فهرست مطالب efat mohamadi

The performance evaluation of the Iranian Health Insurance Organization (IHIO), considering the responsibilities, objectives, and duties outlined in the higher-level documents and laws, is an important issue that has received less attention. Given the importance of systematic monitoring and evaluation to facilitate planning based on overarching domestic policies, it is necessary to adopt a suitable approach to monitor programs and policies and to respond to higher-level authorities to fulfill assigned tasks. The present study aims to identify performance indicators for IHIO based on the analysis of relevant higher-level documents and laws.

This study was conducted qualitatively and based on content analysis of documents, policies, and executive activities related to monitoring the performance of IHIO, from the year the Universal Health Insurance Law of the country was passed (1373) until 1402, in the year 1402 (Solar Hijri calendar, equivalent to 2023/2024 Gregorian calendar). The Scott method was used to examine the validity of the documents, and qualitative content analysis and the deductive approach were employed to analyze the data.

Nine policies related to monitoring the performance of the IHIO were identified, with 11 themes and total of 188-indicators identified as follows: Population indicators (8 indicators), National Health Accounts (NHA) (13-indicators), Covered population (25-indicators), Covered health services (19-indicators), Covered costs/financial participation status (11-indicators), Organization’s financial resources (26-indicators), Contracted centers (11-indicators), Cost trends, cost burden, and visit burden (23-indicators), Monitoring indicators (11-indicators), Operational efficiency of the organization (30-indicators), Access to services and health outcomes (11-indicators).

In order to conduct a thorough and comprehensive evaluation of the Iranian Health Insurance Organization's performance, which aims to enhance transparency and public trust in the organization, it is imperative to take into account a diverse range of indicators that encompass all operational and performance aspects of a health insurance entity. Additionally, national macro indicators, including population metrics and national health accounts, play a crucial role in this process. Failing to consider these indicators may lead to challenges and biases when assessing the organization's performance.

The estimation of the unit cost and per capita of family physician services is one of the influential factors in the decision-making process of healthcare system managers to determine appropriate tariffs for these services. This study aims to calculate the unit cost and per capita of family physician service packages in the Fars and Mazandaran provinces in 2023.

This applied research was conducted with a cross-sectional and retrospective approach in 2023. The study population consisted of family physicians working in the Fars and Mazandaran provinces. Sampling was carried out using a stratified and purposive method. The required data were obtained from two different sources, including interviews with family physicians and data from the Iranian Society of General Practitioners, the Statistical Center of Iran, and the Central Bank of Iran. The data were analyzed using Excel software.

The total annual cost of a family physician’s clinic was 10.05 billion rials. Out of this total cost, 47.7% was allocated to the technical component and 52.3% to the professional component. Considering the number of minutes of clinic activity in a year, the unit cost per minute was calculated to be 73,500 Rials. Taking into account the average population covered by the examined physicians, if all attending patients are considered to be within their coverage, the per capita cost would be 322,400 Rials. However, if it is assumed that 85% of the attending patients are covered by the physician, the per capita cost would be approximately 274,000 Rials.

Comparing the per capita obtained for family physician services with the approved per capita by the Council of Ministers has shown a significant difference. This difference indicates that the approved per capita is much lower than the unit cost of per capita. Therefore, it appears necessary to revise and reconsider the per capita for family physician service package.

There are substantial differences in the health outcomes across countries. Then, assessment of the status of health indicators can give us a valuable information to adjust policies to improve the health status in the world. This paper examines differences and relationships of health status and contextual factors.

This is a multi-country cross-sectional study performed using secondary data of different sources in 2019. We identified indicators that revealed the relationships of health status and health coverage and also contextual factors by expert panel which consist of two categories of indicators: (1) producing health indicators as dependent variables (Life expectancy, Healthy life expectancy, Maternal mortality ratio, Under-five mortality rate and Universal Health Coverage (UHC) service coverage indicator); (2) contextual indicators as independent variables (Current Health Expenditure, Skilled health professionals density, Population density and Government Type). Also, countries were categorized based on the income level and six regions of World Health Organization (WHO). We used SPSS 20 software for a descriptive analysis and R 2018 software for statistical analysis and also drawing of scatter charts.

