Journal of Evidence Based Health Policy, Management and Economics
Volume:4 Issue: 1, Mar 2020

  Managers can avoid waste in resources and provide valuable insight by studying the variables associated with the costs in the intensive care units (ICU). The aim of this study was to evaluate the variable costs of ICUs and factors that contribute to cost structure in Iran.

A retrospective micro-costing method was performed on 468 admissions with a length of stay ≥ 24 hours in ICUs in a university hospital in 2017. The variable costs were consumables, laboratory tests, and medicines. The IBM SPSS24software was used to analyze the data.

The variable costs per ICU day and patient were $94.14 and $1,309, respectively, and the total variable cost was $612,641. The costs for consumables, laboratory tests, and medicine were responsible for 19 %, 27 %, and 54 % of the variable costs, respectively. The average variable costs for non-survivors were 2.5 times higher than the other variables. Medicine was the key driver of costs in all ICUs. Overall, antibiotics, blood derivatives, blood biochemistry, blood group & Rh, cutter, and tracheal intubation had the highest costs.

To reduce the costs, national standard treatment guidelines and essential medicine lists based on treatments of the choice should be revised. Patients who are in the final stages of a terminal illness can continue their treatment at home-based care or alternative cares such as palliative to reduce the hospital costs.

The operating room staff is exposed to stress due to the frequent contacts with patients, which may ultimately leads to burnout. The aim of this study was to determine burnout and its related factors among the operating room staff in teaching hospitals affiliated with the Isfahan University of Medical Sciencesin 2018.

The present quantitative and qualitative study was conducted in Isfahan. In the quantitative phase, 206 employees were selected by simple random sampling method and data were analyzed by SPSS23 using descriptive statistics, one-way ANOVA, t-test, and other related tests.  Data were collected by “Demographic form” and “Maslach Burnout Inventory” (MBI) questionnaires.  In the qualitative phase, data were collected by conducting interviews with 20 participants including managers, supervisors, and matrons of the operating roomby using MAXQDA12. Software.

Results showed that the demographic variables had a significant relationship with burnout variable and its dimensions. Work experience and academic degree had a significant relationship with depersonalization (P-value < 0.05). According to the multiple linear regression, academic degree had the highest predictive power for depersonalization. In the qualitative phase, three factors associated with burnout included: internal factors of organization, external factors of organization and individual and personal factors of organization.

Burnout affects the staff's efficiency and performance in the operating room. Therefore, managers must provide programs to reduce burnout among the staff, so that they can provide high-quality services and reduce costs.

The uneven distribution of human resources in the health sector, especially in the medical profession, is a global phenomenon that poses a significant challenge to the population's access to quality health services. The aim of this study was to investigate the influencing factors on the retention of specialists and subspecialists working in training hospitals of Qazvin University of Medical Sciences in order to provide appropriate suggestions and practical solutions to increase their chances of survival in these areas.

This research is a descriptive-analytical study using conjoint analysis technique conducted between 2017 and 2018 among physicians. The study was conducted among 109 physicians who met the inclusion criteria of the study. DCE questionnaire was used to collect the research data. The collected data were entered into STATA software version 13 for statistical analysis and were statistically analyzed by Probit and Logistic regression models.

The results show that the probability of physicians' retention in the city of work is 1.2 times higher if they were allowed to work in the private sector (β = 1.2). Providing proximity to the family also doubles the chances of physicians' retention (β = 2.2). Provision of adequate educational facilities (β = 1.07), moderate clinical facilities (β = 1.18) and favorable accommodations (β = 1.12) also increase the likelihood of physicians' retention in the workplace.

Considering all factors identified as the preferences of physicians due to the limitations of resources and the existing legal requirements cannot be applied in planning and policy making in the field of health care. However, being aware of these factors and then considering legal considerations that are considered mandatory by the Ministry of Health and Medical Education can greatly help in making effective policies in the area of physician retention.

Insurances are the most important financial sources of hospitals but sometimes insurance companies deduct amounts as deductions from the sum of requested amounts after investigating financial documents sent to hospitals monthly. The current study aims at determining the level and reasons for insurance bill deductions in AL Zahra Hospital in Isfahan.

This applied study is descriptive-cross sectional in method and has been conducted retrospectively. The statistical population of this study contained file information of hospitalized patients who have been referred to Isfahan AL Zahra Hospital in 2016. The sample size determined by Cochran Formula and 400 files has been investigated. Random sampling employed. The information has been extracted from patients through a checklist whose reliability and validity has been confirmed by insurance experts and management specialists. Qualitative methods of interview used to identify the most important reasons for increasing the deduction sums and statistical indices and descriptive scales (frequency, percent etc) have been analyzed. 

The most and the least percent of insurance deductions are related to Armed Forces Insurance (36.8 %) and Social Security Insurance Organization (3.64 %) respectively. Also, the most deductions of hospitalized files were related to visiting deductions of hospitalized patients’ doctor and drug and consumables deduction, other services, surgeon and anesthetist commission, experiments and pathology, radiology and sonography are in next rates and the least deductions is related to doctors 2k visit cost, hoteling, and surgery room. 

According to high percent of insurance deductions and investigation of its reasons, it has been revealed that hospitalized files related to visit by resident year 1 and 2 and absence of resident physician in center and the academic status of hospital that managers have to clarify this issue and use residents year 3 and 4, attending and resident physicians to reduce difference between hospitals and insurance companies and consider documentation as one of main elements of their agenda. So training all individuals who are influential on patients’ bills such as doctors and nurses is essential.

