مجله مدیریت بهداشت و درمان
سال هشتم شماره 3 (پیاپی 25، پاییز 1396)

Identifying the trends and causes of mortality can be a base for health-care policy-making and planning in society. This study aimed at identifying the causes of the mortality of hospitalized patients based on International Classification of Diseases.
This retrospective study was a descriptive-analytical one. Research population included all inpatients died in hospitals under supervision of Semnan University of Medical Sciences during a 5-year period (2011-2016). Sampling was done as the senses and data were collected by a checklist extracted from death registration system of the Treatment Deputy of the university. Data were analyzed in SPSS by applying statistical approaches in the significant level of p≤ 0.05.
8,270 hospital mortalities were registered during the period. 6,370 (76.3%) of dead patients were burghers and 4,450 (53.8%) were male. The most frequent causes of the mortality were cardiovascular diseases (3,201, 38.7%), cancers (1,287, 15.5%), and respiratory diseases (865, 10.5%). There were significant differences among the mortality rates according to patient's gender, residences, and age ranges (p Chronic and non-communicable diseases were the main causes of the mortality. Health policy-makers can decrease in these diseases by applying screening programs, empowering people and endorsing regulations on safety life style and so on.

The effect of exchange rate fluctuations on the balance of payments is very important in economic literature. Pharmaceutical is one of the sub-sections of the balance of payments.
By using vector error correction model, this paper seeks to identify the effect of exchange rate changes on the balance of payments by evaluation the existence of J-Curve in Pharmaceutical industry over the period of 1991 to 2012.
The results show the existence of J curve in IransPharmaceutical industrybalance of payments. It means that exchange rate appreciation has reduced Pharmaceutical industrybalance of payments in the first period but after a period it has increased Pharmaceutical industry revenues and improved its balance of payments. According to the analysis of variances of export and import functions the pharmaceuticalindustryhas highly been affected bychanges in exchange rate. 0.19 And 0.016 Changes in these functions have been caused by exchange rate changesand the balance of payments is more sensitive to changes inforeign income.The rate of effectiveness of the income variation is 0.25.
The increase in the exchange rate has improved the pharmaceutical industry trade balance of the country in the last periods of shocks. Also, changes in gross domestic product have had the greatest impact on the fluctuation of Iran's pharmaceutical trade balance.

Today, the relationship between economic growths with the development of healthcare is well known. Tourist satisfaction of a destination is one of the important factors which effect on word of mouth. So, identifying the influencer factors on health tourist satisfaction of a destination and their word of mouth could help improving of Tehran competition position in the health tourism.
For this purpose, based on the two models of Kitapci et al.(2014) and Araslı H, Baradarani (2014), was collected the views of health foreign tourists in Tehran, from countries such as the United States, Azerbaijan, Iraq, Syria, Afghanistan, and other Asian and European countries , A total of 391 questionnaires were collected for analysis. For Validity test was used from confirmatory factor analysis and AVE and for reliability was used Cronbach's alpha which results shown confirmation?
Seven hypotheses have been approved but six hypotheses have been rejected that is the influence of empathy, knowledge, equipment and tangibility, accommodation equipment, environmental safety and transportation facilities on tourist satisfaction.
Following the investigation, it was concluded that two types of factors: internal environment and the external environment have effect on the Tehran's foreign health tourists’ destination satisfaction that factors affecting the internal environment include: accountability of medical environment personnel and trust of medical environment personnel and factors affecting the external environment include: tourist attraction and a food and restaurant factor.

Pharmacies are considered as the necessary centers for public and patients. In Iran, a great deal of health sector resources is consumed for procurement of medicines. This survey is conducted to investigate pharmaceutical system of Shiraz pharmacies from the clients` view points.
This was a cross sectional survey that was conducted in 2016. The study population includes those who refer to community pharmacies, governmental and special pharmacies. The study sample was considered 150 according toCochranformula. A researcher made form was applied for data collection which its reliability was estimated 0.88 applying Pearson Correlation and the validity was approved through experts` views. SPSS22 was used for data analysis was applying Kruskal–Wallis one-way analysis of variance and Fisher`s exact test.
According to Kruskal–Wallis a significant relationship was considered between patient satisfaction and pharmacy type(p=0.046), pharmacy type and waiting time(p0.05).
It seems that considering the present results, the university superiors must try to decrease out of pocket payment on medicines through correct policy making. At the same time, accordance with general educations about drug use and social marketing for improving health literacy they should try to increase satisfaction toward the pharmacies.

