reza rezayatmand

Countries possessing robust primary healthcare (PHC) systems typically yield superior health outcomes, reduced inequality, and diminished healthcare expenses for their citizens. Moreover, PHC demonstrates a direct correlation with the efficient utilization of resources. However, the allocation of financial resources dedicated to PHC varies significantly among countries and lacks explicit clarity. Therefore, this paper aims to conduct a review of published literature to ascertain the extent of resource allocation to PHC across diverse nations. In addition, it aims to explore associated factors, challenges, and mechanisms influencing this allocation.

This scoping review protocol will adopt the Joanna Briggs Institute’s scoping review methodology, which was updated in 2020. It will leverage library studies and refer to reputable databases. The inclusion criteria will include studies conducted between January 2000 and December 2023, focusing on criteria, amounts, mechanisms, and challenges associated with financial resource allocation to PHC globally. In addition, studies must be published in either English and Persian. Studies lacking full‑text availability will be excluded from the review. Mendeley software will be utilized to organize and manage the collected studies. The study selection process will be visually depicted using the PRISMA‑SCR diagram. Conventional content analysis will be employed to analyze the studies.

Considering the position and role of primary health care in promoting the health of society, by implementing this protocol, the data obtained from the proposed scoping review will enable the managers and officials of the health system to follow the experiences of different countries in the field of scientific and fair allocation of financial resources to PHC, reinforcing Universal Health Coverage (UHC).

The incidence of colorectal cancer (CRC) is rising in Iran, but reports vary across different regions due to diverse methods and data sources. This study aimed to conduct a systematic review and meta analysis to provide an overview of theincidence rate of CRC and its trend among Iranians in various provinces.

A comprehensive literature search based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist was performed using national and international databases for papers published up to December 2023. CRC incidence rates were extracted from the numbers, crude rates, and age standardized rates (ASRs). A meta analysis was conducted to calculate the incidence rate and 95% confidence intervals (CIs) in subgroups of sex and province.

The initial database search retrieved 1287 papers, with 47 studies meeting the inclusion criteria after further screening. Overall, the trend of CRC incidence has been increasing, although a different pattern was observed in 2008. The pooled incidence rate of CRC was 8.46 (95% CI: 7.16–9.86) per 100,000 population beforethe publication of the annual continuous reports of the Iranian National Cancer Registry. The latest national data (2014–2017) indicated an ASR of approximately 15 per 100,000 population.

The incidence of CRC in Iran is lower than the global average. However, inconsistent cancer registration policies and gaps in registration have hindered the ability to establish a reliable trend of CRC incidence over time.

 In Isfahan, the fecal immunochemical test (FIT) has been used since January 2016 as part of the Iran’s Package of Essential Non-communicable Diseases (IraPEN) program for colorectal cancer (CRC) screening. The test is recommended for people who are 50-70 years old. Then, those with positive results would be referred for colonoscopy. This study aims to describe the uptake of the program and its outcome.

 A retrospective observational study was performed by collecting data from Isfahan Vice-Chancellor for Health database for this study purpose. The number of participators, the number of positive FIT, and the number of detected polyps or cancers were determined.

 Between 2016 and 2019, the number of participants in the program reached 345 207 individuals (nearly 40% of the eligible population of 874 674). Totally, 21 264 participants (6.1%) had positive tests, of whom about 20% underwent the recommended colonoscopy with available reports, and 971 (24%) and 110 (3%) patients were diagnosed with polyps and CRC, respectively.

 Over four years of screening with FIT in Isfahan, 40% of the eligible population participated. Among those with positive FIT results, 20% underwent colonoscopy, and approximately 26% of these individuals were identified as having polyps or cancer. This study provides valuable insights into the uptake and outcomes of a population-based CRC screening program in Isfahan, Iran. The findings highlight the need for targeted interventions to increase participation rates and improve the detection of polyps and CRC cases.

