یافته و تخمین‌زن‌های آرلانو- باند صورت پذیرفت. در این پژوهش چگونگی تأثیرگذاری سیاست‌های اصلاحات مالی از جمله شاخص کل اصلاحات مالی و همچنین شاخص‌های فرعی کنترل نرخ بهره، خصوصی‌سازی، موانع ورود، آزادسازی جریان سرمایه و خط‌مشی بازار اوراق بهادار بر توسعه بیمه درمان برای 30 کشور منتخب درحال‌توسعه طی سال‌های 2018-2000 بررسی شد. یافته‌ها: نتایج این پژوهش نشان داد که اصلاحات مالی می‌تواند منجر به توسعه بیمه درمان در کشورهای درحال‌توسعه شود، بااین‌حال نتایج تعاملی نشان داد که افزایش سطح توسعه اقتصادی در کشورها می‌تواند این اثر را افزایش دهد. شاخص‌های فرعی کاهش موانع ورود و خصوصی‌سازی در مدل‌های پایه و تعاملی اثر غالب را داشته و تأثیر مثبت و معنی‌دار بر توسعه بیمه درمان دارند. شاخص آزادسازی جریان سرمایه در مدل پایه معنی‌دار است اما تحت تأثیر توسعه اقتصادی و گستردگی بازارهای مالی معنی‌دار نیست، همچنین خط‌مشی بازار اوراق بهادار اثر معنی‌داری بر توسعه بیمه درمان در کشورهای درحال‌توسعه ندارد. شاخص کنترل نرخ بهره نیز تنها در یک سیستم مبتنی بر بازار با توسعه بیمه درمان ارتباط معنی‌دار دارد.‌ نتیجه‌گیری: به‌عنوان یک نتیجه‌گیری کلی از این مطالعه می‌توان بیان داشت که دخالت‌های زیاد دولت‌ها در کشورهای درحال‌توسعه یکی از عوامل بازدارنده در سیستم‌های مالی و تأثیرگذاری آن‌ها بر بخش بیمه است.‌ نتایج این مطالعه نشان داد که اکثر سیاست‌های اصلاحات مالی به‌صورت مستقل یا تحت تأثیر متغیرهای شرطی، تأثیر خالص مثبتی بر توسعه بیمه درمان دارند، ازاین‌رو، کشورهای درحال‌توسعه در جهت بهبود شرایط سلامت جامعه و توسعه بیمه درمان، می‌توانند اجرای این سیاست‌ها را به‌عنوان راهکاری میان‌مدت در نظر بگیرند. 2 Introduction: Health insurance is one of the health requirements that is being considered by governments in most developed and developing countries. Since the insurance industry is one of the most important components of financial system, it is necessary to investigate the effect of financial reform policies on development of this industry, especially health insurance development. Methods: This study, investigate how financial reform policies, including the overall financial reform index, and also the sub-indicators of interest rate control, privatization, entry barriers, capital market liberalization and securities market policies, affect the health insurance development for 30 selected developing countries during 2000-2018. This research is a practical and quantitative study that has been performed using dynamic panel estimation using Generalized Method of Moments. Result: The results of this study show financial reforms can lead to development of health insurance in developing countries, however, the interactive results show increasing economic development level can increase this effect. Sub-indicators of entry barriers reduction and privatization in the basic and interactive models have a dominant, positive and significant effect on the health insurance development. The capital flow liberalization is significant in the basic model but is not significant under the influence of economic development and expansion of financial markets; also, the securities market policies has no significant effect on health insurance development in developing countries. The interest rate control has a significant relationship with health insurance development in a market-based system only. Conclusion: As a general conclusion from this study, it can be stated that high government intervention in developing countries is one of the deterrents to financial systems and their impact on insurance sector. The results of this study showed that most financial reform policies, independently or under the influence of conditional variables, have a positive effect on health insurance development, therefore, developing countries can consider implementing these policies as a medium-term solution to improve public health and develop health insurance. 104 115 2020/03/162020/07/62020/04/42020/05/10 1399/2/21 2020/09/192020/07/62020/08/32020/08/19 1399/5/29 مصطفی شمس الدینی Mostafa Shamsoddini دانشگاه هرمزگان m.shamsoddini@hormozgan.ac.ir بهرام هرمز Bahram Hormoz دانشگاه پیام نور، واحد ایرانشهر، زاهدان، ایران bahramhormoz53@yahoo.com Health Insurance Financial Reform Developing Countries Dynamic Panel Data بیمه درمان اصلاحات مالی کشورهای درحال‌ توسعه پانل پویا ‎1.‎ Kabiri M. What is Basic Health Insurance? Which is the best and most popular? Mahan ‎Insurance Magazine‎. 