جستجوی مقالات مرتبط با کلیدواژه "نظام سلامت ایران" در نشریات گروه "پزشکی"

Dear Editor,
Climate change is one of the most important challenges of the current century. High temperatures, ice melting, sea level rise, floods, droughts and wildfires are the consequences of climate change. Climate change affects human health directly by changing weather patterns (extreme heat, floods, hurricanes, storms and droughts) and indirectly by changing the quality of water, air and food. Climate change increases the risk of respiratory and cardiovascular diseases; food, water and vector borne illnesses; infectious diseases, injuries and premature deaths.
Iran is very vulnerable to climate change due to its geographical location, dry and semi-arid weather conditions (80%) and economic structure. Iran's health system is facing the double challenge of dealing with the human impacts of climate change and reducing its significant contribution to the country's carbon footprint. As a result, the country's health system should be adaptive and resilient to climate change to decrease vulnerability and increase adaptive capacity and ensure continued health services. Therefore, Ministry of Health should formulate national strategic and operational plans to strengthen the adaptability and resilience of the country's health system to climate change. Such plans provide a roadmap for healthcare policymakers, managers and employees to protect and improve people's health in unstable and changing weather conditions.

The health financing system is "the process of collecting, pooling and managing financial resources and purchasing healthcare services”. Iran's health financing system is facing challenges. The aim of this study was to evaluate the Iranian health financing system.        

This descriptive study retrospectively evaluated the health financing system of Iran between 2000 and 2019 using archival data. Data were collected from the World Bank website and analyzed using the Excel software.

Iran's health expenditure per capita increased by 3.7% annually between 2000 and 2019 and reached $868 (purchasing power parity) in 2019. Iran's total health expenditure increased from $32 billion in 2000 to $72 billion (purchasing power parity) in 2019 (5.9% annual increase). Iran accounted for about 0.6% of the world total health expenditure in 2019. In that year about 6.7% of the country's gross domestic product was spent on health, the global average being 9.8%, while the general government health expenditure (% of the then current health expenditure) in Iran and the world were 49.5% and 59.8%, respectively. Out-of-pocket expenditure (% of the then current health expenditure) decreased in the last decade in Iran, reaching 39.5% in 2019, compared to 18% worldwide.

Iran’s health system costs are increasing at a faster rate than the growth of its Gross Domestic Product (GDP). The country’s health expenditure (% of GDP) and, as a result, the general government health expenditure (% of general government expenditures) has decreased and out-of-pocket expenditure (% of current health expenditures) has increased. Therefore, reforms should be implemented to strengthen the country's health financing system.

One of the important goals in health policy is to ensure equity in health. Equity in health means absence of systematic and potentially remediable differences in one or more aspects of health in a population and economic, social, demographic and geographic subgroups.

This study was conducted by reviewing available scientific literature and texts and examining articles, theses, reports and resources available in internal and external databases and the conference held by the Academy of Medical Sciences by using relevant

  Analysis of the studies showed that the progress of the index of the policies of the health sector has not been able to create a significant change in the direction of improving equity. Discrimination in service coverage, gender discrimination, access to services in remote areas and lack of health services in low-income groups still exist despite the 40-year achievements of the revolution and emphasis on this issue in the first to fifth development programs. Although the transformation plan was able to reduce costs of inpatient services, the costs of justice in financial participation and the index of health costs of the poor is high.

Recurring budget deficit in the health sector shows the instability of the financial resources of this sector. The inconsistencies between the Ministry of Health and Medical Education and the Ministry of Economy and Welfare are effective in not achieving justice in health.One of the approaches to improve indicators and control costs in all societies, whether rich or poor, is management of limited health resources. According to the law of the fifth development plan, full implementation of the family physician program, the referral system, and expansion of insurance coverage can help improve equity in health and reduce costs for the public.

 The health financing system is the process of collecting, pooling and managing financial resources to purchase health services. Sustainable financing of the Iranian health system is crucial for achieving universal health coverage. The purpose of this study was to identify strategies for sustainable financing of the Iranian health system.

 This study was conducted using the scoping review in 2020. The following databases and search engines were searched systematically between 21.03.2002 and 21.09.2020 to find studies related to sustainable financing strategies for the Iranian health system: PubMed, Web of Science, Scopus and Embase, Magiran, Iranmedex and SID databases, and two search engines; i.e., "Google" and "Google scholar”. Finally, 47 studies were selected and analyzed using the MAXQDA software and the framework analysis method.

