alireza olyaeemanesh

The increasing growth of treatment costs indicates the necessity of insurance coverage of the population. The continuance of this coverage requires sufficient financial resources. One of these financial sources is the insurance premium. Failure to pay it timely causes problems for the insurer and the insured. This study seeks to identify the causes of non-payment of insurance premiums by the health insurance organization and provide solutions to solve them.

This qualitative study was conducted through semi-structured interviews and focused discussion sessions. The snowball method was used to identify the interviewees. The interviews continued until data saturation was reached. To analyze the data, the conventional content analysis approach was used based on the method suggested by Granheim and Lundman.

Based on the findings of the study, the causes of non-payment of insurance premiums include non-payment/late payment of insurance premiums by the government, non-payment/late payment of insurance premiums by the executive body, unscientific budgeting, budget deficit, non-compliance with the law, and allocation It is a quarterly budget. By using a set of legal and non-legal solutions, it is possible to facilitate the timely collection of insurance premiums.

Although the government is the main provider of the organization's insurance premium, the organization as a key institution should seek to find solutions to solve its financial problems. Active management of the organization's expenses, taking advantage of new methods of income generation, and attracting the support of charity organizations are suitable solutions to solve the relative financial problems of the organization.

Healthcare program monitoring can play a key role in evaluating their implementation and identifying their strengths and weaknesses.

This study was performed with the exploratory sequential mixed methods design in 2023 at Tehran, Iran. The information was categorized into indicators, refining, analysis, interpretation, reporting, and proposed challenges and recommendations.

Medical Sciences Department of Public Health (TUMSDoPH) evaluation of its public health programs revealed a comprehensive approach covering a wide spectrum from disease management to health promotion, emphasizing electronic health records, targeted disease interventions, and strategies for non-communicable diseases, alongside efforts to enhance community health.

There is a need for initiating “the monitoring committee” under the supervision of the deputy chancellor for public health to monitor key performance indicators and policies to discover the problems of each part of the health system and provide recommendations.

The economic sanctions imposed on Iran in recent decades have impacted the country's healthcare system and the health of its people. However, there has not been a thorough examination of the full scope and changes in these effects over time. Therefore, we designed a mixed-methods study, comprising a parallel quantitative analysis and qualitative study. The quantitative part assesses the effects of sanctions on public health and the healthcare system using 28 indicators, i.e., macroeconomic, healthcare resources, and health outcomes indicators at both national and sub-national levels from 2000 to 2020. The analyses will include descriptive analysis, change point regression analysis, and mediation analysis, performed using R software. The concurrent qualitative study aims to explore the pathways of the sanction effects by considering the perceptions of both patients and health policymakers. The perceptions and experiences of patients regarding living with and dealing with the long- and short-term health implications of sanctions, and the experiences of health policymakers regarding the effects of sanctions on the healthcare system will be analyzed. This study will provide comprehensive and evidence-informed recommendations for global health policymakers to support countries under economic sanctions to protect and promote the human right to health and well-being.

Context: 

Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran.

Evidence Acquisition: 

This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022.

The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers.

The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

The COVID-19 pandemic has impacted medical education worldwide with several opportunities and challenges. This study aims to provide an overview of medical education's opportunities and challenges according to the experience of the COVID-19 pandemic in order to guide future endeavors in conducting the teaching-learning process in post-COVID era support.

In this systematized review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, databases of PubMed, Cochrane, Scopus, Web of Science, and Eric, in addition to Google Scholar as a search engine, were searched to retrieve relevant original peer-reviewed, review, editorial, and commentary articles published from Dec 2019 to the end of Sep 2022.

As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). On the other hand, post-COVID medical education opportunities have been grouped into four main categories, which are teaching and learning processes, psychological impact, accessibility and education equity, and management and administrative affairs. Post-COVID medical education opportunities also consist of four main categories: teaching-learning process, psychological impact, accessibility and education equity, and management and administrative affairs. 

Changes in teaching and learning processes in medical education caused by the COVID-19 pandemic created opportunities and caused important challenges that should be considered in the post-COVID era. In this regard, blended learning with the integration of technology using a flexible approach could be an effective recommendation.