2019:‎[updated 2019 March 3; cited 20 May 9]. Available from: ‎https://bimemahan.com.‎##‎2.‎ ‎Na'emani F, Yahyavi Dizaj J. The Relationship Between Health Insurance Coverage and ‎Catastrophic Health Expenditure ‎Among Iranian Households. Iran J Health Insur‎. ‎‎2019;2(4):216-27.‎##‎3.‎ ‎Keikha A, Sarani M. Identification and Prioritization of Health Insurance System ‎Implementation Barriers Based ‎on a Three-Branch Model (Case Study: Zahedan ‎City)‎. ‎Sanaat-E-Bimeh‎. 2018;32(4):105-23.‎##‎4.‎ ‎Yahyavi Dizaj J, Saeidpour J, Na'emani F, Irandoust K. Inequality in Payments for ‎Health ‎Insurance in Iran: During the Study Period 2011-2017‎. Iran J Health Insur‎. ‎‎2019;2(2):81-7.‎##‎5.‎ ‎Ahmadi A, Rostaminia MS, Gheibi A. The Effect of Financial Development on Income ‎Distribution in Developing Countries and ‎Developed Countries: Gmm Method. Journal Of ‎Financial Economics. 2016;10(36):15-32.‎##‎6.‎ Habicht T, Reinap M, Kasekamp K, Habicht J, van Ginneken E, Webb E. The 2017 reform ‎to improve financial sustainability of national health insurance in Estonia: Analysis and first ‎lessons on broadening the revenue base. Health Policy. 2019;123(8):695-9.‎##‎7.‎ Alshammari AA, Alhabshi SM, Saiti B. The impact of oil prices and the financial market on ‎cost efficiency in the insurance and Takaful sectors: Evidence from a stochastic frontier ‎analysis. Economic Systems. 2019;43(3-4):100716.‎##‎8.‎ Lee D. Effects of health insurance coverage on household financial portfolio: Evidence from ‎the Affordable Care Act. Economics Letters. 2018;171:176-9.‎##‎9.‎ Angrisani M, Atella V, Brunetti M. Public health insurance and household portfolio Choices: ‎Unravelling financial “Side Effects” of Medicare. Journal of banking & finance. ‎‎2018;93:198-212.‎##‎10.‎ Lee C-C, Chang C-H. Financial policy and insurance development: Do financial reforms ‎matter and how? International Review of Economics & Finance. 2015;38:258-78.‎##‎11.‎ ‎Azam Pour M. The Insurance Industry and Its Role in Financial Markets ‎Liberalization. ‎1st International Conference on Economic Planning, Sustainable and ‎Balanced Regional ‎Development; Approaches and Applications; Iran‎: University of ‎Kurdistan; 2017.‎##‎12.‎ ‎Shahabadi A, Ahmadi M, Moradi A. The Interaction of Financial Development and ‎Economic Freedom on Insurance Penetration ‎Unsuccessful Countries in the Development of ‎the Insurance Industry‎. Journal of Economic Modeling Research. 2018;8(31):41-68.‎##‎13.‎ Abiad A, Detragiache E, Tressel T. A new database of financial reforms. IMF Staff ‎Papers. 2010;57(2):281-302.‎##‎14.‎ Lee C-C, Hsieh M-F. Bank reforms, foreign ownership, and financial stability. Journal ‎of International Money and Finance. 2014;40:204-24.‎##‎15.‎ Levine R. Bank-based or market-based financial systems: which is better? Journal of ‎financial intermediation. 2002;11(4):398-428.‎##‎16.‎ Bun MJ, Sarafidis V. Dynamic panel data models. The Oxford handbook of panel data. ‎‎2015:76-110.‎##‎17.‎ De Blander R. Which null hypothesis do overidentification restrictions actually test? ‎Economics Bulletin. 2008;3(76):1-9.‎##‎18.‎ Mohy Ul Din S, Abu-Bakar A, Regupathi A. Does insurance promote economic growth: ‎A comparative study of developed and emerging/developing economies. Cogent Economics ‎& Finance. 2017;5(1):1390029.‎##‎19.‎ Lee C-C, Lin C-W, Zeng J-H. Financial liberalization, insurance market, and the ‎likelihood of financial crises. Journal of International Money and Finance. 2016;62:25-51.‎##‎20.‎ Sakellarides C, Castelo-Branco L, Barbosa P, Azevedo H. The impact of the financial ‎crisis on the health system and health in Portugal. Copenhagen: World Health Organization. ‎‎2014.‎##‎1.‎ Kabiri M. What is Basic Health Insurance? Which is the best and most popular? Mahan ‎Insurance Magazine‎. 2019:‎[updated 2019 March 3; cited 20 May 9]. Available from: ‎https://bimemahan.com.‎##‎2.‎ ‎Na'emani F, Yahyavi Dizaj J. The Relationship Between Health Insurance Coverage and ‎Catastrophic Health Expenditure ‎Among Iranian Households. Iran J Health Insur‎. ‎‎2019;2(4):216-27.‎##‎3.‎ ‎Keikha A, Sarani M. Identification and Prioritization of Health Insurance System ‎Implementation Barriers Based ‎on a Three-Branch Model (Case Study: Zahedan ‎City)‎. ‎Sanaat-E-Bimeh‎. 