Results showed a considerable gap between the average of life expectancy (84.2 vs. 53 years) and healthy life expectancy rate (72-63.3 years). This disparity was observed in the Maternal mortality and Under-5 mortality rate (from 882 to 3 per 100000 live births), (5 is 2.1 and the highest is 127.3). Although there was a marginal correlation between population density indicator and life expectancy, healthy life expectancy, and under-5 mortality rate indicators (±0.2), there was no correlation between population density and maternal mortality rate with UHC (P>0.05).

There is a considerable difference between countries in producing health indicators based on contextual indicators; a comprehensive health system approach that can result in improvement in the health outcome.

In pursuing improving healthcare quality and enhancing efficiency, public hospitals in Iran have undergone numerous reforms over the past two decades. This study aimed to assess the efficiency of all public hospitals in Iran from 2012 to 2016. This study was conducted as a quantitative and descriptive-analytical research project. The authors employed an innovative approach called Extended Data Envelopment Analysis (Extended-DEA), a modification of conventional DEA, to assess the technical efficiency and productivity of 568 public hospitals. They obtained nationally representative data from official annual health reports. The data were analyzed using GAMS software version 24.3. The study found that the average efficiency score for all hospitals was 0.733. Among all the hospitals, 10.1% were deemed efficient, while 2.68% had low-efficiency scores below 0.2. The Malmquist Productivity Index (MPI) showed improvement in 49.3% of hospitals and remained unchanged at 2.3%. In comparison, 48.2% of hospitals experienced a regression in productivity from 2015 to 2016. On average, the MPI was 1.07 throughout the analysis. The findings of this study suggest that there is a need for increased efforts to improve the efficient utilization of resources in public hospitals. It highlights the importance of developing appropriate policy solutions and tools to address these efficiency challenges. In particular, one proposed strategy is the merger of small-sized district hospitals to establish larger and more efficient hospitals in different geographical regions across the country.

Context: 

The issue of insurance deductions is one of the major problems that lead to the shortage of financial resources in hospitals. The present study was conducted to review the root causes of insurance deductions and propose solutions to reduce them in Iranian hospitals.

 This was a scoping review of the literature on health insurance deductions in hospitals in Iran within 2000 - 2023 to synthesize the findings of original Persian and English studies that focused on the causes of deductions and propose strategies to reduce them in Iranian hospitals. The relevant concepts and terminology in health insurance deductions were found through medical subject headings (MeSH). The articles were screened based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Analysis of research data (text of the articles) was carried out by the content analysis technique in MAXQDA software (version 10).

 A total of 1121 publications were identified, of which 41 publications met the inclusion criteria and were reviewed. Based on the present analysis, most studies (61%) were published within 2016 - 2020, 12.2% of the included studies were qualitative, and 48.8% were performed in hospitals. Finally, 46 causes of deductions and 35 solutions to reduce insurance deductions were extracted. The leading causes of deductions were associated with service delivery, service registration, sending documents, and conversion of services into revenue. The most important causes of deductions in dimensions of providing and registering services were a lack of familiarity of service providers with insurance rules and regulations, coding and relative value book, extravagance and motivation of providers to earn more revenue, and lack of strong infrastructure to register services. Furthermore, strategies for reducing health insurance deductions were categorized into three groups, namely meta (ministries of health), macro (universities), and mezzo (hospitals). The top strategies to reduce health insurance deductibles were associated with several dimensions, such as providers, process modification, policy reform, and infrastructure modification. The most important strategies to reduce deductions in these four dimensions were teaching the documentation principles to all medical staff, familiarizing physicians with insurance laws and correct coding, continuous interaction between insurance companies and hospitals, and revisions in the repayment system.

