Introduction: Hepatitis is the most prevalent disease of liver, which is caused by different viruses, drugs, and other etiologic agents. Hepatitis C virus infection is one of the most important blood- borne viral hepatitis infections. Taking into consideration its considerable prevalence among injective drug users, assessment of the HCV infection status among prisoners is of special importance.

Methods: This cross-sectional study was carried out in prisons of 10 cities or provinces of Iran to determine the prevalence of contamination with HCV. Results of 8630 blood sample tests from prisoners who had been in prison for at least three months were studied and prevalence of contamination with HCV and its determinants like age and injective drug abuse were investigated.

Results: Frequency of contamination with HCV varied from 7.8% to 67.9% in prisons. Overall prevalence of contamination with HCV was 37.85% (95% CI: 36.8%-38.9%) in the studied prisons. There was an increase in percent of HCV disease with increase in age in almost all groups, and rate of contamination was significantly higher in age group of more than 30 years. There was also a significant relation between injective drug use and increase in prevalence of contamination with HCV.

Conclusion: Altogether, the results show that the prevalence of HCV is increasing among the Iranian prisoners. Since the high-risk behavior groups like the injective drug users are aggregated in prisons and standard precautions are not practiced, regular case finding, preventive measures, and facilitation of access of this high-risk population to treatment are recommended.

Hakim Research Journal 2008 11(1):1-8.

Introduction: During the past decade, neonatal mortality rate in Iran has not decreased satisfactorily. Regionalization of perinatal care services is a potential solution to improve the access of those in need to the best quality care within economic and administrative constraints. This study aims to develop a framework for optimized and efficient distribution of perinatal care services at different levels of care provision.

Methods: We utilized small area analysis in an iterative process to divide the country into service areas of Perinatal Care Regions (PCRs), to distribute three levels of perinatal services and hospital beds in PCRs, to minimize patients’ traveling distances, and to fit the facilities to the needs while incurring minimum changes to the current administrative borders and available infra-structure.

Results: We divided the country into 33 PCRs. A total of 1256 level-III (Neonatal Intensive Care Unit) beds and 3768 level-II neonatal beds were required in the country and distributed to the districts. One level-III district was designated as the center for each PCR. Sixty one districts were identified as level-III and 104 as level-II. Level-I and Ib districts were allocated to the nearest next level districts. Our proposed model decreased the average distance of districts from the center from 125 to 109 km. The average distance and the distance weighted by population of the districts from the PCR center also reduced to 79 and 42 km, respectively.

Conclusion: Our model reduced the distance between levels of care provision and balanced the care facilities with population needs at the district level. Implementing this model requires resources. It may encounter some resistance in practice. Such resistance should be tackled with setting regulations, monitoring, training, advocacy, and appropriate incentives. A sustainable national regionalization model should be developed centrally, and customized to the specific needs and circumstances of each region.

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  Hakim Research Journal 2008 11(2): 1- 11.

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  Methods of Resource Allocation Based on Needs in Health Systems, and Exploring the Current Iranian Resource Allocation System

  Yousefi M¹ (MSc) Akbari Sari A * ¹ (MD, PhD) Arab M¹ (PhD), Oliaeemanesh A² (MD, PhD)

  ¹ Department of Health Management and Economics, School of Public Health and Centre

  For Knowledge Translation, Tehran University of Medical Sciences, Tehran, Iran

  ² Department of Health Economics, Iranian Ministry of Health and Medical Education, Tehran, Iran

  Received: 10 Apr 2010, Accepted: 24 Jun 2010

  Abstract

  Introduction: This study aims to explore the applicability of a needs-based resource allocation method in Iran and to compare healthcare resources currently allocated to Iranian provinces using this method.

  Methods: MEDLINE and Google Scholar were searched and experts were contacted to identify methods of resource allocation based on needs in addition, experts were interviewed to explore which methods are more appropriate in Iran according to the level and accuracy of data available. A combination of indicators was used to estimate the relative amount of resources each province should receive and compare it with the exact amount each province received.

