جستجوی مقالات مرتبط با کلیدواژه « نظام سلامت » در نشریات گروه « علوم اجتماعی »

For over a century now, the medical discourse has played an important role in shaping the meanings and experiences of pregnancy and childbirth. In this research, a part of the mechanisms of the health system related to pregnancy and childbirth in the economic, political, social, and cultural context of contemporary Iran has been studied.

Multi-field ethnography was conducted, and individual and group interviews were carried out in two public and private hospitals and several other treatment centers in different areas of Tehran and their online components during one year (2020-2021). The findings of this research are the result of the thematic analysis of the data obtained.

The hospital represents a part of the class system, hierarchy, and unbalanced power structure in the society outside the hospital. The pregnant body faces different types of judgments in the process of referral to delivery based on the economic and cultural class in which it is placed. The level of visibility and objectification of the pregnant body also varies depending on the type of hospital and the fees paid. The difference in economic and cultural capital and the imbalance of access to information also affect the views and decisions of families regarding the date of birth, pregnancy care, the birth process, and "unhealthy" and "abnormal" fetuses.

Pregnant women are not a homogenous social class, and due to the intersection of the conditions in which they are placed, they are led to develop a kind of unequal nation whose coordinates are the first step in the quantity and quality of services offered by the health system.

In a rapidly changing world, health systems are facing new challenges. Among these challenges, we can mention economic inflation, which can have profound effects on the health of society. Therefore, the importance of experiences and concepts of inflation management in the health system is increasing. Controlling inflation in this area requires principled management, transparency, strict monitoring and participation of all stakeholders. The increase in the costs of treatment, medicine and medical services leads to a decrease in the access of the public to health care. In addition, inflation in the health system can cause inequality in access to services, a drop in the quality of treatment, and ultimately public dissatisfaction. The role of public relations in the health system is defined as a key element in communication and promotion of communication between health institutions and society. This role is very broad and influential. The ability of the media, individuals and institutions to convey correct and reliable information to the people about the increase in inflation and its effects on the health system is very fundamental. In this situation, public relations can provide the basis for effectively dealing with the challenge of inflation. In this article, we try to interpret and examine the very important role of public relations in controlling the inflation of the health system and especially point out the importance of this role in promoting a sustainable health economy and social justice. This article can help politicians and economic and health decision-makers to provide appropriate solutions to manage inflation in the health system and provide the society with more accurate information so that better decisions can be made.

Responsiveness is a main component of the health system which is related to the social characteristics of the society. The aim of this study was to evaluate the responsiveness of the health system in the slum areas of Ahvaz.

In this cross-sectional study, 385 residents of the marginal areas of Ahvaz city were selected by multi-stage sampling method Data were collected using Socio demographic-checklist and WHO responsiveness questionnaire. Data were analyzed in SPSS V22 applying descriptive statistics tests, Mann-Whitney, Kruskal-Wallis, ANOVA and t-test. 

The age range of the participants was 18 to 97 years with an average of (42.84±16.56). Women constituted 66% of the research population. 76% were married, 26% were illiterate and 4.4% had university education. 85.7 percent of participants under 5 million people. 66.2% used government service providers. 80% had health insurance and 15.1%  had supplementary insurance. Performance of in-patient services was better than outpatient services in terms of responsiveness. Aspect “Choice” received low score for outpatient and inpatient services. Almost 13% of respondents perceived some sort of discrimination while receiving inpatient service. Responsiveness of the participants in this study was significant relationship in all aspects with the type of service provider (charity/private/government), in the aspect of communication with the type of service provision (outpatient/inpatient), in the aspect of informed choice and confidentiality with the having supplementary insurance.  

Paying attention to the quality of facilities, access to social support and choice is suggested as a criterion with points for planning for change in order to improve the responsiveness of the health system in marginalized areas.

