مجله تحقیقات نظام سلامت حکیم
سال بیست و یکم شماره 1 (پیاپی 80، بهار 1397)

Unfair financial contribution and out of pocket payments that are not in line with the capacity to pay, not only leads to more households exposed to catastrophic health expenditures, but also result in impoverishment. Therefore the main goal of this essay is to analyze the situation of fairness and equality infinancial contribution of health payments. These calculations have been done throughout the whole country.In addition, the household’s expenditures in Iran are disaggregated into expenditure quintiles through selectedyears.

This study aimed to investigate health financing by using FFC index, catastrophic healthexpenditures index, and impoverishment expenditures index (based on World Bank Approach). To this end,Iran’s annual household’s survey data, which is produced by Iran statistic center, is used (1989 - 2014).

The index of fairness in financial contribution of households during the selected years experiencedminor fluctuations. The percentage of the households facing the catastrophic costs increased, however, thepercentage of impoverishment expenditures decreased in these selected years. Among the quintiles, thehouseholds in the fifth quintile had the highest rate of inequality in health payments and the highest percentageof households facing catastrophic costs. The first quintile had the highest rate of impoverishment expenditures.

It is concluded that the performed programs during the selected years have not been effective enough and financial contributions in health payments has been poorly targeted. The health system has not had successful achievements in protecting the households against the catastrophic costs and impoverishment expenditures.

This study was conducted to assess the epidemiological aspects and trend of Tuberculosis in Tehran Province during a nine-year period.

In this study all registered TB patient from 2005 - 2013 were evaluated. To assess the relationshipbetween qualitative variables, chi-square test was used. The incidence rate of TB was calculated during theyears of study. Trend the frequency of cases were reported as a line chart. All statistical analyses were performedat a significance level of 0.05 using Stata software, version 11 (Stata Corp, College Station, TX, USA).

In this study 11446 TB patients were evaluated. About 45% of patients were female, 52.69% were Iranians, 84.86% were in urban residents, and 13.93% were new cases. A total of 49% of patients were co-infected with Human Immunodeficiency Virus (HIV). Proportion of sex, age, place of residence,history of contact with patients, hospitalization for TB, and kind of disease (

Zoonotic cutaneous leishmaniasis (ZCL) is one of the most important parasitic diseases in Iran and common in rural districts of 17 of the 31 provinces of the country. In recent years, ZCL has become a serious and increasing public health problem in Yazd province. Following the epidemic of CL in the Abarkooh county, Yazd province, the purpose of this study was to determine the frequency of the disease and was carried out to determine the animal reservoir hosts and human infection in 2009 - 2010.

In order to investigate the frequency of the disease, at the end of autumn, 300 hundred households whose buildings were located near each other were visited and all members of the households were examined from each district, including 1130 people in Abarkooh city and the villages of Esfandabad and Haroni. Rodents were caught by 20 live traps biweekly from the summer and autumn of 2009. The rodents were identified morphologically and microscopic examination was performed.

Eighteen (1.59%) cases had acute lesions of CL in the study area. Of these, 27.77% were male and 72.23% were female. A total of 353 cases had scars, of these 49% were male and 51% were female. The frequency of active lesions and scars among households with a total population of 1130 in three infected districts were calculated at 1.59 and 31.23, respectively. The frequency of the disease at the end of autumn was 328 per thousand. The most highly infected age group for acute lesions was under 4 years old (8.82%). Forty rodents (Rhombomys opimus) were collected and microscopic examination showed 35% Leishmania infiction rate.

Zoonotic cutaneous leishmaniasis (ZCL) is endemic in the Abarkooh county. The main reservoir host in this area is probably Rhombomys opimus. For rodent control, according to the guidelines of Centre of Communicable Diseases Management, public education and improving the environment is suggested.

The achievement of equitable system in the form of “equal health services for equal needs” are important goals of policy makers. Therefore, measurement of inequity in utilization of services and distinguishing it from equality is very important.

In this study, equity and equality in health care utilization are estimated by using a survey of health services utilization data set in 2008, which is done by the Ministry of Health and Education Medical and applying indirect standardization method. This is performed in Stata software suite.

