Search

Background: Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran. Objective: The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations. Methods: In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005-2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed. Results: Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p

Background: Awareness about the process of law making and the factors that affect the legislative process have an important role in improving legislations that are approved by parliaments. Objective: This study aimed to explore and analyze the process of development and enactment of law in Iran’s parliament, and factors that might affect the enactment of laws that are related to the allocation and distribution of health sector resources in Iran. Methods: In this case study, data were collected through review of literature and national documents, and experts’ interviews. Interviews were performed with selected members of parliament (MPs), ex members of parliament and professionals from the Ministry of Health and Medical Education (MOHME) (15 persons). MAX QDA 10 was used for coding and constructing themes. Data were analyzed in five steps (familiarization, developing a conceptual framework, coding, indexing, and interpretation) using a content analysis with inductive and deductive approaches. Results: The main factors that could affect the approval and enactment of legislations related to allocation of healthcare resources in the Iranian parliament were categorized in seven themes including: Importance of issue, resource availability, legislator’s awareness about the topic, lobbying and unofficial relations with influential officials, mentioning strong reasons by MOHME, weakness of previous laws, and positive feedback related to the same laws. Conclusion: Although the process of law making in parliament, and implementation of them in health organizations have legal stages, the study showed that several key factors affect this trend. In fact, it is suggested the health policy makers and MPs consider extending a range of factors to improve the process of law making and the efficiency of legislation related to allocation of healthcare resources

Introduction: Newborn screening (NBS) is a public health measure aimed at identification of early cases, management of afflicted infants, and making efforts to reduce the morbidity and mortality among newborns. All countries may face challenges in implementation of screening programs. The present study aimed to determine the challenges of implementation of the National Phenylketonuria (PKU) Screening Program in Iran. Methods: In this qualitative study, 38 health policymakers, managers, and PKU experts in Iran were purposively selected as the respondents in 2015. The semi-structured interview was used for collecting the required data and information. After transcription of interviews, their content was analyzed using framework analysis. Results: The results were categorized into five main themes and 22 subthemes. The main themes extracted from data were management challenges, diagnosis challenges, treatment challenges, care challenges, and patients’ family problems. Each category consisted of several subthemes. Conclusion: Considering the challenges of implementing this program, some measures such as increased stability of managers in the health system, greater interaction of the Ministry of Health and Medical Education with the heath stakeholders, improving the level of parents’ awareness, the use of efficient information systems, support and legal backing for requiring parents who refuse newborn screening for various reasons, and appropriate insurance coverage seem necessary to be taken.

Introduction: Considering the scarcity of skilled workers in the health sector, the appropriate distribution of human resources in this sector is very important for improving people’s health. Having information about the degree of equality in the distribution of health human resources and their time trends is necessary for better planning and efficient use of these resources. The aim of this study was to determine the trend of inequality in the allocation of human resources in the health sector in Tehran between 2007 and 2013. Methods: This cross-sectional study was conducted in Tehran Province in Iran. The inequality in the distribution of human resources (specialists, general practitioners, pharmacists, paramedics, dentists, nurses and community health workers (Behvarz)) in 10 cities in Tehran Province was investigated using the Gini coefficient and the dissimilarity index. The time trend of inequality was examined by regression analysis. The required data were collected from the statistical yearbook of the Iran Statistics Center (ISC). Results: The highest value of the Gini coefficient (GC) was related to nurses (GC = 0.291) in 2007. The highest value of the Gini coefficient was related to nurses and Behvarzs in 2008 and 2009, respectively. The distribution of specialists had the highest inequality in 2010 (GC = 0.298), 2011 (GC = 0.300) and 2013 (GC = 0.316). General practitioners had the lowest Gini coefficient for 2007, 2008 and 2012. Nurses for 2009 and Behvarzs for 2010, 2011 and 2013 had the lowest value of Gini coefficient. The dissimilarity indexes for specialists and general practitioners were 26.64 and 8.72 in 2013, respectively. The means of this index for included resources were 31.35, 18.27, 16.91, 22.32, 15.82, 26.74, and 24.33, respectively. The time trend analysis showed that the coefficient of time was positive for all of the human resources, except Behvarzes, and only the coefficient of general practitioners was statistically significant ( p

Introduction: The United Nations (UN) identified health as a basic human right, but, unfortunately, the evidence shows that people with disabilities (PWD) often have lower levels of health than the general population. This can be associated with problems in access to the services and programs. The aim of this study was to explore barriers of the health system to rehabilitation services for PWD in Iran. Methods: This was a qualitative study conducted on 21 participants using semi-structured, in-depth interviews and content analysis from June 2014 to July 2015. Data analysis was performed by MAXQDA version 10. Results: “Barriers” were the most prominent challenge of people with disabilities that needed access to rehabilitation services. These barriers were categorized into eight concepts of deficiency in the system that provides rehabilitation services, defect of education, deficiency in detecting and screening of people with disability, defect of stewardship in rehabilitation, ignoring socio-cultural factors, accessibility hardships, lack of identification, and financial hardships in rehabilitation. Conclusions: An efficient rehabilitation plan requires a common understanding, considering the long-term complications involved in addressing the barriers. Understanding the barriers of the health system to rehabilitation services requires comprehensive management that first should be familiar with all of PWD, providers, policy makers, and other beneficiaries. It also is necessary for policy makers to consider rehabilitation services as a main part of the health plan; especially, they must change their oversight of rehabilitation services and programs. Thus, policy makers should have need comprehensive management and recommended further research.