vahid vatandoost

Crises are often unavoidable events that occur around the world. Hospitals play an important role in treating patients and preventing extensive injuries in times of crisis, requiring adequate preparedness. In order to design a proper planning system, it is essential to be aware of the challenges of hospitals during a crisis. The purpose of this study was to explain the challenges of hospitals admitting COVID‑19 patients in the city of Mashhad, Iran, from the perspective of their managers.

This study employed a qualitative approach, using the method of conventional content analysis and was conducted from May to July 2020. A purposive sampling method was used to recruit the senior managers of hospitals admitting COVID‑19 patients in Mashhad. The interviews were conducted face to face, with open‑ended questions following an interview guide based on semi‑structured questions, and continued until data saturation was reached. Data were analyzed using Atlas Ti software.

After the implementation of the interviews, first 665 initial codes were extracted from the data, and after removing the overlapping sequences, a total of 115 codes were obtained. Three categories (organizational challenges, extra organizational challenges, and challenges related to information domain), 13 sub‑categories, and 33 codes were extracted from the content analysis of the interviews. The main themes propounded in the field of challenges of COVID‑19 referral hospitals in Mashhad were organizational challenges, extra organizational challenges, and information domain challenges.

The results of this study showed that the hospitals admitting COVID‑19 patients in Mashhad faced many challenges. To improve the quality of services in postcrisis phase, replacing hospitals’ equipment, revising curriculums at medical universities, staff retraining, recruiting skilled human resources, and creating a supportive community context are necessary.

For sure, the COVID‑19 crisis will not be the last one, we have to be prepared for the bigger health crisis.

Cost information can help policy makers to set user fees, public and private tariffs and budgets and also to conduct an economic evaluation to provide health care with acceptable quality and affordable price. This study aimed to do a cost analysis for the Iranian Comprehensive Health Centers (CHCs), to estimate the unit cost of different dental services.

This was a cross-sectional study. Capital and recurrent cost information of three urban CHCs in Mashhad was collected. Cost identification was based on the provider’s perspective. The step-down costing method was adopted from Konte and Waker and applied in five steps: defining cost centers, identification of operational activities, assigning inputs to cost centers, allocate all costs to final centers, and compute unit costs.

In dental services, the most important cost driver was human resources that comprised 69% of the total cost. The unit cost of a relative K for dental care was 12,189 Rials (1 USD: 31,407 Rials as in 2016). Accordingly, the unit cost for different dental services varied from 182,834 Rials for dental radiography to 1,589,570 Rials for class II composite restoration. The mean cost of a dental visit for examination and diagnosis estimated 247,436 Rials.

Comparison between the estimated unit cost and the current dental tariffs reveled considerable differences. Integration of dental services to primary health care in the Iranian CHCs would result in the economies of scope.