A total of 40 strategies were identified for strengthening the sustainability of Iranchr('39')s health financing system, which were grouped into three categories: collecting funds, pooling funds and purchasing health services. The most frequently cited strategies for sustainable financing of the Iranian health system were the following: increasing the health share of gross domestics product, expanding tax revenues, pre-payment methods of health financing, strengthening public-private partnership, increasing the efficiency of the health system, reducing health system costs, consolidating insurance funds, eliminating insurance overlaps, value-based health service tariffs, optimizing health services support packages, and fixed payment methods based on  the performance of the health service providers.

The Iranchr('39')s health financing system must be strengthened in such a way as to make it possible to collect, pool and manage sufficient financial resources to be used to purchase health services for the people to ultimately ensure universal health coverage leading to the promotion of the public’s health.

Providing unnecessary services in health systems is common, costly and even harmful. The purpose of this study was to investigate the attitudes of physicians towards the use of unnecessary tests and processes.

The present study was a cross-sectional research. The study population was all physicians working in the health department of Tabriz. Sampling was performed using proportional random sampling method. Data were collected over a period of 6 months. The collected data were entered into SPSS software version 22 and the frequency and percentage of each dimension of the questionnaire were reported.

41% of the participants were female and the mean age of the participants was 43 years. Almost half of the physicians considered the existence of unnecessary services in the Iranian health system as a serious problem (45.8%). However, 33% of physicians state that if a patient requests an unnecessary service, they will prescribe that service with the necessary recommendations. Paying attention to patient safety is one of the most important reasons for not prescribing an unnecessary service (44%). A small percentage of physicians (25%) always talk to patients about unnecessary service costs. Existence of clear and evidence-based clinical guidelines (42.8%) and changing the financing system and rewarding for not using unnecessary tests or processes (36.1%) were cited as influential factors by physicians.

In general, physicianschr('39') attitudes toward non-essential services were moderate. Holding training courses to increase the awareness and attitude of physicians can be effective in raising the attitude.

 The Family Physician Program, one of the most important efforts of the Iran health system to establish a referral system, was developed and implemented in several provinces, but it faced challenges due to several reasons that prevented the programchr('39')s progress. So This study was conducted to analyze the family physician program to identify the causes and challenges of the program failure.

 This retrospective study of policy analysis is a qualitative study with Purposive sampling. Semi-open interviews and document analysis were used for data collection. Data analysis was performed through thematic analysis in the policy triangle framework using MAXQDA software.

 According to the study framework, the challenges of the Family Physician Program in the context are conflict of interest, dependency of plans to oneself, instability in management and plans, insufficient attention to culture, resources, and infrastructure. In terms of content include disproportionate executive approach, Lack of localization, selection of inappropriate tools, insufficient transparency, and ambiguity in goals, tasks, and responsibilities; The challenges of the process were examined based on the policy cycle.

 The implementation of the family physician program is influenced by cultural, social, political, managerial, and economic factors. As the Ministry of Health officials has re-introduced this crucial program, reviewing the content and methods of program implementation seems necessary.

The health system financing is the process of collecting, pooling and managing financial resources and purchasing healthcare services. Health financing plays an important role in achieving the health system goals. The aim of this study was to strategically analyze the Iranian health financing system and recommend strategies to strengthen it.

The method in this research was the scoping review method. All the published studies about strengths, weaknesses, opportunities and threats of the Iranian health financing system were, using suitable keywords, searched in databases including "PubMed", "Scopus", "Science Direct", "Embase", "ProQuest", "SID" and "Magiran", as well as  the "National Database of Medical Science Theses" and two search engines, namely, "Google" and "Google scholar". Finally, 29 studies were selected and anlyzed using the framework analysis method, the software being MAXQDA. 

Increased population health insurance coverage, reduced out-of-pocket payments following the national health transformation plan, and increased healthcare tariffs were found to be the strengths of the Iranian health financing system. On the other hand, regressive financing, high out-of-pocket payments and increased health insurance funds were weaknesses of the national Iranian health financing system. Political sanctions, financial crises and increased healthcare demands by consumers were the threats, while supportive laws, the NGO’s financial participation/support, increased health services delivery centers and modern technologies were among the important opportunities in the health financing system. Increasing the health system financial resources through prepayments, structural and policy unification of health insurance system, health service tariff reform and increasing health system efficiency were found to be essential to strengthen the Iranian health financing system.

The Iranian health financing system is not resilient and faces several challenges. The health system policy-makers and senior managers should adopt the recommended strategies to strengthen the national health financing system.

For achievement of equity in the population health the implementation of health in all policies is essential. The most crucial intervention in this approach is inter-sectoral collaboration. 

