Journal of Evidence Based Health Policy, Management and Economics
Volume:1 Issue: 1, Mar 2017

Determining the inequality in health and the gap level among various socio-economic groups and factors affecting it were always concerns of most politicians and social scientists. This study investigated inequality in utilization of health care among Yazd residents in 2014.
This analytic and cross-sectional study was conducted in 2014. The participants were all households of Yazd. The data were collected through a three-part questionnaire including demographic factors, socio-economic factors, and utilization of health services. The number of samples was estimated to be 1037 households selected by random stratified sampling. After administrating the questionnaire in the form of interview, data were entered into the SPSS software. Later, factor analysis method was carried out and participants were categorized based on their social and economical status. Afterwards, using the logistic regression method, the correlation among variables was calculated and finally, for measuring the concentration index, the stratified data were fed into Stata software version 12/SE and analyzed.
According to the findings, there was no meaningful inequality in the distribution of contagious and non-contagious decreases in the population under study. Inequality in utilization of services for inpatient and outpatients during the past 6 months in the five socio-economic groups was significant (P-value = 0.000). This shows that accumulation of visits occurred in richer groups of society. Also, it can be claimed that self-treatment has greater accumulation in the poorer quintiles (CI = -0.09).
Inequality in benefitting from health services reflects the economical situation of households. As a result, it is expected that by taking steps to improve the living conditions, the equity in service utilization will be increased.

Health and nutrition are important aspects in the analysis of households’ multidimensional poverty. The present research investigated poverty in Tehran’s households through a cohort approach. In this regard, households’ financial participation about health costs and food intake calories were analyzed.
Households’ data of costs – income survey were then collected. Health and nutrition poverty trend was investigated through generational approach, index of poverty "Foster, Greer, Turbak", and in the period of 1984-2014 by dividing Tehrany families into eight various age groups. Excell and Stata11 were applied to process and calculate the indices.
During the study years, the highest level of health poverty (29%) in 1999 was in age range of 21-26 and the highest level of nutrition poverty in 1984 (65%) was in age range of 42-46. There has been an ascending trend of health and nutrition poverty at the end of the Fourth Development Plan (2009) up to 2013 for all age groups.
Generally, rate and severity of health and nutrition poverty had many fluctuations among different age groups of Tehrani households’ heads. This rate has raised during recent years which indicates lack of stable and coherent social policies to reduce households’ exposures with catastrophic health care costs and funding of the food aid needs.

Insurance deductions are not only caused to failure to achieve the paid costs from the provided services but also are caused to the inefficiency of hospitals. So, this research was conducted to determine the amounts and reasons of insurance deductions in patients’ bills of Tamin Ejtemaei.
This descriptive-practical and retrospective study was conducted in the second season of 2012. The statistical population included records of hospitalized patients (discharged) covered by Tamin Ejtemaei insurance that was conducted as census. The data were collected by using a check list which its validity had been confirmed by experts. The collected information was analyzed through the Excell software and descriptive statistics. Information related to the proposed solution was collected by using group discussion.
The amount of applied deductions by Tamin Ejtemaei insurance organization was 47408.62 $ (1$ = 12050 Rials). As bills of hospitalized patients’ records. The mostly applied deductions were respectively related to equipment of surgery-room, the type of bed during hospital stay, and surgeon fees, however, the main part of these deductions was due to the premium (incompatibility between the price on request and the price of equipment applied for patient) as well as additional request (not consideration of the authorized tariff) by hospital.
The hospital efficiency and care therapy quality can be improved by more accurate and better perception of the amount and reasons of insurance deductions and correct management of them.

Economic, physical, and human resources capitals played the most important role in the traditional views of management. However, for development in the current era, social capital is required more than economic, physical, and human capitals. Attitudes and performance of social capital in any organization is one of the important prerequisites for the success in that organization. The aim of this study was to investigate the relationship between psychological capital and organizational citizenship behavior among employees of selected hospitals in Tehran.
This research was an analytical and applied study that was conducted in 2015. Simple stratified random sampling was conducted based on organizational positions (administrative, financial, and para-clinic) among each class to a certain proportion and based on Cochran formula. Data collection tools included two questionnaires of Luthans psychological capital and organizational citizenship behavior of Netmir. Pearson correlation and hierarchical regression tests were used in order to analyze data in the form of Spss18 software at the significant level of 0.05.
Psychological capital and organizational citizenship behavior were desirable among studied hospital staffs. On the other hand, altruism and self-efficacy had the highest mean scores, while chivalry and optimism had the lowest ratings. Hierarchical regression analysis showed that organizational citizenship behavior is able to predict the overall psychological capital (β = 0.285).
Given that citizenship behavior can clearly predict psychological capital in staff, hospital administrators should try to promote organizational citizenship behavior and consequently psychological capital by involving employees in decisions, consult with them, and hold training courses to motivate them.