  Results: The main indicators were population, mortality rate, socio-economic indicators, costs of prevalent diseases, extra costs for rural areas, previous budget, costs of family physician services, hospital services and drugs. In Iran reliable data about population, mortality and the level of deprivation is available for each province. Comparing the two methods, 12 provinces have received a relatively high budget, 14 a relatively low budget and in 4 provinces the budget was relatively balanced.

  Conclusion: Using a good combination of indicators has the potential to improve allocation of Iran’s healthcare resources based on needs. There are currently significant differences between the amount of budget allocated to each Iranian province and the amount should have been allocated according to the needs-based method used in this study. This method has the potential to be further developed for allocating resources, although any change should be implemented gradually and over time.

  Key words: National Health Programs, Health Policy, Resource Allocation, Health Care Rationing, Iran

  Hakim Research Journal 2010 13(2): 80- 90.

  * Corresponding Author: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Keshavarz Blvd, Tehran, Iran. Tel/Fax: +98- 21- 88989129, Email: akbarisari@tums.ac.ir

    Ahmadi AM¹ (PhD), Assari A² (PhD), Yousefi M³ * (PhD student), Fazaeli S⁴ (PhD Student), Maleki B² (PhD student)

  ¹ Department of Iranian Economic and Development , Economic Research Institute , Tarbiat Modares University, Tehran, Iran

  ² Department of Development and Economic Planning , School of Management & Economics ,

  Tarbiat Modares University, Tehran, Iran

  ³ Department of Public Healthcare Management , School of Health , Mashhad University of Medical Sciences, Mashhad, Iran

  ⁴ Department of Medical Records , School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

  Received: 4 Jan 2012, Accepted: 17 Aug 2012

  Abstract

  Introduction: Distribution of professional human resources in health sector is an important issue. This study aimed to propose an appropriate need-based model in order to apply in distribution of professional human resources.

  Methods: In this descriptive study, using four selected criteria in the field of professional human resources distribution, four levels of need to professional human resources in each region were determined. Using the benchmarking of four tax systems, appropriate payment methods for each level were proposed. 

  Results: The best method of payment for the first level, in which most professional human resources are needed, was progressive method. For the second, third, and fourth levels that have respectively lower scores, proportion, per capita, and regressive methods were recommended.

  Conclusion: Creating a purposive economic incentive for need-based distribution of professional human resources in the health sector is a main challenge. Our proposed model in this study could partly solve the problem. Further studies on this model, creating legal requirements, and using appropriate information systems are recommended to take more advantages of this model.

  Key words: n eed-based distribution, professional human resources, health sector, tax system

  Please cite this article as follows:

  Ahmadi AM, Assari A, Yousefi M, Fazaeli S, Maleki B. Proposing a Need-based Model to Distribute Professional Human Resources in Health Sector Using Benchmarking of Various Tax Systems. Hakim Research Journal 2012 15(3): 221- 228.

  * Corresponding Author: Mashhad, Mashhad University of Medical Sciences, School of Health, Department of Health and Management. Tel: +98- 511- 8544643, Fax: +98- 511- 8517505, E-mail: mehdiyousefy@gmail.com

Simulating the financial health system of Health insurance with System dynamics approach

Yousefi Nezhad V (MA), Izadbakhsh H* (PhD), Ghanbar Tehrani N (PhD), Ataeipoor S (MA)

Industrial Engineering Department, Engineering College, Kharazmi University, Tehran, Iran

Original Article

Received: 27 Aug 2015, Accepted: 14 Dec 2015

Abstract

Introduction: The health is one of the main priorities of life which its maintenance and improvement in the social welfare and sustainable development is necessary. Health insurance is one of the ways which people has developed to deal with health care costs. The effective and the efficient use of financial resource is one of the major challenges to achieve the goals of health insurance. The aim of this paper is simulation of the financial system of health insurance according to its resources and uses to predict the health insurance condition in forthcoming years.