Introduction</span>:</span> Financial analysis provides important information to hospital managers and causes resources to be allocated more accurately. The aim of this study was to identify the structure of financial resources of selected hospitals of Isfahan University of Medical Sciences, Isfahan, Iran, during 2011–2021</span>.</span>
Methods</span>:</span> This descriptive study was conducted based on data from the selected hospitals affiliated with the Isfahan University of Medical Sciences. The data were obtained from budget and financial departments of Isfahan University of Medical Sciences and hospital information system, and then were processed in Microsoft Excel 2016.</span>
Results</span>:</span> The total revenue, hospital revenue from national budget and hospital special revenue have always been on an upward trend in current prices. In constant prices, the total revenue of hospitals increased by 20% in 2021 compared to 2011, and the trend of hospital special revenue has also been decreasing in most of these years. On average, operational revenue had the largest share and non-operational revenue as well as donation and charity had the least share of hospital financial resources. The average share of hospital special revenue (56.41%) was higher than the average share of hospital revenue from public budget (43.59%).</span>
Conclusion</span>:</span> Clarifying the structure of the hospital revenue can provide policy makers with a more comprehensive analysis of the current situation. The results of this study indicated the downward trend of the real hospital special revenue in these years, which indicates the fact that the revenue generating capacity of public hospitals is decreasing. The significant decrease in operating revenues of hospitals and the lack of compensation by the government in the form of hospital revenue from ministerial budget have faced a serious challenge to the self-governance of these hospitals. Therefore, health policy makers should pay serious and urgent attention to the revision or modification of the self-management plan in public hospitals.</span></span></span></div>

Resistive economy as a new concept/doctorine has entered to the Iranian economics literature several years ago. However, in order to be applied efficiently, a common perception among experts is necessary regarding its definition, instances and requirements. Thus, this study was conducted with the aim of general explanation of resistive economy concepts, its instances and requirements as well as identification of its requirements in health sector based on the experts’ opinions. In this qualitative study, 8 in-depth and face-to-face interviews were conducted with some economist as well as some health economists who were selected through purposive sampling methods. The interviews were transcribed and analyzed using the conventional content analysis method. MAXQDA Analytics Pro2020 (VERBI GmbH Berlin) Release 20.4.0 was used for coding and data management. Two concepts of “economic resilience” and “comprehensive concept of resistive economy” were identified. Then, the instances and requirements related to these two concepts were determined. An anti-shock economy, an oil-free economy, economic productivity and change were identified as instances of “economic resilience” and justice-oriented, knowledge-based, endogenous, extraversion, democratized, jihadi culture, Islamization of the economy, and resistive economy as a political economy were identified as the instances of “comprehensive concept of resistive economy”. The instances and requirements of resistive economy in health sector were also elaborated. There are numerous interpretations of resistive economy. Based on expert opinions, resiliency is a very important specification of that economy, but other specifications should also exist to address the comprehensiveness of the concept. In order to implement and operationalize the resistive economy in various sectors including the health sector, the first step is to reach a common understanding of resistive economy amongst the experts.

Colorectal cancer is one of the most common cancers that its incidence and prevalence and so deaths due to this cancer have increased worldwide recently. This study examines the economic burden of colorectal cancer from different perspectives by conducting a scoping review.

In this scoping review, by searching Scopus, PubMed, Embase, Cochrane, and Web of Science, the articles reporting the costs of CRC were reviewed. The search was limited to those published in the past years leading up to 2020. In addition to categorizing different aspects of the reviewed paper, per capita costs were adjusted with the purchasing power parity in order to make some comparisons possible. In this study, the calculated costs of retrieved studies were categorized based on the perspective of each study.

Out of 29 studies, only two have reported indirect costs of CRC, and 4 studies have reported both direct and indirect costs. In other studies, only direct costs of CRC have been reported. Nearly 40% of studies calculated CRC costs from the provider’s perspective. The highest reported annual per-patient cost was $175020(PPP-adjusted) which is related to the average annual costs of patients with CRC at the fourth stage in the United States from a provider perspective. The lowest reported amount was $ 954(PPP-adjusted) which was related to average annual inpatient costs in Brazil from a provider perspective.

