Suchergebnisse

Introduction:Today, the provision of healthcare should be efficient and equitable to achieve the health system's goals. The aim of this study was to survey equality in healthcare expenditures and its effects on income redistribution. Methods:This study was a descriptive-analysis, cross-sectional study that was conducted with data obtained from the Statistical Center of Iran (SCI) during 2006 and 2011. The source population and study population were the urban and rural residents of Iran and their households' income and expenditures on health. The analysis was based on annually aggregated data from all provinces relative to their share of the total population. The data were collected using a pre-tested checklist consisting of two sections. The first section was used to retrieve data about total gross non-food expenditures of households. The second section retrieved out-of-pocket payments for healthcare. The data that were collected were analyzed using a Microsoft Excel spreadsheet. The Kakwani index was used to measure the extent of the deviation from equity. The redistributive effect of healthcare costs was considered as the impact of healthcare payments on households' income distribution. Results:The overall Kakwani index during the fourth development program for urban households was progressive (OKI = 0.013), but it was regressive for rural households (OKI = -0.012). Healthcare payments had a negative effect on income redistribution in urban areas during the entire period of the study, and they had a positive effect in rural areas, except for the years 2010 and 2011, for which the effects were negative and non-existent, respectively. Conclusion:By regarding the regressive Kakwani index and the negative effect of healthcare expenditures on income redistribution in some years, the government can use health grants, such as increasing health facilities and supplementary insurance, to increase the ability of households to deal with the cost of developing a remedy and reducing health inequalities.

Background: Board of Trustees (BOTs) in Iranian medical universities has been considered as one of the most important structural and managerial changes to create a revolution in decision-making and accountability. This study aimed to explore challenges facing BOTs in governing Medical Universities (MUs). Methods: In this qualitative study, 27 semi-structured interviews were conducted with current and former members of BOTs, chancellors of universities, BOTs' secretaries, and staff in the Ministry of Health and Medical Education in 2017. These participants were selected using a purposive and snowball sampling method. Data were analyzed by framework analysis and using Atlas-Ti software. Results: Five key themes were identified, including 1) infrastructure (problems in BOT laws and membership requirement), 2) planning and decision-making (evidence-based decision making and planning and meeting), 3) organizing (ambiguity in positions and lack of necessary administrative structure), 4) performance evaluation (self-reporting, lack of time allocation, lack of evaluation criteria and lack of required structure for evaluation), 5) independence and influence on performance (dependency on the Ministry of Health and Medical Education and financial independence). Conclusion: Due to obsolete laws, it seems that the structural and executive reform of BOTs is essential. The issues of university autonomy and empowerment of the boards' members should particularly be considered in such reforms. However, it appears that more delegation and empowering the position of the boards could be effective strategies in governance medicals universities.

INTRODUCTION: Health policymaking seems simple; in practice, but, it is very complex. However, this study aimed to provide a framework to bridge the gap between policy and action in order to present an interconnected model for developing countries. MATERIALS AND METHODS: This was a qualitative study. Using desk search, different models were searched from various scientific databases for formulation of an integrated policy-making framework. In next stage, the identified National upstream documents were analyzed to achieve existing policymaking evidence. Then to determine the validity of the initial model and to gather the views of key experts, two Delphi rounds were used. The tool used in Delphi method was a 9-point Likert questionnaire that was sent to the experts via E-mail. RESULTS: This model, by employing integrated chain of visions and strategic targeting of ultimate aims on the one hand and expected key functions and support functions for generating output (operational goal) on the other, provides an extensive operable insight being influenced by human-Islamic principles and values, social, technological, economic, environmental, and political for strategic as well as operational managers./Policy makers CONCLUSION: This framework consisted of general, strategic, and executive levels. It creates the needed institutional and structural capacity to achieve a comprehensive health approach for all laws and policies to control social factors affecting health, improve health situation, and promote the health of citizens.

BACKGROUND: In the 21(st) century, with the epidemiological and demographic transition and the changing nature of diseases and the increase in the burden of chronic diseases, the need to strengthen primary health care and the development of the family medical program as a strategy is felt significantly. AIM: The purpose of this study is to compare the model of implementation of family physician program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran. MATERIALS AND METHODS: This is a comparative study that examines the model of family physician implementation in selected countries. Data for each country were gathered from the valid databases, were compared according to the comparative table, and analyzed by a framework approach. In order to assure the validity of data, the researchers referred to the websites of the selected nations' Ministry of Health and also cross-checked the findings with reports published by the World Health Organization. RESULTS: In this study, we used the Control Knobs framework to compare countries' FPPs because the framework can demonstrate all necessary features of national health system programs. This framework includes governance and organization, regulation, financing, payment, and behavior in each country. The results of this study show that although the principles of FPP in the selected countries are almost common, they use different methods in FPP implementation. CONCLUSIONS: As the success of any policy depends on the political, economic, social, and cultural context of each country, considering these factors and reinforcing each of the control knobs are critical to the success of the family physician's policy implementation.

Background: Supervision in health sector means a system, process, or mechanism by which some aspects or characteristics of a health care organization is evaluated and analyzed by an external body. This study compared the mechanisms of supervision in ambulatory care in selected countries to provide lessons learnt from global experiences. Methods: In this comparative study USA, UK, Germany, Canada, Turkey, and Iran were selected based on inclusion criteria, including development level and type of the health system. Required data were gathered by searching the internet, browsing the websites of related organizations, and searching research databases. Then, the results were summarized and reported using comparative tables. Results: Some regulations and frameworks exist for assuring and improving the quality and safety of the services in all health systems. The supervising bodies of this subject include central and local governments along with nongovernmental organizations. The supervision in studied countries is mostly compulsory and unannounced. Moreover, accreditation of ambulatory care exists voluntarily and compulsorily. Results of the supervision include temporary or permanent suspension of license for care provision, impact on payment to the providers, and change in popularity of the provider by public communication of the result. Conclusion: Improving the supervision on ambulatory care requires an effective structure for separation of provider and supervisor and the involvement of the professional associations. It is suggested to elevate the ambulatory care supervision through better resource allocation, follow up of the supervision results, enforcement of regulations, and application of novel approaches.

BACKGROUND: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals. OBJECTIVE: The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies. METHOD: This review's methodology was inspired by Arksey and O'Malley's methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020. RESULTS: Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study's objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature. CONCLUSIONS: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and ...