The purpose of this sociological study is to investigate the obstacles to reforming medical tariffs in Iran's health system. To comprehend the impediments to reforming medical tariffs, we will employ Habermas' theory of dialogue democracy and conduct an analysis of stakeholders. This theory emphasizes the importance of open dialogue and participatory processes in complex system decision-making, such as the health system.This study employs in-depth interviews as its primary method of data acquisition. The data was analyzed using the stakeholder analysis table, which included the dimensions of knowledge, position, interest, and influence. This study collects data from both existing and new interviews.The findings indicate that transparency is a significant obstacle in the policymaking process, and that stakeholders need more knowledge and information about the policymaking process. The position of stakeholders toward the proposed reforms is one of opposition and resistance. Conflicting interests within the health system pose the greatest barrier to policymaking, according to an analysis of interests. The power analysis reveals that the health system's power structure is centralized, with a limited number of influential policymakers having competing interests in regulating the system. The conclusion of the study is that the top-down approach to policymaking in the health system, which is dominated by competing interests and the erosion of public spheres and civil institutions, results in the concentration of power. On the other hand, a participatory and dialogue-based approach increases the likelihood of successful policy implementation and the protection of the interests of all stakeholder groups. To establish a collaborative public sphere within the health system, policymakers should restore the authority of civil and professional organizations, such as the medical council.The top-down approach to policymaking, which is influenced by competing interests and centralized authority, has led to opposition from healthcare providers. Service providers must be involved in the successful implementation of health equity policies. Consequently, their participation in the policymaking process is essential to its success.

The development of health in the society for establishing mental security is not limited only to the guardians of the health sector, while social participation of all sectors of the society has a constructive role in this field. On the other hand, taking into account the development of the society in different dimensions of social, economic, political, and cultural life, goal-setting and planning for achieving predetermined goals, and reaching the desired states of its various dimensions, it is necessary that the tools and consequences of achieving such an all-round development be recognized and accepted. In this regard, all the potential, natural, and human resources and facilities should be used effectively and efficiently. In many cases, with the occurrence of a pandemic and non-participation of the members of the society in complying with health standards, psychological insecurity is created in the society and the people’ social life of is severely disrupted. Accordingly, different countries of the world have turned to the discussion of community participation in the management and prevention of pandemics due to aggravation of the problem of widespread diseases. Health care systems must have a proper interaction with the private sector, universities, civil society, and people, implement pandemic prevention and control models in the society with a community-oriented approach, and consider relevant experiences and challenges (Shabani and Taheri-Kharameh, 2021: 358). One of the social issues that the society is still involved in after a few years is the spread of the Corona pandemic, which progressed beyond international borders and affected many people in the world. Governments adopted a series of measures, including restricting entry into cities, closing schools and universities, and quarantining people at home, to control the epidemic and prevent its further spread. Although these measures reduced the duration of the conflict with the corona virus and its incidence and spread, the people's social activities were limited by these measures. In addition to concerns about the physical dangers of the pandemic, its effects on mental health had to be considered as well. Epidemic diseases lead to some psychological disorders, including stress, anxiety and symptoms of depression, insomnia, anger, fear, and significant disorders (Esdalahei and Rafezi, 2021: 122). In general, it can be said that the health sector, with all its facilities and resources, cannot overcome the problems alone until it gets the people’s conscious support. By laying the foundation for increasing public participation, we can do better in preventing the spread of diseases, including Covid-19 (Rezabigi Davarani et al., 2020: 113). Therefore, in this research, a model was designed to increase social participation in pandemic control by using the mixed approach of effective factors and components with an emphasis on psychological security. 