2018;32(4):105-23.‎##‎4.‎ ‎Yahyavi Dizaj J, Saeidpour J, Na'emani F, Irandoust K. Inequality in Payments for ‎Health ‎Insurance in Iran: During the Study Period 2011-2017‎. Iran J Health Insur‎. ‎‎2019;2(2):81-7.‎##‎5.‎ ‎Ahmadi A, Rostaminia MS, Gheibi A. The Effect of Financial Development on Income ‎Distribution in Developing Countries and ‎Developed Countries: Gmm Method. Journal Of ‎Financial Economics. 2016;10(36):15-32.‎##‎6.‎ Habicht T, Reinap M, Kasekamp K, Habicht J, van Ginneken E, Webb E. The 2017 reform ‎to improve financial sustainability of national health insurance in Estonia: Analysis and first ‎lessons on broadening the revenue base. Health Policy. 2019;123(8):695-9.‎##‎7.‎ Alshammari AA, Alhabshi SM, Saiti B. The impact of oil prices and the financial market on ‎cost efficiency in the insurance and Takaful sectors: Evidence from a stochastic frontier ‎analysis. Economic Systems. 2019;43(3-4):100716.‎##‎8.‎ Lee D. Effects of health insurance coverage on household financial portfolio: Evidence from ‎the Affordable Care Act. Economics Letters. 2018;171:176-9.‎##‎9.‎ Angrisani M, Atella V, Brunetti M. Public health insurance and household portfolio Choices: ‎Unravelling financial “Side Effects” of Medicare. Journal of banking & finance. ‎‎2018;93:198-212.‎##‎10.‎ Lee C-C, Chang C-H. Financial policy and insurance development: Do financial reforms ‎matter and how? International Review of Economics & Finance. 2015;38:258-78.‎##‎11.‎ ‎Azam Pour M. The Insurance Industry and Its Role in Financial Markets ‎Liberalization. ‎1st International Conference on Economic Planning, Sustainable and ‎Balanced Regional ‎Development; Approaches and Applications; Iran‎: University of ‎Kurdistan; 2017.‎##‎12.‎ ‎Shahabadi A, Ahmadi M, Moradi A. The Interaction of Financial Development and ‎Economic Freedom on Insurance Penetration ‎Unsuccessful Countries in the Development of ‎the Insurance Industry‎. Journal of Economic Modeling Research. 2018;8(31):41-68.‎##‎13.‎ Abiad A, Detragiache E, Tressel T. A new database of financial reforms. IMF Staff ‎Papers. 2010;57(2):281-302.‎##‎14.‎ Lee C-C, Hsieh M-F. Bank reforms, foreign ownership, and financial stability. Journal ‎of International Money and Finance. 2014;40:204-24.‎##‎15.‎ Levine R. Bank-based or market-based financial systems: which is better? Journal of ‎financial intermediation. 2002;11(4):398-428.‎##‎16.‎ Bun MJ, Sarafidis V. Dynamic panel data models. The Oxford handbook of panel data. ‎‎2015:76-110.‎##‎17.‎ De Blander R. Which null hypothesis do overidentification restrictions actually test? ‎Economics Bulletin. 2008;3(76):1-9.‎##‎18.‎ Mohy Ul Din S, Abu-Bakar A, Regupathi A. Does insurance promote economic growth: ‎A comparative study of developed and emerging/developing economies. Cogent Economics ‎& Finance. 2017;5(1):1390029.‎##‎19.‎ Lee C-C, Lin C-W, Zeng J-H. Financial liberalization, insurance market, and the ‎likelihood of financial crises. Journal of International Money and Finance. 2016;62:25-51.‎##‎20.‎ Sakellarides C, Castelo-Branco L, Barbosa P, Azevedo H. The impact of the financial ‎crisis on the health system and health in Portugal. Copenhagen: World Health Organization. ‎‎2014.‎ ##

بررسی عوامل موثر بر وقوع مشارکت مردمی در نظام سلامت: یک مطالعه تطبیقی Factors affecting the occurrence of public participation in the health system: a comparative study 1 1 مقدمه: نظام سلامت به عنوان یکی از مهمترین ارکان مورد نیاز جوامع بشری می باشد و مشارکت در نظام سلامت به عنوان یک وسیله مناسب جهت تشویق و ترغیب مردم در جهت توسعه و بهبود فعالیت‌های بهداشتی درمانی زندگی­شان محسوب می شود. مطالعه حاضر با هدف تعیین چارچوب و ابعاد مشارکت­‌های مردمی در نظام سلامت به بررسی تجربیات کشورهای منتخب پرداخته است. روش بررسی: مطالعه حاضر یک مطالعه تطبیقی می‌­باشد که در سال 1399-1398 انجام گرفت. مطالعه تطبیقی داده‌های 5 کشور انگلستان، مکزیک، نروژ، سنگاپور و ایران جمع آوری و در هشت مولفه مورد بررسی قرار گرفت. برای تحلیل داده‌­ها از جداول مقایسه­‌ای استفاده شد که شامل مقایسه ابعادی است که از مطالعه الگوی مشارکت­‌های مردمی در نظام سلامت کشورهای منتخب به دست آمد. یافته‌ها: یافته­­های مطالعه نشان داد که در کشورهای مورد مطالعه به منظور ارتقا مشارکت‌­های مردمی در نظام سلامت از