مجله تحقیقات نظام سلامت حکیم
سال بیست و دوم شماره 2 (پیاپی 85، تابستان 1398)

The design of each pay mechanism, theoretically, affects the behavior of providers and creates different responses. This study is a survey of the new Iranian performance-based payment method for the hospital staff (Recommendation 2014) and its possible effects on the behavior of staff and hospitals.

A qualitative study was conducted at two national and provincial levels using a documentary review, taking notes in meetings, and individual interviews (13 people at the ministry, university, and hospital levels). Content analysis was performed using MAXQDA V. 10 software, and the extraction of codes was thematic.

Aligning staff individual objectives with organizational performance; decentralization in employee administration; more predictability of staff costs; motivating to take care of more patients; reducing incentives for induced demand and insurance deductions; effect of three groups of individual, work-related, and functional factors on individual pay and gathering accurate information about the amount paid to employees in the country are the goals and potential positive effects of the program. Complexity, reciprocity of the program, postponement of payment to employees, and lack of transparency in the insurance deductions of each department were program problems.

Potentially, this program provides the right tools to meet the desired goals, however, it depends on the capacity of the executive directors. The postponement of employee payments is the biggest threat to the effects of this program.

Development plans define the goals and responsibilities of each sector of society in each area, and each governmental organization is achieving some of these goals. It is expected that, through appraisal of the program, executive managers across the country will be aware of the challenges of law enforcement and will be resolved for future periods.

This study was conducted based on the participatory evaluation model of programs and policies. The study was conducted in two parts: document analysis and views of experts. The data collection method was in-depth interviews, focused group discussions, and review of written and online documents that were analyzed by content analysis method.

Out of the 25 laws reviewed in the Fifth Development Plan, only three articles of law included the development of a desirable food basket for the Iranian community under article 34. The development of traditional medicine, article 34, the focus of policy, planning, and oversight health in the Ministry of Health has been fully implemented under article 36. Most of the provisions of the law have stopped at the first stage of drafting documents for the conversion of the law into force. The average progress score of the Fifth Development Plan with a different weight approach and different weight stages of the rules was calculated to be approximately 38%.

Considering the low level of implementation of the Fifth Development Plan, consideration of the reasons for the non-implementation of health laws in the country and the need for more periodic monitoring of the implementation of devices to monitor the components of health laws is suggested.

The performance evaluation of the health system is a method of measuring the success rate of this system in fulfilling its objectives.

The present study was conducted to measure the performance of the Health Reform Plan (HRP) in Ayatollah Taleghani Hospital, Tehran, Iran; in terms of reducing the expenses of inpatients and promoting natural childbirth using the balanced scorecard.

The present descriptive, analytical, and cross-sectional study was performed using the balanced scorecard and the data associated with 2010 - 2017, i.e., four years before to four years after implementing the HRP. The data collected were analyzed in SPSS V. 21 using the paired t-test.

Executing the HRP caused significant increases in the average hospitalization cost from 14439773 to 30966249 IRR, the number of natural deliveries from 283 to 455, the number of cesarean sections, the average basic health insurance coverage, the bed occupancy rate, the number of inpatients, the number of surgeries, the satisfaction of inpatients, and the number of nurses per special and ordinary beds. Moreover, this plan significantly reduced the patient share of hospitalization costs from 31.5% to 6.5%, the patient share of the cost of medication and medical supplies from 32% to 11.7%, and the average length of stay from 7.1 days to 6.5 days (P < 0.05).

The HRP has been able to take effective steps towards the financial protection of citizens in public teaching hospitals as its primary and most important objective. Indicators associated with reductions in inpatients’ expenses are recommended to be paid more attention and revised from the perspective of growth and learning, and promotion of natural childbirth indices from the perspectives of internal processes and customer appreciation.

To adopt the best strategies to reduce smoking, identifying the factors that affect the use of tobacco is needed. Socio-economic situation is one of these factors, and this study examines the effect of household characteristics and development indicators of the living area on the probability of smoking in urban households in Iran.

The methods used in this study consisted of Heckman two-step and panel data models. The required data has been extracted from the information of expense and income of Iranian households’ plan during the period of 1383 - 1393, central bank and statistical yearbooks.

Based on the results of the two-step Heckman model, the household size is directly related to smoking and education level of the head of household and home ownership inversely associated with tobacco consumption in the household. Also, in households where the head is male, there is a greater probability of smoking. With increasing household expenses (income), the probability of tobacco consumption increases. Estimated results of the panel model indicates that the increase in GDP per capita, price of consumer goods and services, and the proportion of college graduates in the population has been decreasing the effect on tobacco consumption. In addition, the increase in the ratio of the custodians of the Imam Khomeini Relief Foundation directly related to the proportion of households with tobacco use.