The current research was conducted in the two qualitative (thematic analysis) and quantitative stages. It was exploratory in terms of purpose and descriptive in terms of type, thus being carried out in the field (Ardabil University of Medical Sciences) in the period of February 2022 to July 2022. The statistical population included 20 doctors with more than 20 years of experience in Ardabil Province in the first stage. In the second stage, the size of the statistical population under study was 1392 people based on the Statistics and Information Office of Ardabil University of Medical Sciences, 2022. According to Morgan Table for estimating sample size, 302 employees working at the University of Medical Sciences and Health Services of Ardabil Province were selected for the study. The sampling method in the first stage was a purposeful method (theoretical sampling) associated with the chain reference method (snowball method). The stratified random sampling method was used in the second stage, while the studied community units were grouped in classes that were more homogeneous in terms of attributes. This way, changes within the groups were minimized. For this purpose, the studied sample was classified into administrative (29 people), service (42 people), operational (25 people), nursing (145 people), educational (31 people), financial (21 people), and directorate or presidency (9 people) areas. Also, in the first stage, the data were collected through in-depth and semi-structured interviews. The tool for collecting information in the second stage was a researcher-made questionnaire with closed answers (Likert scale) based on management indicators to increase social participation in controlling communicable diseases with an emphasis on psychological security of the society. The data extracted in the first step were then adjusted. Finally, ATLAS .ti software and Smart PLS and SPSS software were used to analyze the the data collected in the first stage through the theme analysis method and the second stage via confirmatory factor analysis, respectively.

The results of coding showed that the factors affecting the presentation of this model could be generally placed in the 9 main themes of characteristics of communicable diseases, extra-organizational participation, non-governmental organizations, media, people's participation, management, measures, technology, development of a comprehensive program and 62 sub-themes. Based on the results, the factor of "management" had the greatest effect on increasing social participation in controlling communicable diseases with an emphasis on psychological safety of the community. Among the indicators of this factor, the indicator of "clarifying the employees’ roles and duties" had the highest impact in the designed model. The factor of "media" was the second most influential factor. Among the indicators of this factor, the index of "role of mass media" was the most effective one. The third influential factor for increasing social participation in controlling communicable diseases was the factor of "non-governmental organizations". Among the indicators of this factor, the index of "role of fertilizers in people's education" had a high coefficient of importance. The factors of "actions", "characteristics of communicable diseases", "extra-organizational participation", "Technology", "people's participation", and "development of a comprehensive program" were identified as the most influential factors in the presented model.

One of the most essential resources of any health system is its human capital, and emigration of physicians means the loss of human capital. The aim of the study is to explain the phenomenon of emigration of physicians based on the perspective and experiences of the medical interns of Shahid Beheshti University of Medical Sciences in 2021. The participants were selected using purposive sampling and the sample size was determined based on the theoretical saturation. The data were collected through semi-structured interviews with a total of 15 medical students who participated in the study. The data from the interviews were transcribed and analyzed using a content analysis method to extract related categories and subcategories. Based on the data analysis, 24 subcategories and 8 main categories including status of medical education, working status of physicians, degradation of social status of physicians, lack of work / life balance, lack of motivation, being influenced by others, socio-economic conditions of the country and comparison of their status with destination countries were identified. Based on the findings of this study, there are several factors involved in the tendency of physicians to emigrate, all of which need to be considered in order to slow down the migration process.

McDonaldization is a way in which social actions and ways of organizing are increasingly driven by hyperrationality. And the persistence of hyperrationality provides producers, consumers, and managers with more efficient, computable, predictable, and controlled means to achieve their goals. In this study, the four principles of McDonaldization in relation to changes in the health system are examined. Findings indicate that conscious or unconscious macdonalization of the health care system has affected the health system in different ways and has caused the health care system to revolve around four principles of efficiency, calcutability, predictability and inhumane technologies. To take. Efficiency has led to the formation of minute clinics, completion of questionnaires by patients, extended use of medical assistants, robotic surgery and short visit with physicians. Based on the principle of calculability of receiving health care by patients is a function of cost and financial return to the system and issues such as length of stay and patient admission are considered. The principle of predictability has also caused the whole treatment process from the patient to enter the medical centers to leave it, according to a precise and pre-predicted instruction, which has led to more pressure on physicians to treat all patients equally. Based on the principle of control, nonhumane technologies have begun to become more involved in health care. Electronic medical records have controlled interactions between physicians and patients, and the replacement of technology has eliminated customer satisfaction and increased inefficiency.