استراتژی­‌هایی مانند گسترش فناوری­‌های نوین اطلاعاتی، کاهش تصدی­‌گری دولتی و نابرابری اجتماعی، اصلاح نظام سلامت و ایجاد ساختارهای مناسب جهت مشارکت‌­های مردمی، توسعه سازمان‌­های مردم نهاد و تاکید و ترویج ارزش‌های اخلاقی و فرهنگی بهره می‌­برند. نتیجه‌گیری: مفهوم مشارکت مردمی نیاز به شفاف‌­سازی اطلاعاتی بیشتری داشته و تأثیر فاکتورهایی نظیر عوامل اقتصادی، ایجاد ساختارهای سازمانی مناسب و فناوری اطلاعات بر آن باید مورد بحث­‌های بیشتر قرار گرفته و بر اساس شرایط کشورها بومی سازی گردد. 2 Introduction: The health system is one of the most important pillars needed by human societies and participation in the health system is considered as a suitable tool to encourage people to develop and improve health activities in their lives. The present study aims to determine the framework and dimensions of public participation in the health system and examines the experiences of selected countries. Methods: The present study is a comparative study that was conducted in 2009-2010. The comparative study collected data from 5 countries: England, Mexico, Norway, Singapore and Iran and was examined in eight components. To analyze the data, comparison tables were used, which include a comparison of dimensions obtained from the study of the pattern of public participation in the health system of selected countries. Results: The findings of the study showed that in the studied countries, in order to promote public participation in the health system, strategies such as the development of new information technologies, reducing government ownership and social inequality, reforming the health system and Benefit from creating appropriate structures for grassroots participation, developing non-governmental organizations, and emphasizing and promoting moral and cultural values. Conclusion: The concept of public participation needs more information transparency and the impact of factors such as economic factors, the creation of appropriate organizational structures and information technology on it should be further discussed and localized according to the conditions of the country. 116 127 2020/03/162020/07/62020/04/42020/05/102020/04/23 1399/2/4 2020/09/192020/07/62020/08/32020/08/192020/08/19 1399/5/29 معصومه باقری کاهکش Masumeh Bagheri Kahkesh گروه مدیریت خدمات بهداشتی و درمانی، دانشکده علوم و فناوری‌های پزشکی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران masume.bagheri@yahoo.com محمود محمودی مجد آبادی فراهانی Mahmood Mahmoodi Majd Abadi farahani گروه مدیریت خدمات بهداشتی و درمانی، دانشکده علوم و فناوری‌های پزشکی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران masumebagheri3@gmail.com لیلا ریاحی Leila Riahi گروه مدیریت خدمات بهداشتی و درمانی، دانشکده علوم و فناوری‌های پزشکی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران l.riahi@srbaiu.ac.ir کامران حاجی‌نبی Kamran Hajinabi گروه مدیریت خدمات بهداشتی و درمانی، دانشکده علوم و فناوری‌های پزشکی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران hajinabi@srbiau.ac.ir public participation health system comparative study مشارکت‌های مردمی نظام سلامت مطالعه تطبیقی [1].Azmal M. 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رابطه پوشش بیمه‌ای بر استفاده خانوارهای ایرانی از خدمات دندان‌پزشکی The relationship between insurance coverage on Iranian Households' use of dental services 1 1 مقدمه: سلامتی همواره یکی از مهمترین دغدغه‌های بشر بوده است و بدون سلامت دهان و دندان، سلامت عمومی بدن تأمین نمی­شود. بیمه درمانی داشتن همواره از عوامل تسهیل کننده استفاده از خدمات درمانی بوده است و این پژوهش در راستای شناسایی و تعیین تأثیر پوشش بیمه ای بر استفاده از خدمات دندان‌پزشکی خانوار در کشور ایران می‌پردازد. روش بررسی: مطالعه حاضر از نوع مطالعات تحلیلی-توصیفی و مقطعی است و بر اساس آنالیز داده­های مستخرج از پیمایش ملی هزینه-درآمد خانوار طی سال‌های ۱۳۹۱-۱۳۹۶، در سال ۱۳۹۸ انجام ‌شده است. جهت برآورد اثر متغیرهای مستقل بر متغیر وابسته از مدل رگرسیون لاجیت استفاده شد. حجم نمونه مورد بررسی این مطالعه در مناطق روستایی ۱۱۶۴۶۹ خانوار و در مناطق شهری ۱۱۲۶۸۵ خانوار و درمجموع ۲۲۹۱۵۴ خانوار برای کل کشور بوده است. به‌منظور تحلیل داده­ها در این مطالعه از نرم‌افزار ۱۴ STATA استفاده شد. یافته‌ها: از ۲۲۹۱۵۴ خانوار مورد مطالعه ۱۱۳۹۲ خانوار ( ۹۸/۴ درصد) طی دوره ۶ ساله این مطالعه از خدمات دندان‌پزشکی استفاده داشته اند نتایج نشان می­دهد استان‌های با سطح توسعه یافتگی