Context: 

Spinal muscular atrophy (SMA) is a rare genetic disorder that significantly impacts the quality of life. This paper aims to gather current understanding of the safety, efficacy, and economic aspects of common SMA treatments to assist Iranian policymakers in adopting these novel treatments for this vulnerable population.

This rapid health technology assessment (HTA) research was conducted in four steps: Database review, screening, data extraction, and thematic analysis. Inclusion criteria consisted of studies focused on assessing the safety, efficacy, and economic aspects of medical interventions in SMA patients compared to those who did not receive such interventions.

Based on current data, nusinersen was found to be the most effective treatment (increasing mobility achievements in SMA types 1 and 2) with the least side effects for SMA types 1 and 2. In terms of economic evaluations, none of the treatments were found to be cost-effective.

The decision regarding reimbursement for such medical drugs should not focus solely on their cost-effectiveness but rather on creating access to essential care, meeting patient needs, and considering national budget limitations. Managed entry agreements (MEAs) are flexible tools that service providers or payers can use to negotiate and reduce the financial burden for both patients and payers.

Poor oral and dental health significantly affects public health, impacting over half the world’s population. Dental caries can undermine children’s academic success and career prospects. Social inequities result in unequal access to oral healthcare, particularly among populations with lower socioeconomic status (SES). National policies that improve access to oral health can reduce these disparities.

This study aims to compile policies implemented by various countries to achieve universal health coverage (UHC) for pediatric dental services.

This scoping review was conducted according to Arksey and O’Malley’s framework and is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. A systematic search was conducted on databases including Scopus, PubMed, Magiran, SID, Irandoc, Google Scholar, the WHO website, and the databases of Iran’s Ministry of Health. The search aimed to identify literature discussing governmental steps taken to achieve UHC for pediatric dental health, published between January 1, 2011, and December 31, 2022. The results were charted and presented in a table.

This review included 22 studies. Six themes were identified based on the roles played by key players in this field, including schools, government policy and support, community-oriented preventive plans, insurance support, parents’ awareness, and inequality in accessing dental services.

A comprehensive policy that reduces barriers to access, increases utilization, and engages all stakeholders—including parents, schools, and community centers—can effectively achieve UHC for pediatric dental health.

Health inequalities in different populations continue to be the main challenge of health systems; Therefore, it is necessary to address health equity in the developed policies. The study aims to review the studies related to tools and models for assessing the impact of policies on equity in health. This study was conducted as a systematic review to identify the tools and models of assessing the impact of policies on equity in health and the process of assessing health outcomes from 2005 to 09/30/2022 in English and Farsi. National and international databases such as Scopus, PubMed/Medline, and Google Scholar were searched. First, 16901 studies were obtained. After the initial screening, 243 articles entered the abstract review phase. Then, 99 studies entered the phase of studying the text. Finally, 53 studies entered the final phase of analysis. Screening steps, identification of decision-making assessment scope, evaluation, and follow-up were the four dominant steps in most of the developed tools. The study showed that to choose the appropriate tool to assess the impact of policies on equity in health, it is necessary to pay attention to various factors such as assessment time, policy level, available resources, and the population affected by the desired policy.

The performance evaluation of the Iranian Health Insurance Organization (IHIO), considering the responsibilities, objectives, and duties outlined in the higher-level documents and laws, is an important issue that has received less attention. Given the importance of systematic monitoring and evaluation to facilitate planning based on overarching domestic policies, it is necessary to adopt a suitable approach to monitor programs and policies and to respond to higher-level authorities to fulfill assigned tasks. The present study aims to identify performance indicators for IHIO based on the analysis of relevant higher-level documents and laws.

This study was conducted qualitatively and based on content analysis of documents, policies, and executive activities related to monitoring the performance of IHIO, from the year the Universal Health Insurance Law of the country was passed (1373) until 1402, in the year 1402 (Solar Hijri calendar, equivalent to 2023/2024 Gregorian calendar). The Scott method was used to examine the validity of the documents, and qualitative content analysis and the deductive approach were employed to analyze the data.