Due to variations in study characteristics in terms of perspective, type of costs, type of patient included, etc. any comparison between the economic burden of CRC should be made with caution. However, reviewing various aspects of the economic burden of CRC reported in included studies, will provide researchers and policymakers with a better insight into the CRC burden while designing intervention programs will reduce the budget impact of the those programs.

The economic impact of acute respiratory disease pandemics has yet to be specifically systematically reviewed. The aim of this scoping review is to identify and classify the economic impacts and its values and ranges.

We conducted a literature  earch across three key databases using an extensive list of keywords. Then, we included studies which explored direct and indirect costs as well as broader economic impact associated with different nine acute  espiratory diseases, i.e., pandemic and seasonal influenza, avian influenza, equine influenza, swine influenza, severe acute respiratory syndrome, coronavirus disease 2019, Middle East respiratory syndrome, H1N1, and H7N9.

We included 62 studies in English language between 1987 and 2020, mostly from the countries of East Asia and Pacific pertinent. We classified the economic impact into 5 main ategories and 18 subcategories. The main categories were macroeconomic impacts, impacts on health cost, industry, businesses and trade, and education.

Respiratory disease pandemics have widely impacted   fferent sectors of economy such as the direct cost on macroeconomic, providing and receiving health services, disease management, industries, business and trade, education, and indirect costs due to productivity losses. However, lots of the reviewed studies were unable to quantify the actual economic cost of these impacts. This made it challenging to conduct any kind of quantitative comparison of the results. A key priority for future research is to develop standard methods to quantify the oader economic costs of respiratory disease pandemics. Understanding the total economic impact of respiratory disease pandemics is a key step to inform national and international priority setting for disease prevention and  andemic control interventions.

Colorectal cancer (CRC) is the third most common cancer among adults in Iran. The aim of colorectal cancer screening is to reduce the cancer burden in the population by diagnosing the disease in its early stages.

We adapted this guideline for the moderate CRC risk population for Isfahan to determine how to screen them and when to start and end the CRC screening. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of Iranian association of gastroenterology and hepatology.

In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years. In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years. In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally. In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice. Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested.

One of the important economic issues that arise due to limited resources and increasing costs in the health care system is the analysis of hospital costs. The aim of the present study was to investigate and compare the cost structure of the selected hospitals affiliated with Isfahan University of Medical Sciences from 2011 to 2020.

The present applied research is a descriptive type. A researcher-made checklist was used to collect the data. The cost data were obtained from accounting and financial department of each hospital. Then, the data verification process was carried out in cooperation with financial and accounting department of Isfahan University of Medical Sciences. The data were analyzed by using Microsoft Excel 2016.

The results showed an increasing trend in the total cost of hospitals. The cumulative cost structure of the selected hospitals during the years under Study showed that personnel costs accounted for 55.95% of the total cost (ranging from 46.40 to 70.93%). The costs of medicine and medical consumables, which had the highest share after the personnel costs, accounted for 19.76% of the total cost (ranging from 12.98 to 33.30%).

Identifying the cost structure provides a correct and evidence-based insight for planning, cost management and evaluation of hospital efficiency and paves the way for hospital officials to reduce hospital costs and improve the quality of health services. Consequently, this can form the basis for informed decision-making. Considering that in the hospitals under study, a significant share of the total cost was allocated to personnel costs and medicine and medical consumables, hospital officials can pay more attention to the management of these costs and prioritize them in their planning.

Non-compliance of pregnancy and childbirth care with national guidelines and standards incur a huge financial burden on health system. This study aimed to estimate the financial burden of ultrasound screening for low-risk pregnant women which is not in accordance with national standards.

This was a cross-sectional study in which 230 pregnant women with low-risk pregnancies, getting care in comprehensive health centers, were assessed in terms of the number of ultrasounds they had during their pregnancy and to see how it would be in accordance with national standards. The financial burden was estimated based on the total fertility rate per year from the perspective of health insurance as well as patients.