بالا (ازنظر دسترس به خدمات بهداشتی-درمانی) استفاده خدمات دندان‌پزشکی بالاتری داشتند (۰۰۱/۰ > p-value). خانوار ساکن مناطق شهری، دارای پوشش بیمه­ای، دارای تعداد افراد باسواد بیشتر، خانوار دارای تعداد سالمند کمتر بیشتر از خدمات دندان‌پزشکی استفاده کرده­اند (۰۰۱/۰ > p-value). خانوار ثروتمند (پنجک های درآمدی بالاتر) نسبت به خانوار فقیر (پنجک های درآمدی پایین‌تر) و خانواری که خودمراقبتی دهان و دندان داشتند( مصرف نخ دندان، مسواک و خمیردندان) نسبت به خانواری که این مراقبت را نداشتند بیشتر از خدمات دندان‌پزشکی استفاده کرده بودند (۰۰۱/۰ > p-value). نتیجه‌گیری: مداخلات مؤثر مبتنی بر شواهد برای بهبود استفاده از خدمات دندان‌پزشکی در بین خانوارهای بدون بیمه درمانی، داری افراد سالمندان، وضعیت تحصیلات پایین و زندگی در استان‌های کمتر توسعه یافته و خانوار ساکن روستاها باید در اولویت سیاستگذاران و برنامه ریزان این حوزه قرار گیرد. 2 Introduction: Health has always been one of the most important concerns of mankind, and without oral and dental health, the body's general health cannot be guaranteed. Having health insurance has always been one of the factors facilitating the use of health services and this study is aimed to identify and investigate the impact of insurance coverage on the use of family dental services in Iran. Methods: The present study is a descriptive-analytical and cross-sectional study based on data from National Expenditure Survey by Statistics Center of Iran during 2013-2012. Logistic regression model was used to estimate the effect of independent variables on the dependent variable. The sample size of the study was 116469 households in rural areas and 112685 households in urban areas and 229154 households in the country as a whole. Data were analyzed using Microsoft Access, Microsoft Excel and 14 STATA software. Results: Of the 229,154 households surveyed, 11,392 households (4.98%) had dental services during the 6-year period. The results show that provinces with a high level of development (in terms of access to health services) had higher use of dental services (p-value<0/001). Urban households with insurance coverage, more literate people, and households with fewer elderly people have used dental services (p-value<0/001). Wealthier households (higher income quintiles) than poor households (lower income quintiles.  And families that had self-care (using floss, toothbrushes and toothpaste) had more dental services than families who did not (p-value<0/001). Conclusion: Effective evidence-based interventions to improve the use of dental services among uninsured households, elderly people, low education status, residents of less developed provinces, and rural households should be prioritized by policy makers and planners. 128 137 2020/03/162020/07/62020/04/42020/05/102020/04/232020/03/12 1398/12/22 2020/09/192020/07/62020/08/32020/08/192020/08/192020/08/12 1399/5/22 سارا امامقلی‌پور Sara Emam Golipoure گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران s-emamgholipour@tums.ac.ir محمد عرب Mohammad Arab گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران arabmoha@tums.ac.ir جعفر یحیوی دیزج Jafar Yahyavi Dizaj گروه علوم مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران jafar.economic@yahoo.com Dental services Household Iran Factors insurance coverage خدمات دندان‌پزشکی خانوار ایران عوامل پوشش بیمه 1. Mazlumi M, Ruhani T. 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راهکارهای کنترل هزینه در پرهزینه‌ترین خدمات آزمایشگاهی سازمان بیمه سلامت Cost Control Solutions in the Most Expensive Laboratory Services of the Health Insurance Organization 1 1 مقدمه: تقاضای روزافزون برای خدمات بهداشتی درمانی موجب شده است که نظام سلامت همواره با چالش‌های متناقض بهبود عملکرد و کنترل هزینه‌ها روبرو باشد. پیش نیاز اتخاذ تدابیر مناسب برای کنترل هزینه‌ها، وجود توصیفی دقیق از وضعیت موجود است. مقاله حاضر با هدف شناسایی پرهزینه‌ترین خدمات آزمایشگاهی سرپایی تحت پوشش سازمان بیمه سلامت و راهکارهای کنترل هزینه‌های آن انجام گردید. روش بررسی: مطالعه حاضر یک مطالعه توصیفی مقطعی بود که در سال ۱۳۹۶ بر اساس اطلاعات سال ۱۳۹۴ انجام شد. اطلاعات هزینه‌ای خدمات آزمایشگاهی از سامانه اسناد پزشکی دفاتر استانی بیمه سلامت کل کشور دریافت شد و با استفاده از نرم افزار Excel ۲۰۱۳ تحلیل شد. با استفاده از پرسشنامه با سوالات باز مداخلات کاهش هزینه‌های خدمات پرهزینه شناسایی شده از روسای ادارت