بهشته ابراهیمی

Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.

Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.

5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.

The abuse in the health service provision is a high risk for  health care managers  in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

Given the rapid spread of COVID-19 disease around the world, determining the risk of disease in the workplace is one of the essential factors to improve management of this infectious disease. Therefore, this study was conducted to assess the risk of COVID-19 disease in high-risk personnel of the police forces using rapid risk analysis technique.

This study was a descriptive, analytical, and cross-sectional study conducted in Winter 2021 in Tehran. Participants were 474 police officers randomly selected from three different sub-groups including »P« police, »R« police and »A« police (shown as «پ», «ر» and «آ» in Farsi manuscript, respectively). A rapid risk analysis technique was used to collect data. The data collection tool was a questionnaire based on the mentioned technique, which includes three components of disease probability, severity (consequence), and level of health belief. Adjustments and responses were scored based on the Likert scale. Then, the scores obtained from estimating the three components were multiplied and the result represented the final risk index for COVID-19. Data were analyzed using SPSS software version 24 and using the mentioned technique. In this study, Analysis of Variance and Bonferroni post hoc test with a significance level of 0.05 was used.

The risk index score of more than 95% of »P« police officers and more than 88% of »R« police officers and more than 93% of »A« police officers were above 40(unacceptable). The minimum (4.86) and maximum (890.62) risk index was related to »R« police. Based on univariate analysis of variance, there was no significant difference between the risk of COVID-19 disease in the three occupational groups (F=0.13 and p-value=0.87). Comparing the level of three components effective in estimating the risk index, there was no significant difference between the components of the level of disease probability and level of health belief in the three occupational groups, however, there was a significant difference in the level of severity (consequence) component of all three groups. In addition, 47.2% »P« police, 45.7% »R« police, and 35.5% »A« police group were suspected to be sick.

According to the findings of this study, all three occupational groups were at risk for COVID-19 disease. Therefore, in order to control the COVID-19 epidemic, employers must implement infection control strategies based on accurate and technical assessment of the risk of disease in order to prevent the occurrence of disease and consequently reduce lost working days by performing appropriate, timely, and low-cost control activities.

Aging growth and changes in the pattern of diseases in this crowd, cause exponential growth of costs. The aging of population is a demographic and epidemiological phenomenon; however, it requires socioeconomic solutions and healthcare management. The health services required by the insured population vary according to age and demographic conditions. Therefore, it seems necessary to pay attention to the epidemiological and demographic developments of the population to determine the critical measures for effective planning. Furthermore, the aging of population has increased the financial burden of social security systems; it is necessary to consider appropriate measures in this area. Population aging is an opportunity for the insurer organizations; the receivers of the healthcare services might be threatened in the lack of adequate planning. Thus, this study aimed to identify the consumption pattern of inpatient services in the insured elderly covered by the Armed Forces Health Insurance in 2018.

This descriptive–analytical study was of a cross–sectional design. The study statistical population included the elderly aged ≥60 years who were classified in three age categories (60–69 years, 70–79 years, ≥80 years), and used hospital services of the contracted and non–contracted hospitals with the Armed Forces Health Insurance in 2018, where inpatient medical records were filed for them. The number of samples in this study, considering the minimum number required for relational research (causal–comparative), according to Krejcie and Morgan (1970) (who stated that for the communities of ≥100000, 384 individuals suffices), 491 subjects were selected by random stratified sampling method as the research sample from the three mentioned groups of the elderly. The study inclusion criterion was having ≥60 years of age by the beginning of 2018. As per the study exclusion criteria, according to the information provided in the insurance system of the organization, the elderly should have not experienced concurrent overlapping access to inpatient services. In total, the study samples were hospitalized 1330 times, on a temporary or permanent basis, in the contracted and non–contracted hospitals. Accordingly, from each age group of the elderly, the first 100, the second 100, etc. were randomly selected from the inpatient services consumption data, i.e., extracted from the medical documents. We also considered the payroll reports of Organization Database (Oracle); these data were then analyzed using SPSS. In this study, the Kruskal–Wallis test was employed to examine the between–group differences. Additionally, if the Kruskal–Wallis test result was significant, Mann–Whitney U post–hoc test with the adjustment of p–value was applied. The desired significance level was 0.05.

In this study, the default normality of the data was checked using the Shapiro–Wilk test. The relevant results indicated that the data of this study were significantly different from the normal curve. Therefore, non–parametric tests were used to examine between–group differences. The mean±SD duration of stay of the studied elderly was 5.58±1.5 days. The largest proportion of the total hospitalization days of the elderly samples was related to the cardiac ward by 252(18.95%) insured subjects; respecting the type of service, this rate belonged to the coronary artery bypass with the mean±SD duration of 8.17±4.70 days. Among the referrals for hospitalization, the hospitals of contracted military/corps nature were the most visited military hospitalization center. The least–cost was paid for the radiotherapy ward (1.041.871 Rials) and the highest was paid for the cardiology ward (8.593.036.458 Rials). There was a significant relationship between the mean stay duration at different wards and the service type (p=0.001). Moreover, there was a significant difference between the treatment costs in different age groups (p<0.001). The highest–paid expenses were related to cardiovascular care services and the younger group of elderly. The obtained data suggested that older women’s cost of hospitalization (18.531.525 Riala) was significantly more than that in men (16.701.832 Rials) (p=0.041).

Based on the current research findings, the highest–burden and cost of hospitalization of the elderly belonged to cardiovascular diseases. Thus, planning to expand insurance organization commitments to prevent the occurrence of such diseases is necessary. Such issues could reduce the quality of life and present premature disability in the elderly. It is also crucial to address the phenomenon of population aging.