Nine policies related to monitoring the performance of the IHIO were identified, with 11 themes and total of 188-indicators identified as follows: Population indicators (8 indicators), National Health Accounts (NHA) (13-indicators), Covered population (25-indicators), Covered health services (19-indicators), Covered costs/financial participation status (11-indicators), Organization’s financial resources (26-indicators), Contracted centers (11-indicators), Cost trends, cost burden, and visit burden (23-indicators), Monitoring indicators (11-indicators), Operational efficiency of the organization (30-indicators), Access to services and health outcomes (11-indicators).

In order to conduct a thorough and comprehensive evaluation of the Iranian Health Insurance Organization's performance, which aims to enhance transparency and public trust in the organization, it is imperative to take into account a diverse range of indicators that encompass all operational and performance aspects of a health insurance entity. Additionally, national macro indicators, including population metrics and national health accounts, play a crucial role in this process. Failing to consider these indicators may lead to challenges and biases when assessing the organization's performance.

In the context of Persian traditional medicine, there are several therapeutic strategies for managing diseases, ranging from lifestyle changes to herbal remedies.

Given the application of Persian traditional medicine in the management of chronic diseases, the burden of chronic illnesses, and the public’s recourse to traditional medicine specialists, this study aimed to assess the cost-effectiveness of traditional medicine dietary regimens for the treatment of non-alcoholic fatty liver disease from the perspective of the payer.

In this study, we investigated the cost-effectiveness of providing nutrition counseling for lifestyle modification (changes in the aforementioned Setteh-e-Zarurieah) by a traditional medicine specialist compared to receiving counseling from a nutritionist for nonalcoholic fatty liver disease from the payer’s perspective. The outcomes measured were changes in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes, body mass index (BMI), and the grade of fatty liver. Cost and effectiveness data were entered into Excel software, and the ICER ratio was calculated.

The results indicated that the dietary regimen prescribed by Persian traditional medicine when compared to the nutritionist’s recommended diet, resulted in a lower decrease in AST and ALT enzymes but led to a greater decrease in BMI (mean change = 0.42) and a significant change in the grade of fatty liver (OR = 9.75). Since the costs of tests, ultrasounds, and visits were equal in both groups, the cost difference was zero. In the first scenario, where traditional medicine is considered an alternative therapy and liver enzymes are the
primary focus, providing nutritional counseling services by Persian traditional medicine may not be cost effective. However, if we consider the grade of fatty liver and BMI as the primary variables, providing nutritional counseling services by Persian traditional medicine may be cost-effective.

Based on the available evidence, the treatment of fatty liver using Persian traditional medicine can be considered an effective and cost-effective complementary (or alternative) intervention. Considering the long-term costs imposed by the health system and insurance organizations, it is predicted that adding visits to Persian traditional medicine specialists may reduce overall healthcare system costs.

The estimation of the unit cost and per capita of family physician services is one of the influential factors in the decision-making process of healthcare system managers to determine appropriate tariffs for these services. This study aims to calculate the unit cost and per capita of family physician service packages in the Fars and Mazandaran provinces in 2023.

This applied research was conducted with a cross-sectional and retrospective approach in 2023. The study population consisted of family physicians working in the Fars and Mazandaran provinces. Sampling was carried out using a stratified and purposive method. The required data were obtained from two different sources, including interviews with family physicians and data from the Iranian Society of General Practitioners, the Statistical Center of Iran, and the Central Bank of Iran. The data were analyzed using Excel software.

The total annual cost of a family physician’s clinic was 10.05 billion rials. Out of this total cost, 47.7% was allocated to the technical component and 52.3% to the professional component. Considering the number of minutes of clinic activity in a year, the unit cost per minute was calculated to be 73,500 Rials. Taking into account the average population covered by the examined physicians, if all attending patients are considered to be within their coverage, the per capita cost would be 322,400 Rials. However, if it is assumed that 85% of the attending patients are covered by the physician, the per capita cost would be approximately 274,000 Rials.

Comparing the per capita obtained for family physician services with the approved per capita by the Council of Ministers has shown a significant difference. This difference indicates that the approved per capita is much lower than the unit cost of per capita. Therefore, it appears necessary to revise and reconsider the per capita for family physician service package.