Despite the thousands of years old of traditional Iranian medicine background, this health care system has not yet been able to find a complementary place in modern medical treatment. This study is an attempt to show the political mismatch in the field of cultural contextualization that is necessary for determining the place of traditional medicine in the Iranian health system. The research method is exploratory study with a qualitative approach that has used the thematic analysis method of Brand and Clark to extract and analyze the data. The applied tool was in-depth interviews with 30 key specialists and experts in traditional medicine. After extracting the main concepts and reviewing the upstream documents, the sub-themes and finally the main theme were gradually obtained. The results of this survey make it clear that some of the inconsistencies in traditional medicine go back to the mismatches of cultural policy in representing the position of Iranian traditional medicine, which is subject to cultural resistance in some parts of society and the medical education system. At the same time, the ideological formulation of some proponents of traditional medicine and the incoordination within and between departments in relevant organizations to introduce and realistically inform the capabilities of this medical knowledge has caused incredulity in some members of society to the capacity of this knowledge.

According to the research literature, the review of previous research indicates the lack of a comprehensive model in the field of religious lifestyle and socio-Islamic responsibility in the country's health discipline. The purpose of this study is to provide a comprehensive model. This research is applied in terms of purpose and in terms of data collection is a non-experimental and survey method and has been implemented as a mixed research in both qualitative and quantitative stages. First, the studied factors have been obtained by reviewing the research literature and interviewing elites. Then, the relationships between them through the opinion of 30 experts forming the decision team by questionnaire method, to evaluate the relationships between factors with the statistical method of structural equations and the partial least squares approach. Based on the research results and the results obtained from the significant graph of path coefficients and t-statistics between causal factors (economic benefits, legal requirements, religious teachings and managerial personality) with the main category of the research, i.e. the process of Islamic social responsibility in the health discipline, there's a relationship with the number 1.969. Based on the relationship between research strategies that include: religious affairs, cultural affairs, social affairs, implementation of necessary policies and development of educational policies with its consequences (credit sustainability, organizational sustainability, human welfare and health empowerment), the number 8.420 at 99% confidence level it is obtained that results in the implementation of the main category of research. Although a comprehensive structural model is presented in this study with the aim of examining the internal relationships of the determinants of research subject policy-making, but it can be generalized and applied by examining and adding other dimensions related to the research topic and specific study of some research dimensions. He also acted in areas other than health.

Being at the center of risk and taking responsibility for caring of covid 19 patients has attracted a lot of media and professional attention to nurses and the nursing profession and has helped to create a new image of them in all countries in crisis. Professional ethics and medical ethics were constantly rethought during this crisis, leading nurses to a different understanding of the importance of their professional roles. The present article seeks to recognize the lived experience of Iranian nurses in the Covid 19 crisis. For this purpose, through semi-structured interviews with sixteen nurses involved in service delivery and thematic analysis of the results, categories such as negative emotions and high stress in the early stages, positive attitude changes and empirical experience were extracted. The importance of rethinking the biomedical discourse and its multifaceted and generalized effects on the status of the nursing profession were other results of this study. This study points to the importance of nurses' expertise and technical knowledge along with the multidimensional nature of this profession as a profession that requires technical and cognitive knowledge. It also emphasizes the importance of psychological and legal support and the need for multifaceted attention to the situation of nurses and their role in the overall health system, especially in pandemics, multilateral measures and the importance of discourse developments in the field of health.

The health system as the main custodian of health in Iran has a history of nearly a century and during this period has witnessed many changes to the current form and structure. This study aims to investigate the factors affecting the formation and evolution of the health system and the policy-making process in it with an interdisciplinary perspective.

