مجله بیمه سلامت ایران
سال چهارم شماره 3 (پیاپی 14، پاییز 1400)

The status of coverage of pension funds and institutions for the support of the elderly, which is effective in promoting the health and social welfare of the elderly, their families and society as a whole, is one of the important issues in geriatrics. The desirable and effective benefit of this coverage for citizens is one of the characteristics of an advanced society and the birth of extensive changes in the development system of the countries. The purpose of this study is to identify the status of insurance pension coverage and support services for the elderly in different regions of the world in order to identify and compare the regions with the highest and lowest levels of this coverage.

The present study is a review study. The required statistics and information have been obtained through library and documentary methods and with reference to the statistical reports of the International Labor Organization and the World Social Security Union.

The highest rate of coverage in 2019 was in North America with 100% coverage and the lowest was in sub-Saharan Africa with 22.7% of insurance coverage and support for the elderly.

The results show a significant increase in the status of insurance coverage and support for the elderly, especially in recent years. A condition that has been upgraded from a low level of coverage to a high level. However, insurance coverage and support for the elderly are not the same all over the world, and there are many differences.

Due to the importance of distributive justice in health services, many studies have been conducted in Iran. However, the accuracy of the methodology of most of these studies indicates weaknesses and inaccuracies, and the results of some studies do not correspond to tangible facts; Therefore, in this critique, by evaluating the methodology of these studies, an attempt has been made to identify their weaknesses and introduce alternative solutions.

This is a critical study that was conducted in 2020 on 40 articles in the field of measuring the level of access and development with health indicators. The period of articles is from 2002 to 2019. To review the articles, first the full text of the article was received and read, according to the methodology and also according to their results, the article was reviewed. Frequent objections were then selected and corrected.

After reviewing the articles, 7 types of problems were in 3 categories, which are: correct identification of indicators (including number - grading - weight - type and unit - removal of overlaps), selection of tools Suitable for ranking and using complete and appropriate databases.

By using more comprehensive and complete indicators, more accurate calculation of indicators, and more appropriate methodology that calculates the weight of indicators correctly, More accurate results would be achieved.

People's health is always one of the most important factors in any society. It is clear that during illness, one of the things that can make the situation worse is the cost of treatment. Therefore, a basic strategy to increase health per capita, reduce stress and anxiety, as well as reduce costs, is the use of supplemental health insurance, which provides a safe margin for individuals to accelerate their recovery. The aim of this study was to investigate the factors affecting the intention to purchase supplementary health insurance.

The present study is applied in terms of purpose and in terms of descriptive-correlation method is based on structural equations and the partial least squares method has been used to analyze the data. The statistical population studied in this study were the clients of supplementary health insurance of Saman Insurance Company. A standard questionnaire was used to collect data.

The findings indicate that all independent research variables including employee ethics, customer engagement and perceived value with coefficients of 0.398, 0.685 and 0.343, respectively, have a significant effect on the intention to purchase supplementary health insurance. Accordingly, among the research variables, the variable of client mental involvement has the greatest impact on the intention to purchase supplementary health insurance and the effect of the perceived value variable is less than the other two variables.

Basic insurance package has a high coverage and reduces the perceived value of basic insurance for people. Supplemental health insurance is needed to cover surplus services to increase perceived value for clients. Due to the high mental involvement of customers, it is likely to increase the intention to purchase supplemental health insurance. Based on the findings of this study, insurance companies are suggested to have a specific plan on the ethical behavior of employees, customer mental involvement and perceived value to increase the intention to purchase supplementary health insurance.

Strategic purchasing in health services has been one of the basic components in improving performance and one of the most important issues in order to improve the health system in the world. Although the Ministry of Health and insurance organizations in Iran sometimes address the issue of strategic purchasing goals, it is not possible to achieve or even implement it due to existing problems. For this purpose, this study was conducted to identify the most important factors affecting the launch of strategic procurement of health services and its implementation in the treatment department of the Social Security Organization and to provide an applicable model.