 The causes of deductions could be determined through several dimensions. To manage and reduce the number of deductions, these causes should be carefully examined in the dimensions of service delivery, service registration, and document regulation and audit, and each hospital should use relevant strategies according to the weak points. However, solving the issue of deductions is not only related to hospitals; it is necessary for policymakers and health managers in the ministries of health, universities of medical sciences, and health insurance organizations to adopt necessary policies, especially in the field of hospital information management, to reduce deductions. According to the presented topics, the efficiency of hospitals and, ultimately, the quality of medical care can improve through a correct and more accurate understanding of the causes of deficits. It also prevents the waste of financial resources in hospitals, which is the main support in providing services and survival.

To improve healthcare services’ quality, countries should measure their health systems’ efficiency and performance by robust methods.

We aimed to develop a national study to measure the efficiency of the health system in Iran.

The literature review identified several methods for measuring efficiency; the most common one was data envelopment analysis (DEA). We adopted DEA, but its findings were simplistic and inaccurate, so we began to modify the method by determining the weight of each indicator. We identified the efficiency measurement indicators, in line with international standards and uniformed units, and then readjusted our input/output indicators according to the study context through four expert panels. We collected data and classified the input/output indicators, followed by determining each indicator’s weight and standard limits. Then we rationalized our previous results by applying the revised model. The initial new results of the refined model were valid, accurate, and consistent with previous studies, as approved by experts. We defined proper modeling to achieve the stated objectives. After investigating various DEA models, we finally designed a new model that was consistent with the existing data and conditions, entitled EDEA (extended DEA), to analyze other subprojects.

The conventional DEA methods may not be accurate enough to measure health systems’ efficiency. By modifying modeling process, we propose a modified DEA with a very low error rate. We suggest that others interested in measuring health system efficiency adopt our modified approach to increase accuracy and create more meaningful policy-oriented results.

The impact of the COVID-19 pandemic on human life has led to profound consequences in almost all societies worldwide, and this includes its significant impact on all aspects of health. Health equity has been among the main challenges in any healthcare system. However, with the COVID-19 crisis worsening health inequalities, the need to prioritize health equity in upstream national and international plans must receive scholarly attention. Therefore, this paper reports the findings of a review of the current synthesized evidence about the impact of the COVID-19 pandemic on health equity.

This is a comprehensive review in which we retrieved relevant studies during the period starting from 12/01/2019 to 01/15/2021 are retrieved from various databases. The PRISMA flow diagram and a narrative approach are used for synthesizing the evidence.

We initially retrieved 1173 studies, and after a primary quality appraisal process, 40 studies entered the final phase of analysis. The included studies were categorized into five main outcome variables: Accessibility (95%), Utilization (65.8%), Financial protection: 15 (36.5%), Poverty (31.7%), and Racism (21.9%)

COVID-19 pandemic has been the most devastating global challenge in recent history. While the COVID-19 crisis is still unfolding, its multidimensional adverse effects are yet to be revealed. Nevertheless, some people, e.g., the elderly, minorities, as well as marginalized and poor persons, have suffered the COVID-19 consequences more than others. In line with the whole government/whole society approach, we advocate that governments need to strengthen their special efforts to reduce the extra burden of the pandemic on the most vulnerable populations.

Virtual water in Tony Allen's definition is the amount of water that consumes during agricultural or industrial products and services (Sadek, 2011; Mousavi et al., 2009; Mohammadi, 2012; Agahi et al., 2011; Mehdi Zadeh, 2014; Mokhtari, 2013). The population growth, water crisis, global warming increases the challenges of food security. Therefore, it is essential to consider enhancing water productivity as well as reducing virtual water. Livestock is a kind of activities that consume a considerable amount of water. Some previous studies have been done to the estimation of virtual water in the livestock industry in India (Brindha 2017) and in Saudi Arabia (Shakhawat Chowdhury et al., 2017) in recent years. Moreover, Ibidhi and Salem (2020) reported the water footprint of livestock products strongly related to the water footprint of forage and other kinds of livestock nutrition. Although Iran located in an arid region and the Khorasan Razavi province has an active livestock industry, there were not any surveys in the virtual water trend of live stocks in Khorasan Razavi province. Accordingly, in this study, the virtual water of the purebred, hybrid and native cows has estimated in each city of Khorasan Razavi province.

