فهرست مطالب ali akhavan behbahani

The participation of people in legislative processes takes place via different methods. In the last two decades, Information and Communication Technology has vastly progressed and provided a greater capacity to support the participation of citizens in democratic processes. This technology is employed in various ways in different countries. Digital tools can transform parliaments, and so new media platforms and more transparent data help parliaments to communicate better with their citizens.The present study is a comparative study and the research environment included legislative meetings in a number of selected countries, such as Finland, Turkey and Iran. These were then compared and carefully analyzed based on the criteria of the legal systems of America, England, Malaysia, Brazil, France, Germany and South Africa, and the efficiencies of these countries and the successes in their legislation. These countries were selected by carrying out targeted searches.Based on the findings, in all the countries studied, parliaments had legislative power in various forms and benefited from traditional or electronic participation of their citizens. As a result, the information collected varied.In Iran, there is a great deal of potential for people to participate in legislation and parliamentarians can easily interact with the relevant stakeholders. These circumstances provide a suitable platform for professional and expert participation in the field of legislation.

Law is an important tool for the realization of health policies and health legislations must be in accordance with “good legislative” procedures. Based on the legislative formalities in Iran, the Cabinet develops the bills and the parliament is the legislative body. The current study aimed to investigate the laws passed in the field of health from the perspective of legislative initiative. 

In this comparative study, ten terms of the Islamic Parliament of Iran are investigated. Laws and bills submitted in each term were identified and reviewed.

From the first to the tenth legislature a total of 60, 53, 46, 48, 46, 39, 40, 44, 39, and 37 health-related bills have been presented, of which 36, 31, 27, 31, 28, 22, 25, 29, 8, and 14 laws are passed, which most of them have been bills. In various legislatures, the ratio of bills to plans has been different. As we approach the present, the number of passed health-related laws decreases.

The higher number of bills, compared to plans, is in line with good legislative principles. Due to the existence of powerful associations, which based on the constitution can provide legal comment, the higher number of bills is not unexpected.

 This study aims to identify the challenges for public participation in health legislation in Iran.

This is an exploratory and qualitative study. The study data were collected by using semi-structured interviews. The participants were experts in the field of health law with at least ten years of work experience. They had both experience and enough knowledge about the country’s health system. All interviews were transcribed verbatim after recording and then analyzed using thematic analysis.

 We identified five main categories (themes) and 26 subcategories related to challenges. The main themes included legal barriers, infrastructure barriers, sociocultural barriers, people’s barriers, and legislators’ barriers. The legal barriers had three subcategories of parliament’s structure, legal requirements for participation, and facilitating laws. The infrastructure barriers had seven subcategories of the existence of mass media and communication networks, informing, ability to access to/meet the legislators, ability to categorize opinions, the possibility of electronic participation, financial resources, and structural facilities. The sociocultural barriers had three subcategories of people’s desire to participate, belief in teamwork, and social capital. Barriers related to people included eight subcategories of access to information, access to legislators, getting answers or feedback from legislators, feeling safe after participation, people’s awareness of their rights, education, ability to exchange views, and the existence of a highly-skilled expert team. Barriers related to legislators had nine subcategories of the desire to use others’ opinions, capacity to accept different opinions, party-related factors, regional factors, administrative health, education, opportunity, priorities, and motivational factors.

 Iranian citizens have several challenges to participate in health legislation. Regarding legal challenges, it is necessary to determine the participation right of citizens in the legal system. Besides, members of parliament should be educated to use the capacity of public participation. On the other hand, people should speak freely with the legislators and gain health knowledge as well.

Health legislation provides a framework to implement various health policies. Participatory democracy in healthcare is inevitable. Citizens and health professionals should participate in participatory democracy, and health laws should be the result of a process in which participatory instruments and techniques have a prominent role. Health democracy can be achieved through the expansion of mechanisms for citizens’ participation in the legislative process. The health democracy enables citizens to participate in the decision-making process and to have equal access to services provided by the public health system.