This was a qualitative study based on the national policy framework. Data were collected using literature review, in-depth interviews and focus group discussions with the stakeholders. The results were categorized into three sections, namely, situational analysis and factors affecting it, developing goals and objectives, and requirements and interventions.

Currently inter-sectoral collaboration in the Iranian health system potentially allows to have health in all policies policy in terms of explicit legislative support, national macro-policies/upstream documents and organizational structure. It will require proper planning as regards designing and institutionalizing appropriate mechanisms for collaboration, as well as cultural and skills capacity building, for stakeholders within and outside the health sector.

The findings of this study can be used in annual operational planning of the High Council of Health and Food Security secretariat.

Donors can contribute to the funding, resource generation, and provision of healthcare services in the Iran health system. Several factors can influence the donors’ contribution to the health system. This study aimed to explain and predict the donors’ participation in the Iran health system.

A qualitative and inductive study was performed using semi-structured interviews with 38 donors and 26 policymakers and managers in the Social Affairs Department of the Ministry of Health and the Universities of Medical Sciences in 2018. The interviewees were recruited using a purposeful and snowball method. The thematic content analysis method was used for data analysis. All major ethical considerations were observed in this research.

Healthcare donors followed a purposeful and planned behavior for contributing to the health system. Nine factors can influence a donor’s charitable behavior in the health system, including goal, intention, attitude, norms (ethical, descriptive, and subjective norms), personal characteristics, background knowledge, experience, past behavior, and control of perceived behavior. The donors’ participation in the health system is a function of their goals, intentions, attitudes, and their control of perceived behavior. The donors’ attitude is shaped by their characters, background knowledge, experience, past behavior, and ethical, descriptive, and subjective norms.

The purposeful and planned behavior model developed in this study guides healthcare managers and policymakers in explaining and predicting the donors’ charitable behavior in the health system.

Tackling inequity in health is one of the main objectives of health systems. The aim of this study was to assess the achievements and challenges, as well as solutions, in reaching the equity in health in Iran. This study was conducted using a qualitative approach. Data were gathered by reviewing documents and conducting focused group discussions with the stakeholders. The analyzed data were categorized into three groups including achievements, challenges, and solutions. The Iranian health system has achieved many successes in the past 10 years including expanding the primary healthcare networks to city outskirts, implementing the family physician program (urban and rural), implementing the Health Transformation Plan (HTP) and subsequent decrease in catastrophic and impoverishing health expenditures, and increasing the public access to health information and subsequent responsiveness of policymakers. However, some factors hindered further achievements, including the absent or incomplete implementation of laws and practical policies, insufficient attention to the social determinants of health, and poor designing and implementation of the health annex for the policies. It seems that there are little problems in legislation and policymaking in the country and the laws are almost compatible with the recommendations of the World Health Organization, aiming at the inequity reduction in health. However, there is a gap between the policymaking/legislation and the practice. In other words, legislation is poorly practicable and the principles of good governance, including attracting the participation and cooperation of stakeholders, are not fully respected.