The virtual water content of livestock products was calculated based on Chapagin and Hokestra (2003). At first, the water requirement of purebred, native and hybrid cows was calculated with CROPWAT software for three consecutive years from 2015 to 2017in 28 cities of Khorasan Razavi province. Then the virtual water content of live cows was calculated. Finally, the virtual water of milk and meat was calculated separately for each city.

The results showed that the highest values of milk’s virtual water, related to hybrid dairy cows with 1590 cubic meters per ton (m3 ton-1) in in Gonabad and Bajestan cities and the lowest one related to native dairy cows with 309 m3 ton-1 in Mashhad. Moreover, the highest amount of virtual water of meat production belonged to hybrid dairy cows with 52350 m3 ton-1 in Gonabad and lowest was for purebred 9232 m3 ton-1 in Mashhad. Therefore, it would be recommended to produce milk from native cows and meat from purebred. Compared to world average values, virtual water of native cow’s milk in Mashhad was 68.8% lower while in Gonabad it was 60.6% higher. Therefore, it could be recommended to produce milk from native cows and meat from purebred.

Livestock feed compositions are one of the most influential factors on the total amount of virtual water in livestock products. In accordance with the previous studies, it could be suggested, the most milk should be produced in industrial conditions as well as should produce in cities which have advantages in producing fodder, based on virtual water aspects. It also might suggest changing the cultivation patterns of the province with less water consumption such as clover, fodder peas, fodder beet and sorghum. Other influential factors in the total amount of virtual water are cattle breeds and the value of milking. Virtual water for milk and meat productions in Gonabad city had the highest values in all three types of livestock and was the lowest for Mashhad and Quchan cities, so it might be better to grow more dairy cattle in Mashhad as well as to decrease the livestock productions and development in Gonabad and similar areas. Calculating the virtual water trends for the whole country also are deeply recommended in order to achieve a better vision for water resource management. Keywords: Virtual water, Khorasan Razavi province, Animal feed, Milk and meat, CROPWAT.

In order to lessen health inequalities, the obstacles to health equity will need to be identified. This study aimed at investigating the barriers to access to health-care services from the medical ethics point of view. Data were collected through a qualitative study by performing semi-structured interviews. Purposive sampling was used to recruit participants involved in health provision and/or management. Content analysis was done using MAXQDA software. Overall, 30 interviews were conducted. The content analysis of the interviews identified two themes including “micro factors” and “macro factors”, five sub-themes including “cultural, financial, geographical, social and religious barriers”, and 44 codes. Based on our findings, differences in individuals’ perceptions, cultural control, religious beliefs and social stigmas create cultural barriers. Financial barriers consist of the financial connection between service recipients and service providers, insurance premiums, and inadequate coverage of health-care services. The most important geographical barriers identified in our study were differences in urbanization, inequality in various geographical areas, marginalization, and inequality in resource distribution. Finally, differences in the level of income, education and occupational diversity were among the social barriers. Given the wide range of barriers to access to health-care services, a comprehensive plan covering various dimensions of health equity should be implemented. To this end, innovative and progressive strategies emphasizing the principles of equity and social equality should be developed.

Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.

This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.

We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).

As a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and context-based, economic, social, and political aspects of health as well.
We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.

Various studies have used multiple attribute decision making (MADM) techniques to assess and rank health technologies.  The goal of the present study was to prioritize health technologies using various techniques of MADMs in combination with decision rules.