The current study aims to assess participatory mechanisms used by selected countries to participate their citizens in legislative processes.

The current study is a comparative study of the legislative processes of selected countries. To select countries, four issues were evaluated: (a) overall legal system; (b) how laws enforce; (c) legislative backgrounds; and (d) health system basic model.

The number of legislative chambers, legislative initiatives, legislative authorities and institutions, legislative commissions, and citizens’ participation in the legislative process were analyzed in the selected countries. An analysis of the factors affecting public participation in healthcare legislation shows that participation in the legislative process is a complex phenomenon influenced by social, legal, cultural, political, and sovereignty factors. This phenomenon cannot be analyzed isolated from these factors. However, the way should be paved for citizens' participation. The selected countries use different methods for citizens’ participation, depending on their legal systems.

Research results show that there are various public participation mechanisms. In Iran, there is a huge potential for public participation, and members of the parliament can easily interact with the interest groups and relevant individuals. These conditions provide a golden opportunity for expert health legislation.

Parliaments are the embodiment of democratic political systems. Each legislative assembly is a complex organization usually with several hundred members. The two main tools for organizing legislative assemblies are political parties and internal parliamentary committees. On the other hand, governments' involvement and interference in health is often achieved through legislation. Legislation in a complex, highly specialized, sensitive and challenging environment such as health requires a great deal of care and attention. Therefore, the role of committees in organizing health approvals is crucial.

This research is a comparative study. The research environment consists of legislative assemblies in ten selected countries that were selected and evaluated by 4 criteria of legal system, executive regime, efficiency and success in legislation and type of health system through targeted search. The level of duties and responsibilities of the commissions varied across the countries studied.

The legislatures of the studied countries use different models with different levels of authority to legislate in the health sector. There were various active legislative commissions in all 10 countries studied. In 6 countries )Japan, Turkey, South Africa, USA, Egypt and Iran) there was an Commission on Health Affairs and in 4 other countries such commission were not seen.

In the Iranian Parliament, the Independent Commission on Health Care is considered to have a wide range of functions and responsibilities and can easily interact with stakeholder's.Provides expert and specialized work in the field of health that should be considered.

Physicians do their job as the patients’ perfect agents as well as they can manipulate their patients’ demands for healthcare services. This line of reasoning drives from the Physician-Induced Demand (PID) which leads to create additional demands of these services for patients unnecessarily. Under the PID hypothesis, physicians (suppliers) influence patients’ demands to suit their own interests. The research relies on mixed methods research synthesis (MMRS) that integrates both qualitative and quantitative evidences as well as it is conducted through using thematic analysis method and decision making models. According to findings of the research, the most obvious factors affecting physicians’ behaviors in occurring induced demand for healthcare services include expectations of physicians to activate other medical sections, physicians' authority in patients' compliance, insufficient supervision over physician prescribing practices (irrational prescriptions), physicians' independency of insurance contracts and physician's tendency to provide inappropriate healthcare services for the patient in the public sector.
Results of the research reveals that the implementation of a well-functioning referral system to healthcare provision on Iranian (rural) family physician is determined as a major goal to impede physician-induced demand. In this regard, clinical guidelines for family physicians which are mandatory should be developed. Hence, it is suggested that a permanent legislation on “the establishment of a comprehensive system for health services” (electronic health record system) is approved.

Today, growing increase of costs is one of the challenges for health systems. The purpose of this study is to investigate the health costs trend in Iran and the policies adopted to manage them better.

This descriptive-analytic study was carried out in two steps: 1- General review of the Iran's health system costs trend based on National Health Accounts. 2-identification of Experts views on factors lead to increasing health costs in Iran and the strategies used to manage these costs better in last few decades, through simple and accessible sampling and semi-structured interviews. Data analysis was done through deductive / inductive hybrid framework, and a thematic framework was developed during the analysis. The NVivo software was used to manage and categorize data.

health costs in Iran has increased over the past years, and various strategies have been used to manage these costs that Extending primary health care, expanding insurance coverage, implementing a family physician program in small towns, villages and among nomads are the most important ones.