اسناد پزشکی استان‌ها و کارشناسان مسئول مربوطه جمع‌آوری گردید و از طریق تحلیل محتوای کیفی تحلیل انجام شد. مداخلات پیشنهادی به صورت مداخلات اختصاصی هر خدمت و مداخلات غیر اختصاصی دسته بندی گردیدند. یافته‌ها: پرهزینه‌ترین خدمات آزمایشگاهی سرپایی تقریباً نیمی از هزینه‌های آزمایشگاهی سازمان بیمه سلامت ایران را تشکیل داده است. آزمایش‌های اندازه‌گیری TSH، کلسترول خون CBC، و بررسی سطح ویتامین D در رتبه های اول خدمات پر هزینه آزمایشگاهی قرار دارند. مهمترین مداخلات کنترل هزینه‌ها شامل اجرای پزشک خانواده و نظام ارجاع، نظارت بر ارتباط پزشکان و موسسات پاراکلینیکی، تجمیع بیمه‌ها/همسان سازی بیمه‌ها، رصد کردن مراکز پر هزینه، تهیه و ارسال کارنامه عملکردی به پزشکان، توانمند سازی بیمه شدگان، تعیین سقف ارائه/مصرف خدمات و ایجاد پرونده سلامت الکترونیک بود. نتیجه گیری: خدمات شناسایی شده تقریباً نیمی از هزینه‌های سازمان بیمه را تشکیل داده اند. اتخاذ سیاست های اجرایی در خصوص راهکارهای شناسایی شده توسط سازمان‌های بیمه و وزارت بهداشت درمان و آموزش پزشکی، می‌تواند در راستای کنترل و مدیریت موثرتر هزینه های فزآینده خدمات سلامت نقش چشمگیری داشته باشد. 2 Introduction: The increasing demand for health services has made the health system constantly faced with inconsistent challenges of improving performance and cost control. The prerequisite for taking appropriate cost control measures is a detailed description of the situation. The aim of this paper is to identify the most expensive outpatient laboratory services covered by the Health Insurance Organization and cost control strategies. Methods: This study was a cross-sectional descriptive study that was done in 2017 based on data from 2015. Laboratory cost data were obtained from the Medical Records System of the Provincial Health Insurance Offices of the whole country and analyzed using Excel 2013 software. Chiefs of provincial Medical Records Bureau and responsible experts were asked to propose cost-cutting interventions pertaining to identified the costliest services. Suggested interventions were reviewed and after excluding duplicates, they were categorized as specific interventions for each service and non-specific interventions. Results: The most costly outpatient laboratory services accounted for approximately half of the costs of the Iranian Health Insurance Organization. TSH measurement tests, blood cholesterol, CBC and vitamin D levels are at the top of the costly lab services. The most important cost control interventions include family physician and referral system implementation, monitoring of physicians and Para clinical centers, insurance aggregation, observing costly centers, preparing performance reports to physicians, empowering insureds and creating electronic health records. Conclusion: It is suggested that appropriate policies regarding the strategies proposed here by insurance organizations and the Ministry of Health and Medical Education need be taken into consideration in order to more effectively control and manage the rising costs of health services. 138 144 2020/03/162020/07/62020/04/42020/05/102020/04/232020/03/122020/02/20 1398/12/1 2020/09/192020/07/62020/08/32020/08/192020/08/192020/08/122020/08/31 1399/6/10 کیوان رحمانی Keyvan Rahmani کمیته تحقیقات دانشجویی، دانشکده مدیریت و اطلاعات پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران keivan.rahman@gmail.com احمدرضا ریاضیات Ahmadreza Riaziat موسسه ملی تحقیقات بیمه سلامت، تهران، ایران علیرضا فرشید Alireza Farshid موسسه ملی تحقیقات بیمه سلامت، تهران، ایران رضا رضایتمند Reza Rezayatmand مرکز تحقیقات مدیریت و اقتصاد سلامت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران r.rezayatmand@mng.mui.ac.ir Health Cost Health Insurance Costly Services Cost Control Laboratory Services هزینه سلامت بیمه سلامت خدمات پرهزینه کنترل هزینه خدمات آزمایشگاهی 1. Davari M. Economic Challenges of Iran's Health System. J Health Inf Manag. 2011;7(8):7-915.##2. Masoudi Asl I, Bakhtiari Aliabad M, Akhavan Behbahani A, Rahbari Bonab M. Health System Costs in Iran, How to Manage it. Iranian Journal of Health Insurance. 2019;1(4):117-27.##3. Alamshah SA. Calculating the Cost of Services of Laboratory in Alami Herandi Clinic of Isfahan Social Security Organization Using Time-Driven Activity-Based Costing and Comparing It with the Approved Tariffs in 2015. Journal of Health Accounting. 