The study is an applied research using multi-attribute decision making (MADM) methods. This study extracted the attributes related to health technology assessment from global literature and experts’ opinions. In this study, two different types of experts were consulted: the first type, including three experts in the field of the decision-making techniques, on the subject of setting priority on health focusing on MADM; and the second one consists of seven experts in the field of HTA, asked about the selection of attributes and determination their importance. Candidate health technologies were individually weighted and ranked using TOPSIS, SAW and VIKOR by the weight and decision matrix. The results obtained from various techniques were combined and ranked using Copeland’s technique to obtain the final ranking of health technologies. To determine HTA type reports, decision rules were defined. All models were designed via MS Excel.

This study chose eight technologies according to six tradeoff attributes. These attributes included health benefits at the population level, vulnerable population size, availability of alternative technologies, budget impact, financial protection, and quality of evidence. Their exact weights were 0.25, 0.121, 0.146, 0.132, 0.167 and 0.181, respectively. Also, safety and uncertainty about the cost-effectiveness were considered as the veto and decision rules respectively. Copeland’s method was therefore used to combine the methods Whereas HT2 (The technology for treating patients suffering from varicose) was ranked the highest priority and HT3 (The palliative method for patients who suffer from various cancers) was ranked the lowest (for preventing from any ethical issue, the exact name of each technology wasn’t mentioned).

Finally, in accordance with decision rules which are based on various conditions of “uncertainty about the cost-effectiveness”, it is recommended that full health technology assessment report be performed on three technologies, rapid health technology assessment report be performed on four others, and, finally no prioritizing for health technology assessment be made on one of them.

In recent years, health technology policy-making science has gone beyond just a health technology assessment or systematic review or economic evaluation study and the science of operational research in decision making, i.e. multi-attributes and multi-objective decision-making has been included. Hence, currently, health technology policy-making follows a seven-step process. After a technology undergoes these steps and is proven that it is useful for the health system, it must be determined how many of it is needed in the health system. Determining the required number of health technologies is a challenge that remains to be considered. Therefore, this study was designed to overcome this problem. The authors intend to introduce a multi-objective decision-making methodology considering the limited budget, to determine the number of technologies required to complete for the health technology policymaking cycle.

Hospital deductions are predominantly costs that are spent by the hospital, but are not funded and reimbursed. The deductions are 10-30% of the hospital income, of which more than 20% of these deductions are applied to the documents through the hospitals themselves. The purposes of this research is to examining the deductions imposed by insurance organization and hospitals, as well as identifies the causes of these deductions and provide practical solutions for reducing deductions.

The present study is a descriptive-analytic study that was done retrospectively and a combination of quantitative and qualitative methods. The statistical population consisted of a set of hospitals providing health services in the country. The sampled hospitals were 14 units. The number of medical records in order to examine the insurance deductions, using the Cochran method, was estimated at 1715 cases. Data analysis was performed using descriptive and analytical methods in accordance with each of the levels of subtraction. At each end of the analysis, the amount of deduction was extracted from each case.

on average (geometric mean), there is a 87% probability of not registering at least one service in a medical record. The highest financial burden due to the lack of registration of the service at HIS occurs in private hospitals at a rate of 558241 Rials per case. There was a significant correlation between the type of hospital and the set of factors examined about the causes of the deficit in the audit by the hospital income experts (P <0.001). Anesthesiology/ Consultant (15.27%) is the most common cause of the deduction by the insurance companies. The average cost of a deduction applied to a medical record in is 3,873,723 Rials, which accounts for 5.5% of the total cost of each medical record.

Analysis of the findings shows that a high cost of hospital-provided services for patients is not reimbursed to the hospital. This challenge depends on many factors, in which not only insurance organizations, but also hospitals and service providers, who are in charge of the service record and financial statements regulators, are affected.

This study aimed to identify the public preference in health services, the principles that Iranian people consider important, and the aspects of trade-offs between different values in resource allocation practices.

This quantitative study was conducted to investigate public preferences on Health Insurance Benefit Package (HIBP) in 2017. A structured questionnaire was used for data collection, including the preferences of the people who live in Tehran, were above 18 year, and were covered by basic insurance for the HIBP contents and premium. The sample size was calculated 430 subjects and SPSS Statistics was used for data analyzing.