Despite the adoption of some strategies to control the health costs in Iran in different periods, growing increase in health costs is a concern. Therefore, health policy makers need to make and implement appropriate polices in order to manage these costs better, while improving access, quality of service and eventually welfare of patients.

The health insurance organizations in Iran are an important part of the health system. However, they are not conscious to many unnecessary costs incurred by providers and recipients, and the health system suffers from a lack of an efficient health insurance system. Therefore, it is essential to assess the performance of insurers and implement appropriate measures. This study aims to investigate the performance of Iranian health insurance organization and present solutions to the challenges.

This study employed an explanatory sequential mixed method. The quantitative part of the research is a descriptive cross-sectional study and the qualitative section is conducted through qualitative content analysis. Quantitative data were collected by a researcher-made tool and analyzed based on descriptive statistics. For the qualitative section, the focus group discussion method was used for collecting data.

Quantitative results show an increase in the population covered, especially in Self-employed fund, and increase in the number of contracting providers except physicians and dentists. The analysis of indicators related to utilization of health services indicates that the distribution of health facilities varies in different provinces which Sistan and Baluchestan Province has the lowest ranking. Also, financial indicators show that overhead costs and medical expenses of health insurance organization have been rising significantly since 2014. The analysis of qualitative data led to identification of three themes including: factors affecting budget deficit, suggested solutions for health insurance organization and suggested solutions for the health system. Based on the findings, the increasing of tariffs, population covered and benefit packages coverage are the most important factors in increasing costs, which strategic purchasing and revising of basic benefit package can play a significant role in meeting challenges.

In recent years, the population covered by the health insurance organization and the number of contracting providers have risen, and the utilization of health services has increased. On the other hand, the costs of this organization experiencing a significant increase for various reasons. Therefore, it is vital to design and implement appropriate strategies to manage the costs.

Many factors affect physicians’ dispersion across various locations in Iran. Identifying these factors can be effective in planning for a fair distribution of physicians throughout geographical areas.
This study aims to identify the key factors affecting newly graduated general practitioners’ (GPs’) choice of service delivery in Iran in regard to location.
This was a mixed-method, applied study using a descriptive survey. A questionnaire was designed based on key variables extracted from relevant literature and analyzed from interviews with experts in the field. We used expert opinions to assess the questionnaire’s validity, and Cronbach’s coefficient alpha was calculated (0.925) to confirm its reliability. The questionnaire was randomly distributed among 400 participants (GPs) applying for their mandatory service in Iran during four periods in 2015 (100 participants were surveyed in each period). The data was analyzed using the 8th edition of SPSS and AMOS, and both exploratory and confirmatory factor analysis methods were applied.
Forty key factors were identified loading on five main factors during EFA, which explained 77.90% of the total variance. We used the following designations for the five factors: 1) socioeconomic developmental status, 2) geographical conditions, 3) personal reasons, 4) district health services, and 5) demographics. In CFA, the third factor has the highest weight with 0.97, and the first factor has the lowest weight with 0.89. But the slight differences among factor load show the importance of all factors. The highest weighted factor relates to a number of health center variables, such as the type of roads in the district, social development and liberation, physician efficiency in the region, and distance from the provincial capital.
To resolve the unequal geographic distribution of physicians, it is necessary to consider the key factors affecting the attractiveness of a district for GPs and the existing demand for health services. Attempting to resolve the developmental inequalities among different districts, as well as implementing motivational policies to encourage physicians to work in less developed districts, is recommended.