The average number of ultrasounds performed in pregnancy per person was 5 times (4 one-dimensional ultrasound and one three-dimensional ultrasound), which is almost twice the defined level of the national standard (3 one-dimensional ultrasound). It was estimated that this imposed a financial burden of about 364,707,521,587 Rials on basic insurers. Also, individuals incur a financial burden of about 2,898,188,006,140 Rials. It meant that following national standard for performing ultrasound examination during low-risk pregnancy would have saved 3260 billion IRR for Iranian health system.

Non-compliance of ultrasound services with national standards is associated with several effects such as imposing additional costs on the family and insurance organizations. Following national standards for prenatal care would stop providing unnecessary services during pregnancy and reduce related costs which would be beneficial both for pregnant women and health system.

Despite the fact that medical equipment is critical for providing good health services and also incurs significant expenditures for the health system, little is known about how to procure it effectively. To date, only a few comparative studies on the procurement framework for medical equipment between nations have been conducted. Thus, the purpose of this study was to examine this issue between the leading countries.  

To conduct this comparative study, Canada, the United Kingdom, Australia, Spain, Italy, Turkey, Thailand, and Iran were selected. Medical devices, medical equipment, procurement, purchasing, and acquisition were keywords considered to search PubMed, ProQuest, Web of Science, Scopus, Science Direct, and Google scholar databases. Also, the websites of the related organizations, such as the World Health Organization (WHO), the World Bank, and the Ministry of Health of respective countries were searched for the gray literature. Providing information about the procurement framework and availability of evidence in the English language was considered as the inclusion criteria and the lack of access to full texts, letters, and commentary article designs were the exclusion criteria. The results were summarized and reported using comparative tables.  

Most of the countries involved in this study are trying to align procurement activities with national health care priorities. In view of this, there is a trend toward centralized procurement, especially in Italy, Spain, England, Italy, Canada, and Iran. While a range of actors participate in the procurement process, a greater role for physicians and patients is necessary to be defined to meet patient needs. Moving from price-based approaches to value-based approaches is in the agenda to consider a broader range of criteria to achieve value for money and support patient access to innovations.  

Most of the countries have reorganized the mechanism of medical equipment procurement. The price of products is the important factor, and recently the value factor has become more important in procurement. Reinforcing the role of decision-making teams and hospital committees in the procurement of medical equipment is suggested. Further studies are needed on the application of value-based approaches to evaluate their effects in hospitals.

Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017.

This descriptive study used insurance claim data (time period: 2011–2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts’ opinions.

The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011–2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost.

The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction.

Nowadays, various strategies are applied by governments to control costs and finance hospitals and the health sector. Public‑private partnership (PPP) option is one of these strategies. Considering the growing importance of hospitals in different communities and their problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This study aimed to identify the challenges and opportunities of PPP in the country’s hospitals and then offered an appropriate solution to overcome these challenges.

This is a qualitative study and content analysis approach is undertaken. The participants were selected through purposive sampling and data were collected using a semi‑structured interview with experts in the public and private health sector until the saturation point achieved. Data analysis was performed through the thematic analysis of expert’s statements using MAXQDA. 10 software in this sector.

According to the study results, 3 main themes (challenges, opportunities, and solutions), 10 sub‑themes, and 32 codes were identified in relation to the public and private partnership. 4 sub‑themes on challenges of PPP, 3 sub‑themes on partnership opportunities and 3 sub‑themes on challenges solutions were identified.

The results of this study revealed that given the discussed challenges the most important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated outsourcing backed with adequate supervision could solve many current hospitals’ problems.

 Breast cancer is the most common cancer in women. Patients are treated with chemotherapy initially, and if not chemically treated, the risk of recurrence of the disease increases yearly. Therefore, methods for identifying patients for whom chemotherapy would be most beneficial are very important. The Oncotype DX test is a prognostic assay that predicts the likelihood of breast cancer recurrence as well as the effectiveness of chemotherapy. Because of the novelty and the high cost of this test, the current study aims to determine its effectiveness and economic effects.

