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سال دهم شماره 3 (پاییز 1390)

Informal health payment in several middle and low income countries is a serious impediment to health care reform. This payment is effectively a form of systemic corruption. Informal health payments have adverse impact on access and utilization of health services, efficiency, quality and equity. Informal payments lead to false information about the real costs of disease and the patient share of these costs and consequently wrong government policies. The objective of this paper is analyses of informal payments among hospitals covered under Tehran University of medical sciences (TUMS) 2009. In this cross- sectional study, we used random sampling and selected finally 3 hospitals. Then in a simple random sampling, we recruited 300 discharged patients from general,surgery, emergency, ICU & CCU wards. All of the data are collected by interview and questionnaire.We analyzed data with Chi- Square, T-test, Annova, Bonferroni. According to the findings, Of the total 300 respondents in the study sample, about 3.7% had requested informal payment. 21% of respondents reported at least one informal payment. Cash payments constituted the bulk of total informal payment (88.8%). In the majority of the cases, the Patient paid for appreciation (55.6%). All of the people who had paid informal payment, it has been paid to the servant and maid, Only in one case, in addition to the servant and maid, the Guardian has also been paid. None of the socio-economic characteristics of the family, Insurance status, type of referral, payment form (voluntary or solicited) were related to the size of informal payments. And there is a relationship between length of stay and size of informal payment (p-value=0.015). There isnt relationship between these factors- except marital status(p-value=0.042) - and frequency of informal payments. It seems that training about informal payments properly, increasing health sector resources, increasing official income levels, improving quantity and quality of health services and Trying to change the opinions which believes informal payments are necessary (changing culture) can be effective in controlling informal payments.

Health care system is a complicated system that needs to harmonized prevention and medical activities. It should be authorized by a management-based organizational structure in social and political conditions. Health programs absolutely should be started by need assessment of people and their demand on the health care services. This is an applied study which was conducted in 2009 year. Study samples included community household dwellers that have been lived in the state of Isfahan- Naeen province.Random quota sampling method was used for selecting samples throughout of 3 blocks in health centers which included 130 household dwellers in each block. Statistical methods and SPSS software version (12) were used to this data analyses. According to the results, there was significant correlation between socioeconomic components (age of father and mother in a household, job status, education level of household dwellers, number of children, income amount, and types of insurance and living place) with the outpatient services benefit. There was significant correlation between demographic status with demand in diagnostic, inpatient services, and medicine purchased. Furthermore, the average of referral to GPs,specialist, dentist, pharmacists, and outpatient diagnostic services were 1.08, 1.44, 0.6, 2.52, 1.32 and 0.44, respectively. The average costs for receiving medical services were 366296 RLs in the Naeen city; although, but it was calculated 454585 RLs for receiving medical services in other cities. Regarding dissatisfaction among participated people in this study, availability of inpatient services, interesting to refer to clinics into other cities in order to receive health services and also the negative effect on demand, in other hands, considering efficiency indexes in Naeen’s health centers and imposing huge costs and spending long times to receive those services in other cities, it makes health-policy makers give more attention to quality of deliver services through health centers. It is recommended to do more studies in assessing the preventative interventions in level 1 and 2 in the health systems as consider as to common diseases, need assessments of different age groups in society,organizing different target groups in marketing, environmental changes, systematic planning, society training, delivering desirable services to target groups, reducing uncertainty feeling of outpatient,diagnostic and inpatient medical centers in Naeen city.

Although there is consensus on importance of Emotional Intelligence (EI) anddispositional to patients’ satisfaction, there are a few researches that have been performed in this area.To cover the theoretical gap, the aim of current study is reviewing the empirical research in linking emotional intelligence, spiritual intelligence, and positive & negative affectivity related to patients’ satisfaction, in order to propose a comprehensive model. This is a descriptive study. Statistical population included nurses,physicians and their patients in two public and two private hospitals. Data gathered from the total number of 228 participants. Random sampling procedure was conducted to select individuals in each hospital. The data gathering instrument was questionnaire that reliability for all of items was greater than 0.70. Kolmogrov-Smirnov test, T-test and path analysis is applied to data analyze. The results suggest that spiritual and emotional medical staff’ characteristics explained 71 per cent of the variance in the rate of patients’ satisfaction (R2=0/39) that is a sizeable amount in behavioral studies. Emotional intelligence, positive affectivity, and spiritual intelligence, have positive effects and negative affectivity which has negative effects on patients’ satisfaction. Also effective ommunications with patient, job performance, and cohesiveness among medical staff, have a mediator role in the model. Since nurses and physicians frequently suffer from stressful hard work, they should have particular intelligence and disposition to gain in both performance standards and the ultimate patients’ satisfaction.