Reforming the structure and improving care and service system, particularly at hospitals, are the main priorities of the health system. The board of trustees of the hospitals is the main proposed strategy in this field. Hospitals with board of trustees were created with the aim of improving accountability to the community and guaranteeing efficient management and attracting public support in running the hospital.. The aim of this study was to investigate the association between hospital effectiveness and the board of trustee’s management method.. This cross-sectional study was conducted in Tabriz City, Iran, during the years 2011 to 2013. To assess the effectiveness of board of trustees’ management, two hospitals in Tabriz City were compared. Hospitals selected through purposive typical case sampling method. Two hospitals had equal structure, same doctors, and both were gynecology hospitals of Tabriz City, but one of them was a gynecology hospital managed by the board of trustees and the other was managed by the chairman. The information about the five variables of hospital effectiveness was collected during the years 2011 to 2013 using standard lists and questionnaires, which were available in the hospitals; these variables included quality management, safety, medical equipment management, and patients and staff satisfaction. Then, each variable was weighted through the technique of hierarchical analysis and finally they were analyzed using SPSS 17 and Expert Choice 11.. Among the five variables related to the effectiveness, safety showed to have the highest weight and medical equipment management had the lowest weight. According to the statistical analyses, the score of the effectiveness of the hospital with the board of trustees was 33.08 (on the scale of 0 - 100) and the score of the hospital with the chairperson was 29.52. No significant association was found between the effectiveness of hospital and the board of trustees management (P = 0.81).. Because there was no significant difference in the effectiveness between hospitals with and without board of trustees, decision-makers must monitor how the commands are carried out to make board of trustees for hospitals and make sure its success in achieving its objectives..

Providing high quality and equal healthcare services is one of the most important objectives for any healthcare system. For achieving this goal the human resources is an important influencing factor. Because of individual, social and economic incentives many of physicians prefer dual paracticing and this lead to concerns between health policy makers and planners. Regarding to this, national policymakers and planners designed and approved an action entitled to:” Banning dualparacticing Action within frame of I.R.I 5th Development Plan Action. So this paper aimed to assessing this action by using the health and medical experts and consultants.

We applied a qualitative design throug a Questionnaire and Discussion Groups method with 15 participants which have met the required study crteria. We recognize Three Thematic including: the possible benefits or harms of implementing the action, the feasability of action and finally the probable challenges of implementing this action.

According to experts opinion implementing this Action have benefits for health systems but subject to generating some reforms and condition, which including: improving the managerial and structural infrastuctures, allocating adequate budget, revising of current healthcare services tarriffing and reimbursement mechanisms, pilot and stage to stage impelementing of Action, improving the quality of services by public hospitals, and confidence-building between physicians and planners are usefull for efficient and effective implementation of Action.

Today، one of the approaches that in various domains such as health care policy is adopted، is that decision makers in the process of making and implementation of policies، try as far as possible، to consider the preferences and desires of the target population. Therefore، efficient and effective policy design and delivery of health services requires adaptation of their goals to the preferences of the society، which needs knowledge of health policy makers about population’s preferences and their valuation of health programs. Discrete choice experiment (DCE) is one of the best ways to identify the preferences of the population and valuation of outcomes. Because of little knowledge about this approach in iran and limited application of DCE in internal studies especially in the field of health policy، in this paper we emphasis on the reasons of the importance of using a DCE in the health economics and their theorical foundations and applications. We believe that، one of the requirements and prerequisites to successful implementation of the family physician in iran، is the knowledge of policy makers about preferences and desires of participants in this program، i. e. GPs and citizens. Such knowledge، along with other necessary conditions، such as Financing and provision of necessary infrastructure، significantly increases the probability of successful implementation of the scheme.

Long term development plans are tools to draw future outlooks. This paper seeks to examine the health sector within the context of the laws adopted for the development plans after the victory of Islamic Revolution. In this study, a qualitative method was performed using the coordinated methods and analytical technique. In this method, five development plans, adopted in the Islamic Republic of Iran has been studied. All five development plans ratified and adopted after the victory of the Islamic Revolution on health sector were bold with existing related laws and rules. In the first and second development plans, laws on expansion of the health care network and population control exist. In the third development plan, the law deals with the handling over the responsibility of the health care service. In the fourth and fifth plans, the law insists on the reduction of payments out of the pockets of the patients while enhancing efficiency. A glance at the related-health care materials in five development plans show that the program was initially adopted to deal with the physical development of the health care centers in public sectors. At the beginning of third development plan, the facilities over of the health care services was taken into consideration while regarding the distributive equity. In the fourth and fifth plans the concepts, such as health care equity or justice were introduced and the outlook from physical development was shifted to justice and financial equity in health care service.