81.6% of the sample population agreed with government allocating more money to the health sector compared to other sectors and organizations and 55% were willing to pay higher premiums for expanding the HIBP coverage. The highest and lowest score regarding prioritization of budget allocation between health services was related to hospitalization services (28.6%) and rehabilitation services (1.6%), respectively. The first priority of respondents regarding health care and life cycle, was "prevention in newborns" (15.9%), the second priority was "prevention in children" (14.6%), the third priority was "prevention in adults" (9.5%), and the last priority was "short-term care in newborns" (0.9%).

Iranian people believe that not only the principle of health maximization but also equal opportunities to access health care and a fair allocation of resources should be considered by authorities for effective health insurance policymaking. In this case, given the scarcity of resources, setting priorities for alternative resources is inevitable.

The starting point for any research is the problem-solving and Research Needs Assessment is needed to identify the underlying issues. This study was conducted to determine the research priorities of the Deputy of Health of Tehran University of Medical Sciences. The present study was an applied study that was designed and implemented in five stages; 1. holding a workshop to teach nominal group technique; 2. Carrying out interviews and the primary extraction of research priorities; 3. Conducting the first round of nominating sessions; 4. holding the second round of nominal group meetings, 5. Finalizing research prioritization titles. Data were analyzed by Excel and Spss version 19 software. This study was conducted with the participation of 38 people. At first, 1039 minutes of interview, 258 original research titles were extracted. Initial research titles were scored during the 4 sessions. At the end, 75% of the participants rated the 21 study points as 7-9, which were considered as research priorities. The titles "Investigating the root causes of maternal death" was the most priority and "the assessment of the effectiveness of the screening of hypothyroidism" was the least priority. According to findings, there is consensus among stakeholders on research priorities that require investment in generating knowledge related to health goals. Managing the research resources of the organization towards implementing these priorities will lead to a rational allocation of resources for the production of knowledge and applied products, and ultimately to improve the health of the population.

One of the most important dimensions of strategic purchasing is to consider what kind of service should be purchased, how to set up a basic health insurance package, and how much health care must be covered. Addressing this issue requires conducting scientific studies for relevant policy analysis. The present study aimed at policy analysis of health insurance benefit package and providing policy options. This study was conducted qualitatively during 2014 - 2017 to analyze health policymaking. It was carried out retrospectively and prospectively in two phases. Data were gathered with interviews, document examination, and observation and were analyzed by content analysis using MAXQDA V. 11 software. After the policy analysis of the health insurance benefit package, 10 topics, 22 themes, and 168 subthemes were identified. In the phase of problem identification, by analyzing the findings of the previous step, 20 challenges and constraints were investigated and then, 64 policy options were retrieved under 27 general solutions. Paying attention to the financial and economic resources of the health sector and taking advantage of effective economic and policy measures are among the modifications that need to be considered in the development and implementation of the health insurance benefit package

Many health problems and the slow progress of development plans root in the absence of indicators to measure and monitor the achievement of the goals. This study aimed to identify the categorized indicators for monitoring and assessment of goal achievement in the Sixth Development Plan in the health sector. This qualitative applied study was conducted in the following stages: Identifying the goals of the Sixth Development Plan in the health sector; identifying the inputs and outputs of the programs; initial compilation of indicators; evaluation of the indicators, and designing a conceptual model for health policy assessment. During the implementation of the study, the qualitative methods including high-level documents examination, literature review, and expert consensus were used. After being analyzed, the content of the development plan was divided into 12 topics. Then, a set of indicators were determined for each topic, which led to the emergence of 80 indicators after the final analysis. The highest score was related to the maternal and child health indicators (giving the scores of more than 63 out of 70). Concerning its generalities and details, the progress evaluation of the sixth development plan can be done using small to large-scale indicators. The optimal mode is to compile indicators for each level individually and professionally.

Implementation of the Health Transformation plan (HTP) has had many effects so far. The analysis of these impacts can help policymakers and planners to continuously improve the health system's ultimate goals. Considering that, health financing is one of the most impressive of health system functions from the HTP, the present study examines the effect of the HTP on supplementary health insurance as part of financial providers in the health system in Iran.