Hospitals are one of the greatest and most costly operational units of the health system and a study on its performance may be a criterion for operation and efficiency assessment of its resource consumption. The present study was done in 2017 with the purpose of assessing technical efficiency of the selected hospital under the coverage of Yazd University of Medical Sciences using Data Envelopment Analysis (DEA) in context of Health Reform Plan.

This research is a descriptive-analytical study was done in 2017. In this research in order to determine assessing the efficiency of Yazd University of Medical Sciences hospitals, 10 hospitals affiliated with this university were chosen. To collect data the information collection form including specifications of hospital as well as input and output index is used and the data before and after executing Health Reform Plan were collected and compared. The input-oriented DEA method is used for estimating technical efficiency of hospitals and data analysis is done by DEAP software and two-sample paired-t test SPSS21.

The average of hospitals that have been studied before and after the reform plan is 0.985 and 0.990 respectively. In management efficiency, it is respectively 0.986 and 0.992 before and after the reform plan and the efficiency average of the hospital's scale before and after executing the health reform plan is respectively 0.999 and 0.997. There is no meaningful relationship observed between hospitals' efficiency grades before and after the reform plan in these three technical, management and scale types of efficiency (P-value > 0.05).

According to results we could say the efficiency of the hospitals was not so affected by reform plan. It is recommended to assess the efficiency of the Stochastic Frontier Analysis (SFA) method on a linear basis in addition to identifying indexes that are effective in efficiency of hospitals.

Resource generation in health system provides mechanisms for training efficient and effective workforce and supplies facilities and equipment for delivering health services. Iran’s Health Transformation Plan is one of the major reforms implemented in 2014 designed to realize the scientific authority of the country among the countries in the region in horizon 2025 (Solar Year 1404). Therefore, the state of function of resource generation in the areas of education, research, and infrastructure suitable for provision of health services may provide valuable policy implications for informed decision-making. Therefore, the status of resource generation in the areas of education, research and infrastructure (focusing on human resources and medicine as two expensive and effective drivers) from the lens of productivity and equity can provide invaluable policy implications for informed decision-making. The function of resource generation in the three areas of education, research, and infrastructures of human resources and medicine in health system encounters many challenges in terms of productivity and equity. In this perspective paper, besides assessing these challenges in the light of available research evidence, it has been tried to identify these and aimed to suggest several policy recommendations in these areas for improving evidence-based policymaking.

Organizations usually seek for decreasing problems such as slacking and aggression and increase the behaviors that lead to a benefit such as productivity for the organization. One of the factors creating productivity in the organization is organizational citizenship behavior. Therefore, this research is aimed at investigating the relationship between organizational citizenship behavior and human resources productivity in the selected hospitals of ShahidSadoughi University of Medical Sciences in Yazd, 2018.

This research is a descriptive correlation study. The population includes the staff of three selected hospitals in Yazd. Out of the mentioned population, 211 people were selected by random sampling. Data collection tool was a standard questionnaire. Reliability and validity of the tool have been already approved in a similar study. The questionnaire consists of two parts including: organizational citizenship behavior, , and human resources productivity. Data analysis was done by Pearson correlation, regression, t-test, and analysis of variance in SPSS16.

The mean total scores of organizational citizenship behavior and human resources productivity were 3.06 ± 0.32 and 3.50 ± 0.62, respectively. The investigation of the mean scores of organizational citizenship behavior in each aspect indicated that the highest mean score, 4.11 ± 0.54, belonged to altruism and the lowest, 1.58 ± 0.75, belonged to sportsmanship. Among the various aspects of human resources productivity, the highest mean score was for competency, 3.89 ± 0.55, and the lowest was obtained for support, 3.22 ± 0.57. Based on the employees’ perspectives, there was a positive and significant relationship between OCB and human resources productivity (P-value < 0.001 and r = 0.297).

OCBhas a direct effect on resources productivity based on the staff viewpoints in educational hospitals. So, providing the opportunity of promotion of organizational citizenship behaviors can be an effective factor in increasing human resources productivity.

Self-efficacy and spiritual beliefs can be considered as strong motives for improving the quality of working. Due to the different job description and environment than other service sectors, medical centers need to pay attention to these factors. So, the present study is aimed at identifying the effect of spiritual intelligence components on self-efficacy among operational staff of Qazvin medical centers.

The present research is a descriptive-analytical and cross-sectional study conducted in 2019. About 238 people were selected by stratified sampling out of the medical centers staff in Qazvin, Iran. Spiritual intelligence was measured by King’s questionnaire including four dimensions, and self-efficacy was measured by Sherer’s questionnaires including three dimensions. Primary data analysis was done by Pearson’s correlation test in SPSS20 software, and path analysis was done by structural equation modeling in AMOS software with the significance level of 0.05.

There was a significant direct relationship between all dimensions of self-efficacy and spiritual intelligence except persistence in the face of adversity and consciousness expansion (P-value ˂ 0.01). All the relationships were significant in path analysis of the final model. Also, the fit indices including NFI = 0.901, RMSEA = 0.055, GFI = 0.923, and
CFI = 0.913 suggest the good fitness of the final model.

The managers of the studied hospitals can promote
self-efficacy in clinical staff and improve their performance and behavior in service provision by psychological enrichment of the staff and raising their spiritual intelligence.