The research has been conducted in a historical way and historical texts about the health system and its sub-sectors including health care and education have been reviewed and analyzed with an institutionalist approach.

The government, civil society, private sector, family and international institutions have been the main agents of health policy in Iran from the beginning until now, which in the context of situational, structural, cultural and external factors have directed the health system and its developments in Iran. They have been effective.

Although the government has been the main agent of health policy in Iran from the beginning, but many institutional factors have been effective on its efficiency and performance in the field of health, and this institution needs more serious attention to community elements to formulate health policies and pave the way for social justice. Civility and the characteristics of families and leaving matters to the private sector, and in this way interaction with international institutions and the use of their experiences, especially in the field of health is of particular importance.

In developed societies, the right to health has gained a broad meaning and different countries have redefined it in various dimensions. Explaining the right to women's health influenced by gender and experiencing multiple changes during their lifetime is of particular importance and requires the creation of a new structure based on accurate knowledge and awareness of the needs and the factors affecting it. In public law, the securement of public health and maintaining the health of citizens are among the fundamental responsibility of states. Government intervention includes a wide range of measures to improve health through the formulation and monitoring of laws and the implementation of macro- policies in this area. This qualitative research, has been conducted by describing and analyzing the relevant Micro and macro documents and has identified the right to women's health in various and high important dimensions such as physical, spiritual, psychological, social, occupational, environmental and intellectual dimensions. The findings of the research and review of upstream documents and macro-policies indicate that only some aspects of the right to women's health have been identified and regulated, therefore the development of a comprehensive legislative program for women's right to health in all areas is essential based on macro-transformative policies as one of the indicators of development.

Conflict of interest refers to situations that are created by contrast and conflict between individual or group obligations and benefits and put him in opposition to his responsibility. The health system, as the most important system in society, is always encounter with a challenge named conflict of interest because of complex financial and economic structure and also accessibility of society to services. Conflict of interest in the health system is detectable in all of the management and services area and can provide corruption basis. Due to relation of health system with the most important asset of people, means health, confront with challenge like conflict of interest is really important. One of the most important actions to confront with conflict of interest is creating approaches based on transparency including the creation of electronic health record and creating regulatory frameworks. Also, confront with dual practice problem in the health system is one of the most important actions.