The World Health Organization (WHO) has introduced palliative care as a way to improve the quality of life of patients with incurable diseases and their families. This care begins with the diagnosis of the disease, and continues throughout the illness (1). Palliative care improves the quality of life of patients with life-threatening diseases and their families. Its purpose is to relieve suffering through the identification, evaluation, and relief of pain and other physical, psychosocial and spiritual problems (2).
Palliative care is required for many diseases. According to reports, every year about 40 million people in the world need palliative care, but only 14% of them receive it, of whom 78% live in low-income or middle-income countries. According to the World Health Organization, patients who require palliative care services, suffer from cardiovascular diseases (38.5%), cancer (34%), chronic pulmonary diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Other patients with diseases, such as dementia, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological diseases, congenital anomalies, and resistant tuberculosis may also need palliative care services (1). Palliative care can be offered to patients through various models, including hospital-based palliative care, hospice-based palliative care and home-based palliative care (3). Studies have shown that home-based palliative care has a very beneficial effect on the physical, mental, psychological, social and economic dimensions of patient’s life, and reduces the cost of health system, shortens the length of hospitalization, reduces hospital complications and prevents hospital readmission (4-6). This type of care also facilitates the continuity of post-discharge care and helps patient to easily benefit from the facilities of different centers (7). On the other hand, most people prefer to receive care at their homes with their families (8). Studies have shown that home-based palliative care is clinically and economically effective and leads to the satisfaction of patients and their families. Also, the World Health Organization in 2014 has introduced home-based palliative care as one of the main elements of the health systems all around the world (1). However, reports indicate that many countries in the world do not have palliative care programs in their health care system (7), and the lack of government support for palliative care services, lack of prepared professional staff to provide palliative services, limitation in access to narcotic analgesics, resource constraints, lack of policy-makers’ familiarity with palliative medicine, the negative attitude of society towards palliative care and socio-cultural issues have been mentioned as barriers to palliative care in the world (1, 9,10).
Iran’s health system is faced with increasing number of chronic patients and shortages of manpower and ICU beds in health centers. Most patients with life-threatening diseases in Iran are frequently admitted to hospital during the last days of their lives. Despite the shortage of hospital beds, especially in the critical care units, these patients occupy these beds and receive specialized medications until the end of their lives and eventually many of these patients die on ICU beds in hospital (11). While in many cases, hospitalization of incurable patients in critical care units does not have any positive effects on patients’ recovery, and is considered a futile care (12), which increases the costs of health system, poses financial burden on patient’s family, and leads to dissatisfaction and work burnout in healthcare staff (13). On the other hand, many of these patients prefer to spend the last days of their lives at home with their family and be in close contact with their relatives. Evidence suggests that palliative care in Iran is only offered in isolated and limited centers. Most patients are deprived of this kind of care, and home-based palliative care does not have any place in Iran’s health system (14). Patients with incurable conditions who require palliative care services are lost in the system, and in most cases do not receive proper and timely services they need (15). Also, the traditional attitude of healthcare staff towards the management of incurable conditions, the lack of transparency in the protection of healthcare staff against discontinuation of unnecessary treatments or unreasonable expectations of patients and their families, as well as social and cultural differences are barriers to the promotion of palliative care in Iranian society. Another problem in providing home-based palliative care services is the defect in the payment process and insurance coverage of end-of-life patients (16,17). Therefore, given the high prevalence of chronic and incurable illnesses, the increasing number of elderly population, limited critical care beds, shortages of human resources, limited financial resources and equipment in health centers, and taking into account the benefits of home-based palliative care, healthcare system authorities should consider this care method to be one of the important priorities of the health system so that patients can maintain their quality of life and also experience peace during the last days of their lives. Considering the limited research in this field, further research is required on the management of various dimensions of home-based palliative care in order to provide suitable models for the provision of home-based palliative care services in Iran.

Objective (s): The aim of this study was to review literature on studies that estimate catastrophic health expenditures (CHE) for assessing equity in health financing in Iran. The PRISMA guideline was followed and several search engines including Google Scholar, Pubmed, Scopus, Magiran and SID were examined to restive relevant studies. We used health catastrophicexpenditure, catastrophic payment, equity, health and Iran as keywords. Literature review was conducted without time limitation in Persian and English documents. The initial search yielded 116 studies. After excluding duplicates and non-relevant studies, 38 articles were selected for full text analysis and finally 19 papers selected for this review. 21.1 % of the studies estimated catastrophic health expenditures in patients groups and others considered the whole populations in a distinct area. Estimation ranged from 2.5% to 72.5%. The range of estimations was very wide. It seems that CHE was influenced by the socioeconomic status of population studied, burden of diseases in different areas and sample size. The exact estimation of CHE is recommended in order to define and implement best solutions in improving the present situation.

In recent years، the financial relationship between the physician and the patient and some issues such as informal payments for health care have arisen as an unethical but common problem in many countries، including the Islamic Republic of Iran. Such issues are a threat to the professional reputation of physicians، and can have their own causes in different parts of the world. This study attempts to assess the causes of informal payments and the manners in which they are done in the hospitals of the Kerman Province in Iran in 2012. This study was carried out using qualitative research methods، and semi-structured interviews. Structured interviews were conducted on a purposeful sample of 45 participants including patients، providers and policy makers in the Kerman province in Iran in 2012. This study was authorized by the ethics committee of Kerman University of Medical Sciences، and the consent form was completed by all participants. In this study the participants were asked questions regarding reasons for informal payments، and data were analyzed using content analysis. There are several reasons for making informal payments، which include cultural، legal and quality factors. A number of reasons for asking informal payments by providers were discovered، including those related to tariffs، structural factors and ethical factors as well as to demonstrate the skill and competence of service providers. Most of the reasons discovered for informal payments in Iran are similar to other countries in the world. They showed that inadequate funding of the health systems and inadequate formal payments to providers are the most important supply-side factors leading to informal payments. Given that qualitative studies usually cover potential reasons only، further studies are needed to investigate the matter more extensively.