The article aims to present the experiences of the countries having a proper status in the ranking of the World Health Organization or their tariffs models have been frequently used in Iran. Delphi method and opinions of experts have been used for presenting a proper model and solutions. Data collection about Iran and other countries is based on library recourses until the end of 2011. Methods for determination of medical tariffs in these countries are affected by the financing system of the health sector. In countries with an integrative approach، the priority is given to the method of purchasing services، the professional associations are responsible for determination of medical tariffs، and the government has a regulatory role and final announcement of the tariffs. In countries with Beverage model، the focus is on the public sector and the tariffs are determined by receiving opinions of professional associations. In Bismarck model، the focus is on the sickness funds، which mostly purchase services. Regarding the current situation of Iran and based on the research findings، the structure، organization and management of medical tariffs require revising. In determination of medical tariffs، participation of all relevant groups and centrality of relative value units are suggested. Due to the geographical area of Iran and the significant difference in the consumer price index، especially in medical products، the regional approach should be the second priority. The research findings could be used for the structure of policymaking in the Supreme Council of Health Insurance.

Beggary is a commom phenomenon in many urban areas that has unpleasant social implications. This study attempted to demonstrate an image of beggary and its forms in Iran and to explain it. This study relied on secondary analysis of data collected on beggars in 2007–2010 in Iran. Moreover، meta-analysis of some of the most important studies conducted in Iran during the years 1991–2008 was also done. According to the results most of the beggars (approximately 68%) are male. The proportion of beggars younger than 20 years has increased in recent years. However، most of them are 40 and above. Furthermore، the proportion of illiterate groups has greatly decreased and has fallen from 80. 7% in 1991 to 28. 1% in 2007. Single beggars have also increased in number، although the majority of beggars are still married. The percentage of disabled beggars has also decreased، though many of them use disability as a means of gaining sympathy. In general، beggary is still a male phenomenon in Iran، the main causes of which are poverty and unemployment. Thus creating job opportunities for men is very important، given that usually beggars are married، not single. The rise in numbers of un-maimed beggars is another indication that poverty & unemployment encourage beggary. Nevertheless، it should be noted that some beggars see begging as a lucrative profession، and therefore are not willing to abandon it easily and even feign disability to increase their income.

This research was planned to evaluated depression in nursing students at Azad University of Yasouj. This study is a descriptive and an instrument used was Beck Inventory scale for depression. All undergraduate nursing students at Azad university of Yasouj (200 people) were tested with Persian language version of Beck Depression Inventory (BDI). for analysis of information we used SPSS & Excel. The main statistical method for data analysis was independent T test. Data analysis showed 60٪ of men are normal and 40٪ showed degree depression. Our study showed mild depression in 29. 33٪, moderate depression in 8٪, and severe depression in 2. 67 ٪ of this group. In woman group we found 45. 5٪ are normal and 55. 5٪ are depressed. We found mild depression in 44٪, moderate depression in 7. 2٪, and severe depression in 3. 2 ٪ of this group. On the whole we found that 51٪ of subjects were normal and 49٪ were depressed. In depressed group our study showed mild depression in 38. 5٪, moderate depression in 7. 5٪, and severe depression in 3٪ of studentsUsing a factor analysis test (T test), it was revealed that two factors (sex and depression). The results of analysis showed significant difference between males and females. T test for depression was showed significantly different between female (19. 2) and male (14. 88) subjects. This research shows that is a high proportion of nursing students have depression. We have suggested some recommendations in order to prevent and control the sources of the depression.