Since one of the main areas of understanding of social policy, and that of health policy, is the attention to how the government focuses on the economic, social, political, and cultural development of the country; therefore, it can be traced to its development through the evolution of countries. This research was carried out with the aim of investigating the changes in the health system of Iran during development and development programs before and after the 1979 revolution. The present study was conducted using a comparative method with qualitative content analysis technique based on data collection from valid sources related to the health system in Iran (including medicine, health, etc.) ,the text of development programs ,evaluations , andrelated reports. In this way, the success or failure of development and development programs before and after the Islamic Revolution was compared to achieve social policy objectives, including health policy, and the impact of previous programs on future policies and programs. The research data were extracted from first-hand sources, second-hand sources,  previous evaluation, and research reports, and they were analyzed using the basic concepts of institutionalization approach. In addition to analyzing the impact of developmental plans and development on the changes in the health system, and showing the trend of these changes, the differences and similarities between developmental plans and their impact on health system orientation were counted. The main difference in the planning of the two study periods is the orientation of the established governments; in the government of Pahlavi and modernization of the country happened based on the nation-state andlarge-scale decisions and policies, but in the government of the Islamic Republic, establishing social justice is the basis of large-scale policy making and the welfare of the people. It is also part of the realization of these goals. Another difference is that there was not a long history of programming in Pahlavi era and strategies for achieving goals, and development plans were often conducted with the guidance and involvement of European and American experts and planners. Moreover,hardware infrastructures, such as asphalt roads and railways, appropriate communication facilities, and software infrastructures, such as the level of education and desire to participate in the advancement of programs are very insignificant, and this impediment has been an obstacle to many of the development goals, especially in the field of health.. However, in the post-revolutionary period  due to the particular circumstances of the revolution, the thinking of the mid-term planning was abandoned (the sixth development plan was generally ignored), and attempts to approve the development plan had not survived until 1988, but development plans one after the other was developed internally by experts and, in some cases, by modeling afterother countries. Besides, the required hardware and software infrastructure was provided to a large extent, and implementation of health and medical programs was facilitated more easily.  the planning differences in the two pre and post-revolutionary phases is related to foreign relations and international conditions. In the second half of the year, with the exception of the short period after the nationalization of the oil industry, there was little international pressure on Iran’s economy. After 1332 the American influence onIran’s politics and economy, and financial advisers hasalways been advocating for a dependence on the United States after implementing the policies of the White Revolution. After the 1357 revolution, consideringthe anti-capitalist ideology of the revolutionary architect from the very first days of opposition to the United States and other influential countries, such as the Soviet ::::::::::::::union:::::::::::::: and the United Kingdom beganas a result. After the revolution,the country has always been subject to international tensions and pressures. The imposition of eight years of war, the confiscation of the properties of the state and the Iranian people in the United States, the adoption of a variety of economic, scientific, and military sanctions, and ultimately, the boycott of Iranian oil purchases over the past decade have been examples of the measures that have always been an obstacle to the implementation of development and justice promotion programs. The most important similarity of development planning and social policy before and after the revolution is the dependence of the program resources on the proceeds from the sale of oil, which is the main component of the development and development costs of oil money, and ithas two major consequences for the health system: The formation of the rentier government, the reduction of government accountability to the public ,the creation of uncertainty in the provision of resources for development programs, and the failure to implement many social policies, including health policies. The other similarity of the administrative system before and after the revolution is thatthe scope of the government’s involvement in the administration of state affairs and recruitment has had its roots in both corruption and ineffective administration. Finally, as it is the case in many developing countries, the share of health financing has been very low, and the efforts made to transfer part of health care to the private sector have not been so successful; hence, allocating more funding to the health sector can help improve the health of the people. After seven decades of development planning in Iran, despite the advances and changesmade in the health sector, equity in health, especially in the treatment sector, has not yet been achieved, and inequalities in access to health servicesstill exists, and its cost is high and has increased over the past decade, partly due to rising health care costs and the other part because of lower income levels and an increase in the gap between income groups, which is not reflected in the objectives of development plans in other headings, especially the economic headline. Therefore, the success of the implementation of health policy and the realization of social justice depends on developingprograms based on data and rational and realistic estimates, moving towards mixed plans (guiding grammar), and implementing fundamental structural reforms in social and economic planning.

Family physician program is one of the most important policies that has been proposed in the past decade in the field of health system. Hence the importance and necessity of studying it originate from the importance and the status of health in development and welfare of a society. Therefore, this study aims to investigate the status and the process of the implementation of the Family Physician Program in Iran's health system. This study answers these questions that what is the historical, legal and execution background of family physician program? And what are the challenges and obstacles to implement this program?
This research was a qualitative study applying the purposive sampling method . .Data were collected through applying interview and document analysis techniques. The data drawn by interview were analyzed using content analysis, which was based on coding.
Concurrent with detecting the historical, legal and execution background of the family physician program, executive barriers were identified based on four categories: “dependency of plans to person and the impact of management and government changes on the national program”, “challenges emanating from the way the tenth government supports family physician program”, “cultural challenges” and “illegality and lack of political determination and commitment of senior officials”.
Family physician program that has been gradually introduced in the health system since 2002 should have been implemented across Iran, according to the existing law such as the fourth and fifth development plans. However, in practice its implementation was limited to villages and two provinces of Fars and Mazandaran and with different procedures . This study showed that many of the economic, social, political and cultural conditions which had a key role in the success or failure of any program and should be taken into account in policy making were not satisfied.