Inequality index before standardization indicates that there are slight inequalities between different income groups except health care services for general practitioner, health center, dental services, and services which are offered at private clinics. However, the expected need index indicates that more needs are concentrated among the poor. Thus, it is expected that they utilized more services. However, results of estimation after standardization of inequality and measuring inequity indicates that distribution of health services utilization, particularly outpatient services, is pro-rich and there is horizontal inequity in favor of high income groups.

The concept of inequality is according to the principle that individuals have different needs and different demands in using health services. However, the concept of inequity was achieved according to equal needs. In this case, the difference in utilization is considered as inequity. As a result, the index of inequality cannot be applied for the study of inequity.

The psychological factor and stress can be considered in etiology and treatment of hypothyroidism.Therefore, this study investigates psychological symptoms, quality of life, and stress in patients with hypothyroidismand normal controls.

This research is causal-comparative. The study population included all patients who have problems with hypothyroidism at the Shariati hospital in Isfahan. From this population, 50 patients with thyroid disorders were selected by convenience sampling and 50 normal subjects were selected by available sampling. Instruments included quality of life and stress scale questionnaire. Data analysis by was done byMANOVA in SPSS-19.

The results showed significant differences in stress (stress due to health (F = 8.432)), personal life (F = 11.394) and character and habits of thought (F= 18.889) and quality of life (physical functioning (F =78.893), limitations related to physical problems (F = 28.947), bodily pain (F = 40.357), general health, fatigue (F = 5.519), social functioning (F = 7.762), limitations related to psychological (F = 33.611) and mental, respectively (P < 0.05).

It seems that different psychological symptoms as well as stress and quality of life in these patients compared to normal subjects is due to physical and psychological problems in patients with hypothyroidism; therefore, these problems should be considered in the prevention and treatment of this disorder.

Heart failure is a chronic disease that is one of the most important causes in the world. This subject puts large costs on society. The object of this study is the estimation of direct medical cost on injection technology of patient bone marrow cell affiliated to heart failure in comparison with common treatment methods in Iran.

In order to estimate treatment cost of injection technology of patient bone marrow cell affiliated to heart failure in comparison with common treatment methods, only direct medical costs were considered. The study perspective was ministry of health and providers. Costs were calculated with Excel software based on private and public tariff.

In 2016, treatment cost per capita based on public and private tariff were respectively 120 and 222 million IR Rial for bone morrow cell, 122 and 218 IR Rial for CRT, 120 and 214 for peace maker, 68 and 140 for pharmacotherapy in a one-year period, and also 138 and 233 million IR Rial for IABP in a 10 day period. Therefore, the treatment cost based on private tariff is almost among 1.7 to 2 time’s public tariff. In addition, in terms of cost, pharmacotherapy had the least and IABP had the most.

In general, the result showed that the cost of bone marrow cell had no significant difference with other treatment methods and the costs were almost similar. Therefore, it’s proposed that to enter this technology, we must notice to the effectiveness aspect and the cost effectiveness analysis must be done.

The aim of this study was to determine the effect of Iran’s health system evolution plan, tariffs change on performance, revenue, and expenditure of a big tertiary hospital in Iran in 2015.

This cross-sectional descriptive study was conducted in a big tertiary hospital, (Imam Reza), in 1394 using activity based costing in four time spans: before and after health system evolution, after tariff change, and one year after the inauguration of the evolution. Data relating performance, revenue, and expenditure were gathered and analyzed using descriptive statistics by Excel 2013 Software.

Cost, revenue, and profit of hospital were increased by 31%, 82%, and 4.6% after health system evolution and by 42%, 38%, and 1.7% after tariff change, respectively. Hospital encountered with 17% loss one year after the inauguration of the evolution, however, cost and revenue of hospital were increased 23% and 3%, respectively. The highest change in physician and personnel income with 103% and 91% rise was related to after tariff change. After health system evolution and tariff change, operating room income was increased 33% and 124%, respectively. One year after the inauguration of the evolution, the operating room income didn’t change and the amount of surgeries decreased by 9%.

Performance and financial indicators of Imam Reza hospital have been affected substantially by health system evolution; however, it has not equally affected all revenue and expenditure items.