A significant share of medical care, primary health care, and health-related education and research in Iran is provided by the Ministry of Health and its affiliated universities of medical sciences. We aimed to identify a set of key metrics for monitoring their efficiency in the four areas of medical care, primary health care, education and research.

A combination of scoping review, expert panel and Delphi method was used. First, the relevant keywords were searched in the appropriate databases between 2000 and 2020. The final extracted indicators then reviewed, reduced and refined through the expert panel meetings. The last metrics were established following a three-stage Delphi study.

Out of 2327 studies, 155 were selected following the different screening stages of scoping review. After summarizing and refining the indicators via several expert panel meetings and the Delphi method, a total of 36 key indicators were considered appropriate for measuring efficiency of the health system, 23 of which were for the sub-systems of public health (4 indicators), medical services (10 indicators), education (4 indicators) and research (5 indicators) and 13 indicators for the whole system efficiency.

The set of indicators presented representing both the technical and allocative efficiency, might be a reliable basis for designing information systems and management dashboards for periodic monitoring of health system efficiency at national, regional and local levels.

We aimed to investigate the existence of unnecessary demand for angiography and the factors affecting it to provide evidence for decision makers.

This longitudinal panel study was conducted in public hospitals in Tehran, Iran by using 2458 patients' records that were undergoing angiography for suspected coronary artery disease 2013-2015. To modeling the physicians' behavior based on physician-induced demand (PID), the patients were classified as appropriate, uncertain, and inappropriate and then Hierarchical Linear Modeling (HLM) model besides the physician ethic index was developed and finally the existence of PID showed based on three scenarios.

Angiographies were performed inappropriately in 23.8% of 2458 patients as well 46.7% were uncertain, and 29.5% were appropriate. According to the HLM model, the physician-to-population ratio (δ0= - 0.161) and the interaction variable coefficient are higher than zero and significant (δ1 = 253). The results of the physician ethic index showed that most physicians were at a moderate rate, meaning that their utility was a combination of both pecuniary and non-pecuniary profits (0< │εpδ │<1). Considering the HLM model and the medical ethics index together has almost shown the condition of PID (the necessary condition δ1> 0 and the sufficient condition (1 ≤│εpδ│)) existed for about 26% of all studied physicians who had pure profit maximizer.

To reduce induced demand and improve medical ethics adherence in cardiologist, policy makers should develop native guidelines, rules, and instructions besides policies related to education, and increasing patients' awareness.

There are substantial differences in the health outcomes across countries. Then, assessment of the status of health indicators can give us a valuable information to adjust policies to improve the health status in the world. This paper examines differences and relationships of health status and contextual factors.

This is a multi-country cross-sectional study performed using secondary data of different sources in 2019. We identified indicators that revealed the relationships of health status and health coverage and also contextual factors by expert panel which consist of two categories of indicators: (1) producing health indicators as dependent variables (Life expectancy, Healthy life expectancy, Maternal mortality ratio, Under-five mortality rate and Universal Health Coverage (UHC) service coverage indicator); (2) contextual indicators as independent variables (Current Health Expenditure, Skilled health professionals density, Population density and Government Type). Also, countries were categorized based on the income level and six regions of World Health Organization (WHO). We used SPSS 20 software for a descriptive analysis and R 2018 software for statistical analysis and also drawing of scatter charts.

Results showed a considerable gap between the average of life expectancy (84.2 vs. 53 years) and healthy life expectancy rate (72-63.3 years). This disparity was observed in the Maternal mortality and Under-5 mortality rate (from 882 to 3 per 100000 live births), (5 is 2.1 and the highest is 127.3). Although there was a marginal correlation between population density indicator and life expectancy, healthy life expectancy, and under-5 mortality rate indicators (±0.2), there was no correlation between population density and maternal mortality rate with UHC (P>0.05).

There is a considerable difference between countries in producing health indicators based on contextual indicators; a comprehensive health system approach that can result in improvement in the health outcome.