Despite the importance of the service sector and its contribution to the world economy, studies on the supply chain of the service sector in comparison with the industrial sector are very rare The purpose of this paper are: identify effective concepts on the sustainable supply chain of hospitals, and design a sustainable supply chain model for the hospital.
This study is an applied descriptive survey. its nature is a type of qualitative and Delphi methods. At first, using deep interviews, effective concepts on the sustainable supply chain of the hospital were extracted. Then, using the Delphi method, the concepts were placed in the form of 15 main concepts. then, using of Type-2 fuzzy cognitive mapping method a causal model of sustainable supply chain were desined.
Effective concepts on the sustainable supply chain include 68 concepts that are in the form of the 15 main concepts such as: demand management, resource and capacity management, customer relationship management, supplier relationship management, service management, information management, financial performance management, Attention to the environment, contamination, energy consumption, legal requirements, employees, community and stakeholders, social accountability and business ethics. Based 15 concepts, the mapping of the sustainable supply chain of the hospital was designed. The results indicate that service delivery management is highly central among other concepts.
By focusing on concepts such as service management and capacity and resources management that have a high level of focus, a sustained supply chain supply chain can be improved.

Nowadays due to unemployment crisis that college graduated students are dealt with, developing policies for job creation and entrepreneurship promotion is of the main mission of the country higher education system. On the other hand, student's entrepreneurship spirit is the essential criterion for its development. Thus the aim of this study was to investigate the degree of entrepreneurship spirit among students at Isfahan University of Medical Sciences.
In this cross-sectional study, 78 Bachelor's and Master's students in Health Care Management of Isfahan University of medical Sciences on 2015 were selected through census. Data gathering was done through a questionnaire with 50 item using 5 point Liker scale. Data were analyzed using descriptive statistic, t-test and ANOVA.
The findings indicated that mean of entrepreneurship spirit for all the students (3/70± 0/42) was above theoretical average (3). Also the mean scores for its subscales were as follow: “risk-taking” (3/35 ± 0/59) “autonomy” (3/76 ±0/60) “internal control” (3/75 ± 0/56) “regard to achievement” (4/02 ± 0/47) “creativity” (3/62 ± 0/54). The mean of entrepreneurship score by gender, marital status and economic status had a statistically significant difference. While the average score of all fields of entrepreneurship in schools and educational terms were not significantly different.
The above average level of entrepreneurship spirit in Health Care Management students of Isfahan university of medical Sciences can provide Implementing and progressing the programs related to development and education of entrepreneurship.

The development of healthcare sector in a society is measured by existence of healthcare resources and level of people's access to them. The purpose of this paper was ranking provinces of Iran in terms of existence of healthcare resources and level of people's access to them by using Multiple Attribute Decision Making (MADM).
In this sectional case study that data requirement has earned by referring to statistical yearbook system, development scores of 30 Provinces of Iran by using one of newest MADM methods named Weighted Aggregated Sum Product Assessment (WASPAS) with considering 24 important healthcare indicators were evaluated via Excel 2010 software.
In terms of existence of healthcare resources, the province of Tehran with a great difference compared to other provinces of the country with a score of 0.9131 and the province of Semnan with a score of 0.0603 have earned the first and last rank respectively while in terms of level of people's access to them with attention to the population of each province, Ilam with a score of 0.1146 and Khuzestan with a score of 0.0409 have earned the first and last rank respectively.
Provinces of Iran in terms of existence of healthcare resources and level of people's access to them are different from each other and healthcare sector resources are not distributed equally.

The importance of the referral system in the health system is very high so that it is stated that 80 to 90% of the first-level health care clients are diagnosable and treatable. Therefore, Referral system in the health system is very important so that it is mentioned that 80 to 90 percent of patients in the first level of health cares are recognizable and treatable. Therefore, modification of referral system can reduce greatly amount of specialist and supersonic referral of hospitals. The purpose of this paper is to investigate on the Effect of Health Policy and structure of health insurance on referral system in the Urban Family Physician Program in Iran in order to improve and develop the first, second, and third level services of the referral system in Iran.
The present study is a descriptive-correlation research. The policy makings conducted, as well as the status of the insurance system of different countries was extracted through systematic identification of the Urban Family Physician's referral system. Then the effects of these factors on the referral system were identified using a researcher-made questionnaire and statistical analysis of factor analysis and T test. Statistical population was included 400 subjects who were expert on family physicians at the national level. The Data Sufficiency was evaluated by the Kaiser-Meyer-Olkin’s (KMO) test. Reliability of test was calculated and confirmed according to Cronbach's Alpha and Combined Reliability (CR). Also, the validity of the test was calculated and confirmed according to the average variance extracted (AVE).
The effect of proper health insurance structure and transparent financial rules on the referral system of the urban family physician and proper health system’s policy makings were proved through coefficients of 0.860 and 0.804, respectively. In the health policy factor, the most important variable is the question number 9 on supervision of the provision of services at first, second, and third level of referring in which factor loading is 0.774.also, in the insurance structure dimension , the most important variable is the question number 12 on applying restrictions in order to refer patients in the pharmacy clinic having in which factor loading is 0.793.
It can be calculated that proper health insurance structure and proper health system’s policy play important roles for success and improving referral system of urban family physician.