Methods: A systematic approach is a formulated method for the analysis of system components with causal relationships and logical infrastructure. Causal loops enable users to easily interact with the system feedback and its main assumptions. In this paper the simulation model of health care financing system and influencing factors using system dynamics approach was designed. In addition to the literature review, the semi-structured interviews were conducted with experts of health insurance, and the factors influencing the financial system were identified, and the causal and stock flow model simulation was implemented using Vensim software.

Results: The results of simulations model revealed that insurance organizations will face with shortage of funding resources in future, and reimbursement of medical expenses indicating a deep financial gap in insurance organization in forthcoming years.

Conclusion: The simulated model resulted from this study could help to the researchers, the managers, the policy-makers and the decision-makers to predict the health insurance funds condition in the future, and make a better decision, assuming consistent current trends.

Key words: System dynamics, Financial systems, Health insurance, Casual loop diagram, Stock flow diagram.

Please cite this article as follows:

Yousefi Nezhad V, Izadbakhsh H, Ghanbar Tehrani N, Ataeipoor S. Simulating the financial health system of Health insurance with System dynamics approach. Hakim Health Sys Res 2016; 18(4): 306- 315.

Introduction: One of the interesting and challenging topics in healthcare systems is the methods of financing the costs of patient treatment. During the COVID-19 pandemic, the share of financial resources for patient treatment may have changed. This study was conducted to examine the changes in the share of financial resources for patients’ hospital bills during the pre-COVID-19 and COVID-19 periods.
Methods: This descriptive-analytical study was conducted with an practical approach. The research environment was two the COVID-19 referral hospitals at Mashhad University of Medical Sciences. A total of 305,382 files were reviewed. The main source for data collection was the hospital information system. Data analysis was performed using Excel 2017 and SPSS version 25 software, using the Mann-Whitney test at a significance level of 0.05.
Results: The results showed that the share of basic insurance in the pre-COVID-19 period and in the covid-19 period was 70% and 72%, respectively(P=0.09). The ratio of health subsidy share decreased from 4.8 in the pre-COVID-19 period to 2.2 in the COVID-19 period (P<0.001). The ratio of patient payment share compared to the total files amount for internal-infectious patients increased by about 7% in the COVID-19 period compared to the pre-COVID-19 period (P<0.001).
Conclusion: The results of the study indicate that with the spread of the COVID-19 pandemic, the share of each financial resource in the patient’s bill has changed. The increase in the share of COVID-19 patients highlights the need for structured programs to protect the financial interests of healthcare recipients during potential crises in the future.

Introduction: Due to the nature of healthcare services, decisions leading to changes in hospital processes are more sensitive. Therefore, managing change in hospitals requires special attention. This study was conducted with the aim of providing a framework for initial stakeholder engagement in hospital change management to improve efficiency.
Methods: This applied study by qualitative method and nominal group technique with a targeted selection of 22 people, including 68% women and 32% men, with an average experience of 8 years ,with leadership experience or involvement in successful change processes in hospitals or relevant research at Mashhad University of Medical Sciences were purposefully selected. In total, eight main sessions and ten smaller sessions were conducted. The sessions were managed using the Potter nominal group technique in five stages: topic clarification, idea generation, idea sharing, discussion, and voting.
Results: The four main solutions included: 1)examining the acceptance of change in hospitals (including six actions: examining characteristics, history, the culture of change, achievements, related actions, decision-making centers, and examining resistance status in upper-level institutions); 2) stakeholder analysis (including identifying stakeholders, determining their power and interest levels, drawing a matrix, and identifying key stakeholders); 3) examining the level of acceptance by key stakeholders (including disbelief, belief, trust, and confidence levels); 4) engaging key stakeholders with a participatory approach (including using dialogue, deep conversation, and work partnerships).
Conclusion: Effective change management at the hospital level requires sufficient attention to stakeholder engagement. In this study, the necessity of understanding key stakeholders, considering their acceptance level, and engaging them through appropriate participatory strategies within the organizational culture were emphasized for the success of the initial stakeholder engagement process.