2017;6(1):88-110.##4. Arab M, Ghiasvand H, Darroudi R, Akbari Sari A, Hamidi M, Moghri J. Determination of radiology services cost in selected hospitals affiliated with Tehran university of medical sciences in 20102011, using the activity based costing method. Journal of Hospital. 2012;11(3):27-36.##5. Ziebarth NR. Assessing the effectiveness of health care cost containment measures. 2011.##6. 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(0):1-12.##7. Mehrara M, Fazaeli AA, Fazaeli AA, Fazaeli AR. The relationship between health expenditures and economic growth in Middle East & North Africa (MENA) countries. International Journal of Business Management & Economic Research. 2012;3(1):425-8.##8. Galarraga JE, Mutter R, Pines JM. Costs associated with ambulatory care sensitive conditions across hospital‐based settings. Academic Emergency Medicine. 2015;22(2):172-81.##9. Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clinical Chemistry and Laboratory Medicine (CCLM). 2006;44(6):750-9.##10. Driskell OJ, Holland D, Hanna FW, Jones PW, Pemberton RJ, Tran M, et al. Inappropriate Requests for Glycated Hemoglobin (HbA1c) Are Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability. Clinical chemistry. 2012:clinchem. 2011.176487.##11. Davari M, Haycox A, Walley T. The Iranian health insurance system; past experiences, present challenges and future strategies. Iranian journal of public health. 2012;41(9):1.##12. Damari B, Vosough Moghaddam A, Rostami Gooran N, Kabir MJ. Evaluation of the Urban Family Physician and Referral System Program in Fars and Mazandran Provinces: History, Achievements, Challenges and Solutions. Journal of School of Public Health and Institute of Public Health Research. 2016;14(2):17-38.## ##

قضایی سازی سیاست در حوزه سلامت و تامین اجتماعی Judiciary Policy in the Field of Health and Social Insurance 1 1 روز به روز توزیع قدرت و تفکیک قوا علاوه بر ابعاد سرزمینی در ابعاد موضوعی و فنی نیز گسترش یافته و به شاخه های کوچک و کوچک تر تقسیم می شود تا از طریق کاهش قدرت، نظارت پذیری ممکن گردد. یکی از حوزه های فنی و موضوعی که اعمال سیاسی مهمی را در صلاحیت خود دارد حوزه سلامت و تامین اجتماعی است که حتی در نئولیبرال ترین دولت ها بخش بزرگی از بودجه را به خود اختصاص داده و از لابی قدرتمندی برخوردار است و عدم نظارت قضایی بر ان می تواند به اخذ تصمیمات ناروا و هدر رفت منابع و فرصت ها منجر شود. به همین دلیل معمولا دو نوع نظارت بر این حوزه اعمال می شود، یکی نظارت سیاسی یا مردمی که نظارتی مبهم و ناکاراست و دیگری نظارت قضایی که موثر و شفاف می باشد. این نوع نظارت از زمانی که دیوان عالی امریکا دکترین "مساله سیاسی" را شکل بخشید و "حقوق دموکراسی" را خارج از قلمرو قوه قضائیه غیر پاسخگو و غیرنماینده قرار داد وارد حوزه سیاسی شد و اخذ تصمیم در باب برخی از موضوعات مانند: "سیاست های عمومی، آموزش و پرورش ، بهداشت و سلامت، مهاجرت و کار و محیط زیست و..." را به دیوان عالی سپرد که بعدها این اقدام قضایی سازی سیاست نام گرفت. این پژوهش که به روش کتابخانه ای، توصیفی و تحلیلی به بررسی قضایی سازی سیاست در حوزه سلامت و تامین اجتماعی پرداخته به این نتیجه رسیده است که قضایی سازی در این حوزه مسبوق به سابقه نیست و اگر با معیارهای منظومه حقوق اساسی یک جامعه دموکراتیک همراه باشد، منجر به توسعه سلامت و تامین اجتماعی می گردد ور نه منجر به سقوط های اساسی، تضعیف بهداشت و سلامت و نقض بیشتر حقوق و فساد می شود. 2 Day-to-day power distribution and separation of powers, in addition to territorial dimensions, is also expanded into subjective and technical dimensions and is divided into smaller and smaller branches to allow for monitoring through reduced power. One of the technical and subject areas that has important policy implications is the area of ​​health and social security, which even in the most neoliberal governments has a large share of the budget and has a strong lobby and lack of judicial oversight. It can lead to bad decisions and wasted resources and opportunities. For this reason, there are usually two types of oversight in this area, one being political or public oversight that is vague and inefficient, and the other being effective and transparent judicial oversight. This type of oversight has entered the political arena since the US Supreme Court formulated the doctrine of the "political question" and rendered "democratic rights" out of the jurisdiction of the unaccountable and