This is a descriptive study carried out using secondary data in 2017. Data were gathered using information systems of health insurance organizations and the statistical yearbook of central insurance of the country. Data analysis was performed using Excel and SPSS software. To analyze and report these data, descriptive statistics and analytical tests were used.

The effect of the HTP on the share of health care providers has shown that in private financing, the share of households is the highest, and during the period 2002-2004, the average share of households from the total private sector share was 86.5%. During the period of 2002-2003, the share of the domestic government as the public sector was 54% on average. Findings in relation to supplementary health show that the net loss has been ascending and premium rate has been increasing.

The share of households in health expenditures has decreased since the implementation of the HTP, but the average pocket spending in the public and private sector has not decreased by more than 10%. The goal of creating competition and improving the quality of the public sector with the private sector and increasing the incentive for people to go to the public sector has largely been met by changing the frequency of contributions made by the financiers. In the long run, with the continuation of the implementation of the health system reform plan and the elimination of the way in which supplementary health insurers benefit from health subsidies, a high percentage of supplementary health insurance funds in the private sector is consumed, while it is better to adopt measures for the use of this resource in the public sector.

Formulation of cost efficiency of health insurance benefit package requires an evidence-based policy making, with efficient management of stakeholders, therefore, identifying the stakeholders and considering their characteristics and interests and also the position and power of the main actors involved in policies seems to be necessary. For this purpose, this study aimed at analyzing the stakeholders of health insurance benefit package in Iran to specify their position in the assessed policy.
This was done on a qualitative basis during years 2015 and 2016. Data was collected from semi-structured interviews, document analysis, and participation in decision-making meetings of the Supreme Council of Health Insurance, to identify the stakeholders, and their power, situation, interests, opportunities, and challenges. The data was analyzed with the content analysis approach using the MAXQDA software.
Overall, 23 stakeholders were identified and categorized in 6 groups, including policy makers, service providers, payers, suppliers of medicines and equipment, service recipients, and others. Sixteen stakeholders were at the national level, 3 stakeholders of regional, and 4 stakeholders of local level, however most stakeholders were owned by the public sector. Furthermore, 78% of stakeholders supported the policies of health insurance benefit package, and 48% had moderate power. Stakeholders had different interests and various opportunities and challenges to health insurance benefit package.
The findings show that multiple stakeholders directly and indirectly affect the formulation and implementation of HIBP policies. Meanwhile, the members of supreme council of health insurance, legally being authorized to apply for entry of service and drug into the HIBP, have the most important role in decision making related to HIBP. Establishment of a systematic approach, considering the role of all stakeholders and alignment of their interests leads to a positive outcome of the stakeholders’ power and finally effective formulation and implementation of policies, and facilitates the ultimate goal of this policy, which promotes public health.

Telemedicine is an expanded term in health information technology that comprises procedures for transmitting medical information electronically to improve patients’ health status. The objective of this research is to evaluate the cost-effectiveness of telemedicine interventions in various specialty areas.

The Cochrane Library and Centre for Review and Dissemination were searched up to February 2013 using Mesh. Studies that compared any kind of telemedicine with any other routine care technique and used cost per health utility unit’s outcomes were included.

Twenty-one articles were included. According to the included studies, it seems that using telemedicine in cardiology can be effective and cost-effective enough but pre-hospital telemedicine diagnostics program are likely to have little impact on acute myocardial infarction fatality. In pulmonary, telemedicine can be a cost-effective strategy for delivering outpatient pulmonary care to rural populations which have limited access to specialized services, but telemedicine is not cost- effective in asthma and airways cancer. In ophthalmology, especially in the diagnosis of diabetic retinopathy, the use of telemedicine is a cost-effective tool. In dermatology, telemedicine is not cost-effective enough in comparison of conventional cares. In other fields such as physical activity and diet, eating disorder, tele-ICU, psychotherapy for depression and telemedicine on ships, telemedicine can be used as a cost-effective tool for treatments or cares.