In May 2014, the Iranian government announced it would cover all uninsured Iranians. Despite free-of-charge insurance, the studies found that the coverage still needed to be completed (93%). This study aimed to understand why certain population groups remain without insurance despite the accessibility of free-of-charge coverage. This issue is not unique to Iran; it is prevalent in many other countries where, despite free coverage, not all individuals avail themselves of it, thereby exposing themselves to risks.

In a matched case-control study, 89 non-insured patients were compared with 178 hospital-based controls with health insurance (2:1). The samples were recruited at one of the leading public hospitals in the country (Imam Khomeini Hospital Complex in Tehran) in 2019. Two insured controls were selected and matched for age (± five years) and sex for each person without insurance. A conditional logistic regression was performed to assess the magnitude of effects and the goodness of fit test used to examine the model.

Unemployment (Odds Ratio (OR)=8.33, 95% Confidence interval (CI): 1.05-50.0), being single (OR=3.69, CI: 1.18-11.55), low economic status (OR=1.85, CI: 1.02-3.33) and attitude towards performance of health insurance (OR=0.86, CI: 0.75-0.99) were affected not having health insurance.

Approaches that cover the entire population may struggle to ensure no one is left without needed services. There is a need for greater focus on vulnerable groups to achieve universal health coverage conscientiously. Moreover, improved services and education can positively shape public perceptions of insurance efficacy, affecting their enrollment choices.Health sector reform

Sustainable development goals' (SDGs) analysis can be caused a better understanding of factors contributing to access to health services and help shape policies to attain health goals. This review aimed to measure and compare the SDGs between Iran and selected categories.

This study was a comparative cross-sectional study. We identified indicators of health status based on the SDGs report 2019. The status of SDGs indicators was compared in Iran to four categories, including selected countries with similar social, economic, and health status, six regions of the WHO, the average of each income level group. SPSS 20 and Excel 2019 software were used for descriptive data analysis.

The average life expectancy and healthy life expectancy were 75.7 years and 65.4 respectively in Iran. Iran's mortality rate in indicators named road traffic (32.1 per 100000 population), suicide (4.1 per 100000 population), and unintentional poisoning (1.2 per 100000 population) were higher than most of the categories. Iran's status in morbidity indicators had an approximately lower rate than all categories. Iran had full coverage in three immunization indicators like DTP3 immunization, MCV2 immunization, and PCV3 immunization, which was higher than all categories. Coverage of UHC in Iran (65%) was near to the global average (64%) and higher than the eastern Mediterranean Region (53%). Moreover, the prevalence of tobacco smoking (10.95%) and alcohol consumption (1%) were lower than global (6.4%) and the WHO regions (1.8%) average.

Health status measurement is a trend that requires the collection, processing, analysis, and dissemination of data by a set of indicators. There are several weaknesses in reported data in the SDGs for some indicators, the data collection process should be noticed seriously by policymakers.

In pursuing improving healthcare quality and enhancing efficiency, public hospitals in Iran have undergone numerous reforms over the past two decades. This study aimed to assess the efficiency of all public hospitals in Iran from 2012 to 2016. This study was conducted as a quantitative and descriptive-analytical research project. The authors employed an innovative approach called Extended Data Envelopment Analysis (Extended-DEA), a modification of conventional DEA, to assess the technical efficiency and productivity of 568 public hospitals. They obtained nationally representative data from official annual health reports. The data were analyzed using GAMS software version 24.3. The study found that the average efficiency score for all hospitals was 0.733. Among all the hospitals, 10.1% were deemed efficient, while 2.68% had low-efficiency scores below 0.2. The Malmquist Productivity Index (MPI) showed improvement in 49.3% of hospitals and remained unchanged at 2.3%. In comparison, 48.2% of hospitals experienced a regression in productivity from 2015 to 2016. On average, the MPI was 1.07 throughout the analysis. The findings of this study suggest that there is a need for increased efforts to improve the efficient utilization of resources in public hospitals. It highlights the importance of developing appropriate policy solutions and tools to address these efficiency challenges. In particular, one proposed strategy is the merger of small-sized district hospitals to establish larger and more efficient hospitals in different geographical regions across the country.

