نشریه تامین اجتماعی
سال یازدهم شماره 4 (پیاپی 42، پاییز و زمستان 1392)

This study explains the role of actuary in social security system, especially in its social Insurance sub-system. The main question of this article is: How actuary, as a technical means, can contribute to the improvement of performance in social security system. For answering this question, first, we try to construct a formal analytical model based on abstract theories of functionalism, especially on the basis of Talcott Parsons theory. According to this model, if the performance of a system is going to be improved, the system should be aware of its own internal order requirements, the impacts of macro-social-order and other sub-systems on the system itself. If a social system can continuously consider the aforementioned issues in its own structure, it will experience the improvement of performance. In the second part of this article, we try to show that how actuary and its four activities in social security system (evaluation of the existing insurance plans, evaluation of a new insurance plan, proposing reforms, short-term forecasts) can structurally convert the social security system to a “social-based functional order” which is always sensitive to its internal order and macro-social-order. In this way, the internal disorder will be prevented.

Reduction of fertility rate besides continuous increase in life expectancy in the I.R. Iran and other countries decreased the efficiency of old social security systems and faced the sustainability of Social Security Funds with serious problems. During the last decade, expansive reforms have taken place to reduce the burden of social security commitments. However, despite numerous binding liabilities, reforming the rules of social security has been delayed in our country. This article takes the first step by comparing social security systems in the world considering their efficiency, characteristics, commitments and influential parameters and rules. It was clarified that low retirement age, high accrual rate and unsuitable way of measuring individual earnings in calculation of pension benefits are the main three factors which play the greatest role in expanding the social security commitments in the I.R. Iran and the region. Taxation is another policy tool which can be used to fulfill welfare objectives of retirees. Applying these tools together with social security services may decrease the burden of social security commitments.

Health is one of the most basic human requirements that none of society members could be needless of it. Having a healthy, productive and high quality life is a public right that the government is responsible for it. The rapid increase of costs, public expectation, use of new technologies, and oftenabusing them are the problems that health systems are facing in all countries. The unlimited demand of communities for using these limited resources, have enhanced the role of planning in health systems. This study has been aimed to survey the health planning system in some selected countries. According to classification of health systems in four groups of:1- free market system, 2- social insurance system, 3- national insurance system and 4- national medical system, some countries consisting the United States, Germany, France, Britain and the I.R. Iran were selected as the case-study for the aforementioned groups respectively. The results show that the government has an effective role in planning the health system of a country, the severity of which depends on the centralization or decentralization of health system. For example, in the United States, the role of government is not very remarkable, although, the main responsibility is still due to the government. In France, the role of government is completely visible and effective, so that all strategic and operational plans are design by the government. In this regard, determining the role and function of the stakeholders in planning procedure is of great importance, however, focusing on the issue is the responsibility of the government.

The major part of treatment expenditure of Social Security Organization is allocated to purchasing services from 46 thousands health care providers. Strategic purchasing happens when proactive decisions are made about which health care services, how, from whom and at what price should be purchased to achieve goals. Considering the number of health care providers and the amount of money spent on purchasing the required services, it is a priority and necessity to ensure that purchasing services from health care providers contributes to goal attainment for the purchaser organization. This certainty can be achieved through a series of monitoring measures. In this paper, we described some measures to improve monitoring in strategic purchasing process. However, it’s important to consider that implementation of monitoring measures depends on improving management skills and policy-making process of the purchaser organization besides improving the stewardship function of the Ministry of Health, as a whole.

The price of diagnostic and therapeutic (health) services has always been controversial between both supply and demand sides of these services. The approved Universal health insurance law in 1373 is an important step to reform health care pricing system. This study seeks to answer the question whether, as the mentioned law states, the annual growth rate of health care price is in accordance with the general rate of inflation and health care Premium per capita? For this purpose, the published documents by references such as the Central Bank, Council of Ministers, and Medical Council were studied. The average annual growth rate of health care prices and four reference price indices were calculated and compared. The results of the study are as follows: The average annual growth rate of health care prices in public sector and more significant in private sector has been higher than the average annual growth of the total index (inflation). The average annual growth rate of health care prices in public sector was less than the average annual growth rate of the minimum wage, meanwhile, it was higher in the private sector. The average annual growth of health care Premium per capita was more than the average annual growth rate of health care prices in the public sector and less than the private sector. It seems that health care pricing system has caused the inflation rate of health care prices to be higher than the general rate of inflation in the country.

In present research, we study the effective factors of managers influencing capability and power on the staff of social securing organization in Golestan province. This research is based on the descriptive method. The statistical population includes 434 employees of social security of Golestan province. Using the Kerjcie and Morgan table, 205 persons were selected through random sampling method. The data collection tool of the present research is a researcher-made questionnaire consisting of 24 questions that considered to be effective. We used the inferential and descriptive statistic methods in order to analyze the data. The results show that personal, organizational and technical factors effect on the managers influence on staff. The individual views of male and female participants about the effect of the above-mentioned factors in managers influence on staff were completely different. Regarding the research results, we propose that managers should be aware of different managing systems and principles as well as recognizing their own professional status. Thereafter, considering moral characteristics and talents of the staff, they can implement a combination of different managing systems in order to become capable of influencing the staff besides leading them towards the organizational objectives.