unrepresentative judiciary and made decisions on certain issues such as "politics". Public court, education, health, immigration and labor and the environment and ... "which was later called a policy judiciary. This research, which uses a library, descriptive and analytical approach to examine the legalization of health and social security policy, has concluded that judicialisation in this area is unprecedented and if it is in line with the constitutional criteria of a democratic society. , Leads to the development of health and social security, but not to major crashes, undermining health and further violations of rights and corruption. 145 147 2020/03/162020/07/62020/04/42020/05/102020/04/232020/03/122020/02/202020/02/24 1398/12/5 2020/09/192020/07/62020/08/32020/08/192020/08/192020/08/122020/08/312020/07/11 1399/4/21 مهدی فتحی زاده Mehdi Fathizadeh گروه حقوق عمومی، دانشکده حقوق، الهیات و علوم سیاسی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران mfathizadeh@ymail.com سید محمد هاشمی Seyed Mohammad Hashemi گروه حقوق عمومی، دانشکده حقوق، دانشگاه شهید بهشتی، تهران، ایران mehdi.fathizadeh789@gmail.com ولی رستمی Vali Rostami گروه حقوق عمومی، دانشکده حقوق و علوم سیاسی، دانشگاه تهران، تهران، ایران policy judiciary health social security competence political practice legal practice قضایی سازی سیاست سلامت تامین اجتماعی صلاحیت عمل سیاسی عمل حقوقی 1. Georgian Azandriani Ali Akbar (2008), &quot;The Guardian Council as a Needle Holder of the Constitution&quot;, Article 21, No. 82##Summer: 1.##2. Mashhadi Ali (2012), Principles and Criteria of Judicial Control in Swiss Law, Law Quarterly, Volume 42, Number 3, Fall,: 291-301##1. Dessemontet, François. Swiss Administrative Law. (2004), kluwer law Intenational.##2. Fleiner-Gerste, Thomas, Alexander Misic. (2005), Swiss Constitutional Law., Kluwer law Intenational.##3. Grisel, André. (1970), Droit administrative Suisse. Ides et Calendes, Neuchâtel.##4. Hirschl, Ran, The Judicialization of Mega-Politics and the Rise of Political Courts. Annual Review of Political Science, Vol. 11, 2008, 44-432. Available at SSRN: https://ssrn.com/abstract=1138008##5. Le droit Suiss, (2010), at: www.Format-prod.com/droit-etudiants / activite sadminstration.html.##6. Lombard, Martin, Gilles Dumont. (2007), Droit Administratif, 7th Edition, Dalloz.Dahl R. 1957. Decision-making in a democracy: the supreme court as a national policymaker. J. Public Law 6: 279-295.##7. Macfarlanet. Eeett, The Thesupreme Court Of Canada And The Judicial Role: An Historical Institutionalist Account, Kingston, Ontario, Canada November, 2009##8. Russell Miller, Lords of Democracy: The Judicialization of 'Pure Politics' in the United States and Germany, Washington and Lee Law Review, Vol. 61, p. 587, 2004##9. Russell Peter H., David O'Brien, Judicial Independence in the Age of Democracy: Critical Perspectives from Cloth • 325 pp • Mar 2001 • ISBN 9780813920153##1. گرجی ازندریانی علی اکبر(1387)، &quot; شورای نگهبان به مثابه سوزن بان قانون اساسی&quot; ،دوره 21، شماره 82##تابستان: ##2. مشهدی علی(1391)، اصول و معیارهای کنترل قضایی در حقوق سوئیس، فصلنامه حقوق، دوره42، شماره3، پاییز، : 291-301##1. Dessemontet, François. Swiss Administrative Law. (2004), kluwer law Intenational.##2. Fleiner-Gerste, Thomas, Alexander Misic.(2005), Swiss Constitutional Law., kluwer law Intenational.##3. Grisel, André. (1970), Droit administrative Suisse. Ides et Calendes, Neuchâtel.##4. Hirschl, Ran, The Judicialization of Mega-Politics and the Rise of Political Courts. Annual Review of Political Science, Vol. 11, 2008، 44-432 . Available at SSRN: https://ssrn.com/abstract=1138008##5. Le droit Suiss, (2010), sur: www.Format-prod.com/droit-etudiants / activite sadminstration.html.##6. Lombard, Martin, Gilles Dumont. (2007), Droit administratif, 7e édition, Dalloz.Dahl R. 1957. Decision-making in a democracy: the supreme court as a national policymaker. J. Public Law 6:279-295.##7. Macfarlanet. Eeett ، Thesupreme Court Of Canada And The Judicial Role: An Historical Institutionalist Account، Kingston, Ontario, Canada November, 2009##8. Russell Miller، Lords of Democracy: The Judicialization of 'Pure Politics' in the United States and Germany، Washington and Lee Law Review, Vol. 61, p. 587, 2004 ##