This study, based on rapid health technology assessment, explored the effectiveness and economic consequences of Oncotype DX compared with alternative methods in breast cancer patients. PubMed, Scopus, Web of Science, and Cochrane databases were searched, and only studies about the use of the Oncotype DX test in breast cancer were included.

The results of the 32 relevant studies showed that the difference in outcomes was negligible across Oncotype DX and other gene expression profiling tests, but these differences were significant compared with standard treatment. Also, Oncotype DX testing would be cost-saving when used for patients under chemotherapy. However, using this test for all patients may not be cost-saving depending on the number of patients who switch from hormone therapy to chemotherapy and vice versa.

Although the results of this study are helpful for policymakers and therapists, it is better to make decisions based on the results of effectiveness and cost in Iran.

Despite this seemingly simple definition of value in different perspectives, the definition of value-based procurement for medical devices is still unclear. This study aimed to delineate the definition of value-based procurement for medical devices and its characteristics.

According to the systematic method for scoping review described by Arksey and O’Malley, we reviewed related literature through target databases (PUBMED, ProQuest, Web of Science, Scopus, and Science Direct) during 2004-2020. The publications that focused on the procurement of medical devices and address the issue of value in procurement were selected. The publications whose full-text was not available and were not in English were excluded. By using data charting tables, selected articles were reviewed and concepts and definitions were extracted

According to the eligibility criteria and reference checking, 24 documents were selected. There are different definition and understanding for value-based procurement (VBP). Identified characteristics of VBP are information, actors Collaboration, patient experience, value analysis team, ability to evaluate alternatives, value proposition, competitive dialogue, and weighing evaluation criteria.

VBP is a framework that guides the review and decision-making to procure medical devices. In this framework, all dimensions of the value equation (outcome/related costs) must be considered and weighted. Health systems need to work on identified aspects.

 Identifying Lynch syndrome (LS) in patients with colorectal cancer (CRC) and monitoring their relatives can increase the life expectancy of these patients.

 The aim of this study was to analyze the cost-effectiveness of 5 molecular testing strategies to screen LS among patients with newly diagnosed CRC and to conduct preventive surveillance in their first-degree relatives.

 A decision tree model was designed to identify the number of LS mutations and the related costs in the CRC patients. Five strategies were modeled, i.e., Amsterdam II criteria, microsatellite instability (MSI) testing, immunohistochemistry (IHC), and next-generation sequencing (NGS). A Markov model was also used to estimate the long-term outcome of monitoring (including colonoscopy and taking aspirin) among relatives of those patients with CRC who carried LS.

 All strategies were cost-effective compared with no testing condition. The 2 most cost-effective strategies were strategy 2 (IHC testing followed by NGS testing) and strategy 4 (MSI testing followed by NGS testing), with the ICER of 4,604$ and 4,748$ per quality-adjusted life year (QALY), respectively. Based on one-way sensitivity analysis of IHC sensitivity, the Cost of colonoscopy, MSI sensitivity, and the number of families who inherited LS had the most effect on the results.

 The findings suggested that from an Iranian health care system perspective, IHC testing followed by NGS testing could be regarded as the most cost-effective strategy compared to the other strategies. These results can be useful in offering to screen LS in newly diagnosed CRC patients.

Non-communicable diseases such as cardiovascular diseases are the main cause of death worldwide today. The aim of this study was to determine the frequency and cost of various outpatient diagnostic procedures for cardiovascular diseases insured with the Health Insurance Organization in Isfahan Province, Iran, during the years 2011-2017.

This was a descriptive-analytical study on the data of the Health Insurance Organization of Isfahan Province. After defining the list of outpatient diagnostic procedures for cardiovascular diseases, the information on the frequency and cost of these procedures were extracted in the form of an Excel file.