This is a qualitative study that was conducted in 2020 to identify the factors affecting the implementation of strategic procurement of health services in the Social Security Organization and provide a local model in two stages. In the first step, semi-structured interviews were used to extract important factors in the field of strategic purchasing. In the second step, the Delphi method was used to determine the approval or non-approval of the factors influencing the strategic purchase in the Social Security Organization.

In this study, 6 subjects and 40 sub-subjects were extracted. The main topics of the research include: target groups, social structure, insurance structure, management and coordination of departments, knowledge and information systems and service providers. The two main issues of interest to experts were the target groups and the structure of insurance. The highest score of consensus among experts on the following topics included health needs assessment and prioritization of target groups, equitable allocation of resources, income level of covered individuals, and strategic purchasing discourse.

According to the model, most attention is paid to the role of target groups and insurance structure as a leader in purchasing health services and a suitable distributor of services. It is important that the Social Security Administration is able to communicate with providers and select the best providers and receive price information through competition in the most appropriate mechanism. Also, with this model, it can strategically purchase the best and most effective services for its insured individuals. The practical model presented in this article can help the development of health systems to overcome the existing obstacles in the implementation of strategic purchasing progress. This model meets the need for knowledge necessary for strategic purchasing of health services.

Decision making is the essence of managers' activities and is very important in all their tasks. For example, considering the importance of health, it is very important to study the factors affecting the decision-making of managers and decision-makers of the health system, including the Ministry of Health and Medical Education and affiliated organizations (including Iran Health Insurance) and medical universities. The main purpose of this study is to present the decision-making model of senior managers based on the lifestyle and the mediating role of political action.

The present study is descriptive-correlational in terms of applied purpose and in terms of data collection method. The statistical population of the present study was the senior executives of Fars province. A standard questionnaire was used to collect information. Smart-pls3 software was used to analyze the data.

The results of path analysis showed that lifestyle has a significant effect on political action (Path coefficient = 0.718, P = 0.001). Also, political action has a significant effect on the decision-making style of senior executives (Path coefficient = 0.510, P = 0.001).

Managers, including the Ministry of Health, affiliated organizations, and universities, generally make decisions that are guided by their personal lifestyle and subsequent political teachings. Even if managers deny that their decisions are free from the origins of lifestyle and political affiliation and party currents, what they do make in practice has been shown to be strongly dependent on lifestyle background mediated by political affiliation. In the light of this conclusion, the issue of conflict of interest in sectors such as the health system and health insurance can be justified.

The growth of the elderly population is one of the most important and prominent issues in today’s societies. One of the consequences of an aging population is the effects it has on health spending, which in some countries accounts for a significant portion of government spending. The purpose of this study is to compare the elderly services management system in the selected countries of this study with Iran in terms of policy, planning, financing and organizational structure in providing elderly services.

The present study was a review-comparative study on qualitative studies in 1399. Library method was used to collect data. The study population is all articles related to the research topic. In order to conduct information research by reading texts from the library, the websites of related organizations in selected countries in line with research questions and systematic search based on keywords based on aging, aging services management, aging management strategies and financing from reputable databases and Specializations in English and Persian languages were collected between 1998 and 2019 and were evaluated and compared in a comparative table of areas. Systematic search based on related keywords Scopus, Science Direct, PupMed and Google scholar along with national databases including SID, IRANDOC, ISC. Out of 128 identified sources, the researcher reviewed and evaluated their content according to the research strategy, and finally, after removing 81 of them for reasons such as duplication, irrelevance, etc., 47 articles remained for final analysis.

Aging system policy in all selected countries (US, UK, Japan, Korea and Italy) has been centralized in a way that using regional, provincial or state-based planning using public tax financing systems, funds Insurance, the national medicine system, by defining the target population and specific service packages, plays an effective role in providing quality and accessible services to the elderly. The provision of services in these countries is integrated (health, medical and social welfare) and Providing care services for them is free.

It is suggested to use the experiences of successful countries in the field of aging management, by creating an integrated and centralized policy system in the dimensions of health and social welfare; Relying on sustainable financing from public taxes, labeled taxes and old-age insurance premiums and reforming planning structures in providing and receiving services, the level of effectiveness and efficiency of old-age management can be improved.