The aim of the study was exploring the association between employee perceptions of servant leadership and leader trust, as well as organizational trust and community citizenship behavior among the nurses in public hospitals in Shiraz province. This study applied as a correlation study that was conducted like as a cross-sectional research in 2010. The sample of study consisted of public hospitals’ nurses in Shiraz metropolitan area from whom 250 people were selected throughout the formula of set size correlation studies. Three different types of questionnaires were used which included; 1- Taylor's Servant Leadership Assessment (2002), 2- Ruder's Leader and Organizational Trust Inventory (2003), and 3-Liden's Community Citizenship Behavior Assessment (2008). Data analyses were followed in the two levels of descriptive and inferential by using software spss18. Research finding showed that there are significant correlation relationships (P<0/01) between Servant Leadership and Organizational Trust (r= 0/440), Servant Leadership and Community Citizenship Behavior (r= 0/144) and Organizational Trust and Community Citizenship Behavior (r=0/145). Also, servant leadership has had the power of prediction to nurse's community citizenship behaviors. Perceptions of servant leadership between studied hospitals’ staff had positive correlation with organizational trust as well as community citizenship behaviors. The study also found that organization perceived as a servant-led exhibited had higher levels in both organizational trust and community citizenship behaviors in comparison to organization perceived as a non-servant-led.Therefore, findings lead to support of Greenleaf’s view that servant leadership is an antecedent in organizational trust, and other aspects of servant leadership models.

Economic efficiency in any organization is based on economic attitude of the decision maker’s board. Hospitals are important organizations in terms of health economic and activities related to decision making in an economic attitudes. Regarding the efficiency of Iranian hospitals and their wasteful performance, the present study intended to describe and analyze the economic attitude among decision makers in hospital boards. A cross-sectional approach was taken to the study of efficiency among hospitals. Study has focused on the board of decision maker's mentality about economic concepts particularly those relevant to the health and hospital economics. Teaching hospitals affiliated in Tehran, Iran and Shahid Beheshti Medical Science Universities, and hospitals affiliated with Social Insurance Organization and private hospitals in Tehran were determined as the sample of this study.Executive principals and managers in hospitals are together within the head nurses, accounting and administration officer were considered as members of decision makers board in hospitals. Total of 55 people interviewed as study population. Collected data was processed through SPSS software. Attitude spectrum among decision makers in hospitals board in the following dimensions were:Payment Diagnosis Related Groups (DRG), Fee for Service (FFS), contract, salary, and per case. Financing methods included: DRG, Population Based Budget, FFE, Per capita, fixed (ordinary) and budget. Cost analysis methods composed: cost- effectiveness, cost- utility, cost- efficiency, and cost- profit. Budgeting methods were: Performance Based Budgeting, Plan Based Budgeting,Population Based Budgeting, zero Based Budgeting, and Historical/ Intermental Budgeting.Insurance system Performances included: Elimination of funding relationship between patient,Examination the expects of insured people from services, Supervision on Quality of services,Accreditation of service provider centers, determination of TAREFE and per capita, determination of medical guidelines. Per Capita determining Factors were: Cost accounting price, Inflammation, health price index, Demand on health service, Pattern of consumption, Out of pocket payment, Ability to pay. Assessing managers’ attitude suggest a new prospective in crucial areas of hospital performance. These attitudes would be scientific weather the domain of knowledge will be expanded,so the development of relevant knowledge in hospital management area to make executive in a new patterns to the managers’ attitudes.

The pharmaceutical services in Rural Health Centers (RHCs), plays a crucial role topromote the Iranian people health. Aligning with health reforms, the outsourcing approaches on medicinal services have been run, recently. The aim of this study was to determine whether the outsourcing approach in RHC's pharmacies comparison with the governmental approach has been effective on patient's satisfaction. This study is a quasi-experimental post-test only, including a control group. All of 19 RHCs with outsourced pharmacies and also 19 randomly selected RHCs in governmental pharmacies sector considered as an intervention and control groups, respectively. Outpatient's satisfaction data were collected through interview by using a 6-items questionnaire. To data analyzing Excel 2003 and SPSS ver. 16 software were employed. The overall mean satisfaction from pharmaceutical services of outsourced and nonoutsourced (i.e. governmental) pharmacies were 5.28 and 5.75 points (out of maximum 6 points) respectively (p<0.001). Inadequate time taken to outpatient consults by pharmacie's staff was the most common factor which associated with dissatisfaction. The approach of outsourcing RHC's pharmacies, despite its promise to positive ffect on quality of care, might be failed the user's satisfaction. Thus, essential arrangements like omprehensive and detailed contracts should be provided. Meanwhile, effective mechanisms such as monitoring and evaluation should be considered.