Most of the included studies confirmed that telemedicine is cost-effective for applying in major medical fields such as cardiology; but in dermatology, papers could not confirm the positive capability of telemedicine.

All governments, regardless of available resources, should move to establish a balance between the conflict of resource scarcity of health system and health care services required. This study applied a multi criteria decision analysis (MCDA) approach to contribute to priority-setting and the coverage decision-making on including uninsured orthopedics interventions in the healthcare transformation plan’s subsidized in Iran during year 2015.
This study was conducted in four phases: a comprehensive review of studies related to the methods and criteria for prioritizing health services, identifying prioritization criteria, scoring and finalizing them, weighting of the criteria identified, and planning for a prioritized uninsured coverage for orthopedics intervention.
After screening the retrieved titles via PRISMA, from 350 papers, 12 studies were included. The main criteria used for the priority step in the health sector were as follows: safety, efficacy, need, existence of alternative procedures, life expectancy impact, cost, cost-effectiveness, catastrophic health expenditure, impact on the budget, acceptance of social/economic and equity in access. According to the viewpoint of the experts, the safety criteria had maximum weight (0.4) and equity in access had the least weight (0.03). Finally, ten uninsured orthopedics services were prioritized with a score of 9.01 to 5.01.
This practical and real-life project significantly contributed to rational, apparent, and unbiased priority-setting practice by using the MCDA methodology. Prioritizing and weighting the criteria in this study indicated that the Iranian policymakers should pay more attention to clinical aspects and benefits of the service than financial issues. This could indicate that there are social perspective and health as the public right in the country.

One of the most important criteria for the allocation of resources and efficient management of resources in the health system is cost analysis and calculate the real price of services. This study aimed to calculate the cost of services provided at diabetes clinics using activity-based costing techniques.
The study is a kind of applied and descriptive – analytical. The information of this study is relates to 1392 and these has been collected from diabetes clinic and Endocrine Research Center. Cost of all services was evaluated based on activity-based costing techniques using the human capital approach. Data was calculated using EXCEL accounting software.
The findings show that, personnel costs are the largest in clinical studies were included. It costs diabetes clinic 1 was 6199240835 (56%) and in diabetes 2 was, 6320109004 (52%). The energy costs were the lowest amount of costs with 179258250 in diabetes clinic 1 (2%) and 229,606,800 (2%) diabetes clinic 2. The standard price and the actual price calculation and comparison with the tariff of 92 found that actual prices for some of services in both clinics in 1392 were more than the standard and tariffs price. This difference in the some services was 30 times.
Based on results of clinical studies on diabetes cost category, personal cost, materials, equipment, buildings and energy were the most important costs, in both of clinics, the highest cost were personnel and energy costs have the lowest cost. The average time served by the medicines was below the standard that is calculated to be less than the actual price of services. The improved performance in the field of human resource management and focus some of services in a clinic can lead to lower cost.

Access to health care is a fundamental right of people in communities. Universal health insurance coverage by reducing financial barriers to access to health services is one of the important strategies. Achieving universal coverage is not a simple process. Many countries already have universal coverage، most of it has lasted decades. Studying of health insurance history in different countries is helpful to localizing certain situations due to local conditions، culture and Islamic countries and the many other intent to prevent errors and accelerate the implementation process effectively. The present article analyzed and evaluated the past experience of the development of universal coverage by social health insurance in 5 countries use of reviews the literature. Results show that all countries have increasingly followed the approach and development of the system، some took longer than others. The maximum transition period of 127 years in Germany and the lowest South Korea to 26 years. In all countries surveyed، the process moves to full coverage health insurance، a growing community with a population coverage of a systematic expansion in terms of the transfer. However، the preliminary findings are presented to achieve this expansion is different. Membership in the sickness fund was raising stable in some countries، but in other countries the expansion of membership by the Central Government has led medical insurance.