This study was performed to recognize the structure, covering criteria and basic duties of the ministry of welfare and social security in Iran and some selected countries and to choose an appropriate structure for Iran. This study is a comparative- explorative study and performed to draw a model for Iran health and welfare system according to health, medicare, welfare and social security system in the selective country on the basis of structural concentration. The results of this study showed some differences and some similarities in the structure of welfare and social security in target communities. Similarities: in most countries the basics of duties for reaching goals were the same. The structure was simple, brief and the planning was centralized and the performance was non-centralized. The whole structure of ministry of welfare and social security management was non-centralized. Differences: there were two different methods for analysis of welfare and social security; coverage method and occupational method. In most countries there was a strong bond between the health and treatment, and welfare and social security organizations. Changing the structure of the Ministry of Health, and Ministry of Welfare and Social Security; and combining these two Ministries into the Ministry of Health and Social Security can lead to more coordination in strategic planning; reduction in tasks overlap, redoing, treatment costs and social damages; and appropriate allocation of resources and increasing social welfare.

One of the major problems that higher education has been recently faced is that female graduates have been recently increased than male graduates which it makes worry. The problem made authorities of higher education think of a remedy to remove the problem that following it, gender ratio has been proposed as a solution. There are pros and cons about the proposal.There fore first, the paper outlines it analytically and according to the main findings and second, it discusses whether the proposal should be carried out necessarily or not.

Like other public sector services, health services have serious problems including technical inefficiency. Among other problems this sector has, one can mention undesired use of allocated resources.Inefficiency is also considered as another problem. Many governments have tried to more or less decentralize health sector in order to solve these problems. These reforms in organization of health services paved the way for substantial changes in approaches to the proper role to be played by governments in health issue. But decentralization and privatization in health sector has been beginner of debates between supporters and opponents of this issue. Today there are valuable experiences in this regard from which we can use. In Iran, decentralization in health sector has been noticed in the third and fourth development plans whose experiences can be reconsidered. It is obvious that there are multiple combinations of private and public between two extreme cases of private and public organizations, which can be a proper formula for supplying health and care services in Iran. Apart from this fact that how policies of Article 44 cover the health sector, this paper tries to review privatization of health services in the world, studying the existing opportunities and threats in this sector through emphasizing on Iranian context.

Among major problems in Iranian health system in both before and after victory of the Islamic Revolution are shortage of physician, unjust distribution of physicians in the country, and theconcentration of physicians on the major cities and affluent areas. In order to solve such problems, the law of compulsory service of Physicians and Paramedics in the deprived urban and rural areas was passed with the intention of securing health and justice as well as of reducing deprivation, being exposed frequently to many changes in the recent years. The existing roblems in the health system changed after the Iran-Iraq war and those transformations made in the medical education system. In the 1980s a major problem in Iran was the shortage of physician, while today the problem is unemployed physicians in particular and surplus forces in medical sector in general. Considering the present situation, it seems that appraisal of different initiations and decision to continue them should be made with regard to the present conditions and opportunities. This paper briefly reviews the existing regulations in this regard, their impacts, and the current situation.

The meeting of needs in the society is the main task of organizations established for offering services. It is expected that these organizations have so dynamic and flexible structure that they are capable of changing while receiving changeable messages from the milieu. In doing so, these organizations must be permanently assessed, being able to predict those opportunities, visions, and challenges faced by them. There is no doubt that recognizing problems and challenges is the first step for doing reform in the organizations. This paper tries to review challenges and problems faced by Iranian health system. In doing so, ten items in the health system are selected to briefly study.

Today, election campaigns have been turned into a complicated science. In this concern, the concepts of propaganda campaigns should be identified.One of these important concepts is the issue of health and care. Nowadays the health is known as the precondition for development and the statemen believe that the healthy one plays a main role in achieving the stable development.Although there is no consideration for the issue of health in election campaigns propaganda of candidates in Iran, this contribution examines this issues.