Despite numerous laws and regulations related to access to information and transparency, there are many problems in their implementation. The purpose of this study was to investigate and analyze the challenges facing laws and documents related to transparency in the health system of Iran.

Documents, laws and regulations related to issues of access to information, transparency, and disclosure of information from various fields were collected and analyzed using the READ approach. After systematic naming of documents and laws, their information was entered in a table, after which different parts of each document were carefully analyzed and compared.

There are numerous documents, laws and regulations on the issue of access to information and transparency, but the lack of enforcement for these laws and regulations has caused inefficiency. Some of these documents, laws and guidelines are in conflict with each other and some have shortcomings. Often, there is a long time gap between the drafting of the bill, the approval of the law and enforcement of executive instructions. Sometimes, unawarness of the method of identifying and separating privacy information and personal information causes problems in implementation.

Attention to enforcement while developing transparency and access to information is a fundamental necessity, in order to prevent introduction of a multitude of ineffective laws. Drafting of laws and regulations in terms of form and content should be in such a way that the possibility of misunderstanding and violation of them is minimized. Approval of bills and executive regulations must be achieved at the appointed time, so that the laws are implemented at the right time and have the required effectiveness

Given recent demographic changes, Iran has revised its reproductive health (RH) programs. To respond to the need for monitoring the new programs and policies, this study aimed to identify appropriate indicators for RH and population programs monitoring in the Iranian context.

A mixed-methods approach was applied which was conducted in four phases: identification of goals of RH policies and programs, a scoping review of the RH indicators, developing and ranking the identified indicators, and indicators' finalization. The final indicators were selected through consensus, with a cut-off point of 75%. Data was collected from June 21, 2020, until February 18, 2021. Data analysis was conducted simultaneously during each stage of the study. MAXQDA.11 and MS Excel 2017 software were used in the first and third phases for data analysis.  

A total of 37 RH indicators were finalized after three rounds of screening. The first five indicators with the highest score were: total fertility rate, population under 15 years, total population, population aged 65 years and older, and age-specific fertility rate. The lowest score was related to the recuperation index (degree of recuperation relative to fertility decline at younger ages).

The nature and number of indicators might vary at different organizational levels; so, the need to develop specific indicators is pivotal.

Equitable distribution of health care sector resources is one of the most important goals of health systems in all countries. The purpose of this study is to measure equity of geographical distribution of active specialist physicians in Iran’s health system.

The present study was a descriptive‑cross‑sectional. The statistical population included: all active specialist physicians working in the public, private, social insurance organization, military, charity, and the other health service providers in Iran in 2019. Studied demographic data were collected from Iran’s national statistic center. Also, information of specialist physicians was obtained from several databases. Finally, duplicated records were removed, and the number of specialist physicians extracted. Data analysis was performed using Stata V.16 and ArcGIS 10.4 software.

The results showed that the number of specialist physicians per 100,000 population who worked in Iran’s health system was 46.81. The provinces of Tehran had the highest and Sistan and Baluchestan had the lowest number of specialist physicians. Also, 52.63% of active specialist physicians provide health services in four provinces, whereas these provinces are 37.13% of the country’s population. Total Gini coefficient of the distribution of active physicians in Iran in 2019 was 0.23.

Distribution of specialist physician was different but somewhat equitable in the provinces. However, in some provinces, the ratio of specialist physicians to the population was still low. Therefore, when the number of specialist physicians increased, their distribution should be considered concurrently.

 Trauma-related deaths increase yearly. The distribution of trauma cases is increasing in middle- and low-income countries, and therefore, a national trauma registry system is needed. This study aimed to prioritize the research domains using the data recorded in the National Trauma Registry of Iran (NTRI). This study used three stages of qualitative and quantitative research methods. First, a detailed literature review was conducted to identify the research domains. Then, appropriate criteria for the priority setting of the study were determined. Finally, scientists and experts of the NTRI ranked the research areas. The data provided by NTRI experts were analyzed based on five scenarios.  By literature search, 14 main domains using trauma registry data were identified, and six criteria were included in the final modeling phase to prioritize the mentioned domains. According to the NTRI expert opinion, the priority of criteria from highest to lowest was: “effectiveness of interventions performed on patients,” “improving the quality of medical services,” “prevention of trauma,” “Improving economic indicators of the health sector,” “feasibility,” and “importance in science and knowledge production” respectively. Finally, using the multi-criteria decision-making (MCDM) model, “investigating trauma incidence in children and adolescents” and “investigating the relationship between trauma registry data and hospital care protocols” had the highest and lowest average scores, respectively.  The results of this study show that, based on the data recorded in NTRI and according to experts’ views, “trauma incidence in children and adolescents, and distribution of trauma based on demographic information” were the most critical areas of research. A complete trauma registry system with an assessment of mentioned domains should be a priority for policymakers.