Implementing policies to improve the social and economic conditions of households and development indicators in different regions of the country can lead to a reduction in smoking.

The imbalance in the distribution of human resources in the health sector has provided different capabilities for the provinces of the country. Since knowledge of provincial capability is one of the necessary information bases for the proper planning of the country; a ranking of the provinces is important in terms of development.

This descriptive-applied and cross-sectional study was conducted in 2015. The statistical population consisted of 30 provinces in Iran. In this research, the level of enjoyment of health care services in the provinces was investigated, and after weighing 11 indicators using the Shannon entropy method, their ranking was performed using Maximin, Vikor, and Waspas techniques. Then, the overall ranking was performed using the mean rank, Borda, and Copeland methods. The taxonomy technique was employed to determine the degree of development of different provinces.

According to the results, Tehran, Khorasan Razavi and Fars ranked the first, second, and third, respectively. Qom, North Khorasan, and Ilam got the last three ranks, respectively.

In addition to the differences between provinces in accessing health facilities, the number of non-developed provinces is significant; planners and officials are suggested to allocate the funds according to the development level

Since society is the first respondent to every disaster, it is essential that the community’s ability to cope with such a situation increase. Given the importance of the role of society in the current approach to disaster risk management, the choice of the primary society is important in order to achieve greater success and acceptance in other societies. This study aimed to determine the importance of community selection criteria in community-based disaster risk management interventions.

Using the qualitative technique with the nominal group technique, community-based selection criteria for implementing a people-centered disaster management intervention from the viewpoint of the 12 different organizations in Kerman, which have been involved with risk management, have been developed through four stages of idea creation, idea registration, idea clarification, and prioritization, which was investigated.

In this study, 38 criteria for choosing a community were outlined in the idea of registration. At the stage of defining ideas, the four criteria were combined due to non-relevancy and five criteria due to similarities with other criteria. The remaining criteria are classified into four main categories: hazard and risk, organizational capacities, social capacities, and social indicators.

Due to resource constraints and the impossibility of implementing the program in all societies, it is necessary to define the criteria for selecting communities (as one of the stages of implementing a people-centered disaster management plan), by the matrix system, by rating the best locations from the target communities carefully, and according to the views society itself.

Considering the importance of complementary health insurance and the necessity of designing a supplementary insurance model for the health system of the country, the purpose of this study is to design a complementary health insurance model appropriate to the health system in Iran.

This is a comparative-qualitative study. In the first stage, the selected countries were identified and compared in comparative matrices in a comparative study on the various dimensions of complementary treatment insurance in these countries. Based on matrix results, questionnaire interviewing questions in dimensions (organization and management, population coverage, method of determining the premium, method of reimbursement of expenses, number of insured, and method of financing the insurance) was designed, and qualitative section was done by content analysis method of contract type. After conducting the interviews, the data were analyzed through content analysis method and MAXQDA V. 10 software.

Major challenges mentioned by the experts are organization and management, oversight mechanisms, information system, cultural issues, economic issues, the basis for population coverage, covered services, the method of determining the premium, and the method of reimbursement.

Paying attention to the challenges posed by the experts and determining the details of implementing a complementary health insurance model for Iran, and based on the experiences of lightweight countries in this field, the views of national experts can help supplement health insurance in the country.

The study of the health status in different regions of Iran is a basic step toward the optimal allocation of health resources to different regions. This study tried to determine the enjoyment level and equality in the distribution of health facilities in the counties of Isfahan province during the 5th development plan of Iran.

First, the enjoyment level of Isfahan counties was determined using the TOPSIS method. Then, the distribution of health facilities was evaluated for 23 counties during 2011 - 2015. The data used in this study were obtained from the statistical yearbook of Isfahan.

The counties of Isfahan province were not homogenous in terms of enjoyment level. The overall trend of the Gini coefficient was upward during the study period. The inequality in the distribution of health facilities increased by 38% from the beginning year of the plan to the last year of the study period so that the Gini coefficient was 0.255 in the first year of the plan and 0.353 in 2015.

The increased inequality in the distribution of health facilities indicated that the welfare of less-favored counties decreased compared to more developed counties during the fifth development plan. Hence, due to the intensification of inequality, especially in the final year of the plan, compensation for these inequalities can be put on the agenda of provincial health planners.