The total frequency and cost of outpatient diagnostic procedures for cardiovascular diseases over a period of 7 years were 751,421 procedures and 251,670,136,936 Iranian Rials (IRR), respectively. The per capita frequency of total procedures increased from about 19 procedure per thousand to about 115 procedure per thousand of the insured individuals of the Health Insurance Organization of the Isfahan Province. In addition, the per capita cost of these procedures increased from 1,733,815.24 to 46,130,235.10 IRR per thousand individuals.</div>

As the frequency and costs of outpatient diagnostic procedures for cardiovascular diseases of insured individuals of the Health Insurance Organization of the Isfahan province respectively raised 6.8 and 29.5 times during 2011-2017, the payment system reforms and prevention and effective control of cardiovascular diseases should be considered by policymakers.

Nowadays, estimating efficiency of health expenses and identifying its related factors has become important issue, and due to the increased expenses around the world, has received considerable attention by policymakers in health sector. This study endeavored to assess the factors affecting the efficiency of government health expenses.

This was a descriptive-analytical study using World Bank databases carried out in the distinguished countries (including Iran) during the years 1995 to 2014. In the first stage, according to the Human Development Index (HDI), the distinguished countries were divided into four groups of countries with very high, high, medium, and low HDI. Then, the Data Envelopment Analysis (DEA) approach was employed to estimate the efficiency scores of countries. In the second stage, the Tobit Panel Data model was estimated to identify the influencing factors on the efficiency of the government health expenditures.

The average technical efficiencies observed for countries with very high, high, medium, and low HDI were 0.63, 0.52, 0.28, and 0.48, respectively. The out-of-pocket payment in countries with very high, high, and medium HDI had a positive and significant relationship with the efficiency of government health expenditures. Other variables in countries with very high and high HDI were not statistically significant. Hospital beds had a significant negative relationship with the efficiency of government health expenditures. In countries with low HDI, none of the variables had a relationship with the efficiency of government health expenditures.

Findings reveal that the out-of-pocket payment can play a significant role in controlling unnecessary expenditures in very high and high HDI countries. This can be related to the service packages provided in these countries as well. The findings indicate that a service package which is covered by insurance in these countries, and patient do not pay for that, covers essential services for patient, and those services that are not in this package and the patient have to pay for that, are less essential services.

Health reform plan in dentistry has been implemented systematically in Iran since 2014 in villages and cities with a population lower than 20,000 inhabitants. This study aimed to evaluate the impact of this plan on the utilization of dental services in Isfahan province.

Ten health centers with dentists contracted with the health reform plan were recruited. The frequency of dental services (examination, preventive care, restorative care, and extraction) was assessed. Four centers not in contract with this plan were considered as the control centers. To compare the frequency of provided services, the non-parametric tests of Mann-Whitney and Wilcoxon (α=0.05) were used (SPSS 22).

In the control centers, the cumulative frequency of provided care demonstrated no significant difference between 2014 and 2017. In the centers subject to the reform plan, there were increases in examination (p=0.02), amalgam (p=0.04), and composite restoration (p=0.04) in the age group of 6 years, and examination, extraction, amalgam, and composite restoration (p=0.007) in the age group of 6-12 years. In pregnant women, extraction (p=0.017), composite restoration (p=0.04), and scaling (p=0.012) increased significantly. In the six-year-old group, the means difference of extraction (p=0.036) and amalgam restoration services (p=0.024) and in the age group of 6-12 years, the means of extraction (p=0.014) and amalgam restoration (p=0.008) were significantly increased in the centers subject to the reform plan than in the control group.

After the implementation of the reform plan in health centers, dentists were more willing to provide preventive and restorative care that could be partially due to financial incentives.
 

Pesticides have been used as the main part of the national cutaneous leishmaniasis control program for serveral years in Iran. However, the costeffectiveness of this strategy has not been yet analyzed. The aim of this study is to to analyze the cost-effectiveness and cost-utility of using pesticides as the main strategy to prevent rural CL in Isfahan.