In recent decades, research has shown that social determinants of health (SDH) affect population health more than medical care. Therefore, identifying the SDH has become a top priority. 

It is an explanatory-sequential mixed-method study. We used the meta-synthesis method in the first step to identify and prioritize social determinants of population health in Iran. Then, the identified factors were shown in a semantic map. Afterward, we used fuzzy Delphi to screen and determine each factor’s importance in Iran. 

A total of 172 factors were identified and classified into 4 levels: individual, local, national, and global. After screening items, parental competence, hope, addiction, types of pollution, inflation, and unemployment rate (the crisp value of defuzzification 9-10) are generally the most important determinants of population health at the individual and national levels in Iran. 

The resulting semantic map of SDH demonstrates the substantial effect of non-health policies on the health of Iran’s population. This finding proposes health as a complex and comprehensive system needing an interdisciplinary approach to address its multiple determinants. Specifically, the comparative analysis of this research shows that among the determinants of health in Iran, parental competence, individual behaviors such as addiction, and spiritual and mental health, including depression, suicide, and stress, are the most important SDH in Iran.

One of the most fundamental issues in recent years has been maintaining and promoting the society health, as making coordination in the policies of all sectors with the aim of health improvement has always been highly emphasized. The study aims to identify the socio-economic factors affecting health and to provide a cognitive map of the social determinants of health in Iran.

A retrospective cohort study

This study follows a developmental process with an exploratory sequential mixed methods approach. First, a meta-synthesis qualitative method determines the most critical health determinants by reviewing 54 studies within the period 2000-2019. Then, the fuzzy analysis draws the Fuzzy Cognitive Map (FCM) representing the causal relationships among the social determinants of population health in Iran.

The first stage introduces 170 factors as the health determinants, classified into 4 levels: individual, local, national, and global levels with 7, 4, 13, and 3 branches, respectively. According to the causal relationships and the outdegree, the most effective factors are the economic system (18.24), governance and policy-making (17.13), and national policies (16.93). According to the degree of centrality, these factors are the economic system (33.27), health system (30.37), and governance and policy making (30.15).

Analyzing the causal relationships and FCM of public health determinants help the policy-makers to understand the priorities and the link among the sectors in develop and implement the health-oriented policies in all the sectors.

Health promotion is a crucial task for policymakers. Therefore, this study aims to identify the key factors that determine population health in Iran and illustrate the causal relationships between these factors.

The research was conducted using a mixed-method approach in three stages. First, macro social determinants of health were identified by analyzing available resources from 2000 to 2019. Screening of factors was carried out through the fuzzy Delphi method and a survey involving 15 experts. Finally, the causal relationships between the social determinants of health were depicted using a fuzzy cognitive map.

Initially, 96 health determinants were identified at the national and global levels. After the screening, 8 factors that had less significance in population health were excluded. In terms of causal relationships, the economic system emerged as the most important and influential factor, with a centrality degree of 21.06 and an out-degree of 10.91. Following that, governance and policy-making, as well as national policies, were ranked with centrality degrees of 20.25 and 20.19, respectively.

Irrespective of the causal relationships, the health system holds the utmost importance in population health. However, when considering the causal relationships, the economic system takes precedence as the most critical factor, while the health system does not rank among the top three factors. Therefore, the analysis of fuzzy cognitive maps assists policymakers in understanding priorities and the interconnectedness between sectors in developing and implementing health-oriented policies across all sectors, enabling the adoption of the most effective policies.

Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.

This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.

The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.

Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.