Given the competitive environment prevailing in the market, service organizations are looking for loyal customers and hospitals are no exception. In the meantime, attention to relationships’ quality and establishment of long term relationships have an important role. The objective of the present study is to examine the effect of relationships’ quality on loyalty of patients in selected state hospitals.
The present cross-sectional research was conducted in 2014 in selected state hospitals of Arak and Yazd. The population consisted of 160 patients in the selected hospitals. Simple random sampling was conducted to choose participants. Data were collected through two questionnaires; a part of Hon and Gruning’s measurement of relationships questionnaire with four dimensions (satisfaction, trust, commitment, and mutual control) and loyalty questions as a part of the Parasuraman et al.’s behavioral tendencies with one dimension (loyalty dimension). Data were analyzed with SPSS19 using Spearman correlation coefficient and regression.
Results from Spearman correlation indicated a positive and significant relationship between relationships quality and loyalty (r = 0.722, P-value = 0.001). In addition, results from regression indicated that 60% of the variance of patients’ loyalty is explained by satisfaction.
Findings revealed that strategies to improve the quality of relationships with patients could lead to loyalty in patients.

Activity-based cost evaluation is used as a tool for accurate assessment and calculation of the cost of any operation .The goal of this study was to estimate the absolute cost of an operation on hernia in Shahid Sadughi hospital of Yazd using Activity Based Costing (ABC) method in 2012.
This applied, descriptive, cross-sectional, and retrospective study was conducted in 2012. The required data were collected through interview with hospital officials and personnel of related units, observance of surgical wards’ activities, studying documents and notebooks in these sections, as well as other official and supportive units. In order to estimate the cost share of other sectors in surgical wards’ services, initially the allocation bases were determined. Afterwards, by applying two-way partitioning method (mathematics), costs were estimated. Finally, by using Activity-Based Costing (ABC) approach, and applying the Excell software, the absolute cost of an operation on hernia was calculated.
Studies showed that the absolute cost of an operation on hernia is 307.56 $ (1$ = 12050 Rials). The cost of personnel is 165 $ which is 53.69 %, and the cost of medications and consumed products is 96 $ which is 31.2 % of the total absolute cost of a hernia operation.
Based on the findings, the absolute cost of services can be reduced by improving performance, especially by reforming operations of human resources management and standardizing consumption.

Paying for the global surgery is one of the prospective payment methods in which service providers receive their service costs according to a preset table. In this method, payment is based on patients’ treatment not in terms of any remedial action. Therefore, it reduces the motivation of rendering unreasonable service. However, its weak point is making simple diseases complex as well as reducing consumption of resources for patients and etc. Since surgeries are considered as costly items in Iran’s insurance system, the present study targeted at investigating the hoteling cost of global surgery in Isfahan public hospitals.
This descriptive and Applied research has investigated the difference between real hoteling cost of 60 global surgeries and the amount of paid hoteling in global plan in Isfahan public hospitals in 2012. The real hoteling cost of the global surgery (real rate of patients’ hospitalization) was collected through Hospital Information System (HIS).The required information about the global costs was also obtained from the annual Insurance Council directive on how to calculate the global surgery. Excell software was then used for data analysis.
The average of real hospitalization hoteling and paid hoteling costs by the health insurance to the hospital based on the global plan were respectively 1.77 and 2.81 in which the real difference between hospitalization and the calculated amount in global plan is 1.04 day.
There was a difference between global cost paid by insurance companies to the hospital and the real cost of surgery in all investigated surgeries so that from 60 cases of global surgery in 53 real hoteling, patient hospitalization was less than the amount paid in global plan of hospitals. Real hoteling was more in just two cases.

Today, peace and stability of health diplomacy in the Eastern Mediterranean region is faced with many challenges. In spite of extensive ignorance on health consequences in other fields and priorities of foreign policy, but foreign policy can be applied to improve health particularly in international health negotiations.
To conduct this non-systematic review, articles relevant with the topic were selected from published texts and credible databases for investigation. Databases included Medline, web of science, Google scholar, Springer, PubMed, and all news websites.
Since issues of health are getting more political, having political view and mastering negotiation techniques is necessary. One of these conditions is multilateral negotiations, in which non-governmental organizations, advocacy groups, foundations, research centers, and private sectors get together to affect the present representatives of the member countries’ decision making about health topics and also to be part of the negotiation process.On the other hand, the international commitments of the Millennium Development goals, has put the health issue in a special position in international discussions. Further, epidemic growth of emerging diseases (such as AIDS, hepatitis, and influenza), immigration, and the sanctions have their impacts on the health sector, especially medicines and equipment, its serious impact on public health is also considered as an undeniable threat.
In order to have effective application, health policy principles should be coordinated with other forms of diplomacy and also be placed at the top of all key stakeholders’ affairs including the Ministry of Health and other organizations effective on the health. Thus, to achieve the Millennium Development Goals and to escape from the problems based on the objectives of Vision 2025; this approach will solve many problems.