This is an economic evaluation study performed from a health system perspective to estimate the cost‑effectiveness and cost‑utility of the control strategy with and without pesticides. The outcome measures are incidence rate of cutaneous leishmaniasis and the disability‑adjusted life years (DALYs). The cost‑effectiveness and cost‑utility have been analyzed by calculating incremental cost‑effectiveness ratio (ICER). Data of cost and incidence rate obtained from the health centers of Isfahan University of Medical Sciences and Vice‑Chancellery for Health. The disability weight was obtained from the literature. A one‑way sensitivity analysis was applied with a 20% increase and decrease in costs.

The total cost of control program in 2013 and 2014 were US$578,453 (ppp) and US$14,978.2 (ppp), respectively. The incidence rate of cutaneous leishmaniasis was estimated at 1396 and 1277 (per 100,000 population in hyperendemic areas where pesticides have been used) in 2013 and 2014, respectively. DALY lost due to disease was estimated to be 8.024 and 7.342 in 2013 and 2014, correspondingly. Both the cost‑effectiveness and the cost‑utility analyses resulted in negative ICERs, lying in the rejection area of the ICER plane.

The use of pesticides to prevent cutaneous leishmaniasis (rural sicker) in Isfahan province has not proved to offer a reduction in the incidence rate of cutaneous leishmaniasis as well as reduction in DALYs lost. However, due to data availability limitation, the time frame for this study was limited. A prospective design with longitudinal data is recommended to be used by future research. Other alternatives to raise population awareness about different aspects of disease should be also considered for evaluation.

The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences.

This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively.

Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people‑centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health.

The implementation of resistance economy policies entails planning in the long run, culture‑building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

The increasing demand for health services has made the health system constantly faced with inconsistent challenges of improving performance and cost control. The prerequisite for taking appropriate cost control measures is a detailed description of the situation. The aim of this paper is to identify the most expensive outpatient laboratory services covered by the Health Insurance Organization and cost control strategies.

This study was a cross-sectional descriptive study that was done in 2017 based on data from 2015. Laboratory cost data were obtained from the Medical Records System of the Provincial Health Insurance Offices of the whole country and analyzed using Excel 2013 software. Chiefs of provincial Medical Records Bureau and responsible experts were asked to propose cost-cutting interventions pertaining to identified the costliest services. Suggested interventions were reviewed and after excluding duplicates, they were categorized as specific interventions for each service and non-specific interventions.

The most costly outpatient laboratory services accounted for approximately half of the costs of the Iranian Health Insurance Organization. TSH measurement tests, blood cholesterol, CBC and vitamin D levels are at the top of the costly lab services. The most important cost control interventions include family physician and referral system implementation, monitoring of physicians and Para clinical centers, insurance aggregation, observing costly centers, preparing performance reports to physicians, empowering insureds and creating electronic health records.

It is suggested that appropriate policies regarding the strategies proposed here by insurance organizations and the Ministry of Health and Medical Education need be taken into consideration in order to more effectively control and manage the rising costs of health services.

Public-private partnerships can provide the health systems with the required resources to prevent disease, render effective care services, and promote individual and community health. The purpose of this study was to review application of the public-private partnership model in the delivery and promotion of health services to investigate the scope of this model and its success in health systems.

This critical review was conducted by conducting a search in the databases of ISI, Scopus, PubMed, Science Direct, SID, and Magiran using acombination of the following keywords public-private partnership, health promotion, health delivery, health improvement, health service, health care services, and providing health services. No time limit was considered in the research process.  A total of 238 articles were extracted and reviewed.

Finally, 12 eligible articles were studied, which resulted in 4 main themes: public-private partnerships and prevention, public-private partnerships and infectious-communicable diseases, public-private partnerships and chronic diseases, and public- private partnerships and clinical health services design and information.

The public-private partnerships were successful if supported and organized by the government. In most studied articles, the extent of private sector participation and its benefits were not clear. So, clarification of the interactions between these two sectors will increase the confidence of policymakers in public-private partnerships.