مجله تحقیقات نظام سلامت حکیم
سال بیستم شماره 3 (پیاپی 78، پاییز 1396)

Iran’s trends indicate that substantial reductions have been made in under-five mortality rates. Whether this progress has been accompanied by an increasing or decreasing of the under-five mortality inequality between socioeconomic quintiles is unknown.
We performed a cross-sectional secondary data analysis of 2 demographic and health surveys (DHS) conducted in 2000 and 2010 in Iran. Under-f ive mortality rates (U5MR) were estimated directly from full birth history. Socioeconomic quintiles were constructed using principal component analysis. We measured change in inequality using the odds ratios, mortality rates and the concentration indices change between socioeconomic groups, as well as testing concentration curves dominance.
Under-five mortality odds ratios in the poorest quintile compared with the richest declined from 1.98 (95 % CI = 1.64 - 2.3) in 2000 to 1.85 (95 % CI = 1.13 - 3) in 2010. While the U5MR had dropped to 38.6% in the poorest quintile, the highest reduction in U5MR (52.3 %) had occurred in the richest group. Concentration index (CI) of under-five mortality in 2000 was -0.17 (95% CI = -0.2 to -0.1), though in 2010 it had dropped to -0.14 (95 % CI = -0.22 to -0.05), a 17.6% reduction. The findings of concentration curves dominance test of under-five mortality showed that decreasing change in under-five mortality inequality between 2000 and 2010 is statistically significant.
Regardless of substantial reduction in under-five mortality rates, socioeconomic inequalities in under-five mortality disfavor the worse off groups still exist. Focusing on new pro-poor child health strategies alongside with pro-equity programs in other social and economic authorities may further decrease the underfive mortality across socioeconomic quintiles.

The main axis in the hospital is the patient and all hospital services are carried out to serve him. His satisfaction can show the right performance service, which cannot be obtained merely with high technology, but rather be achieved from public services and effective relationships between physicians and staff with patient. Recent evaluations have become more relevant due to the implementation of the health transformation plan in order to increase quality of care and access as well as financial protection of people. Therefore, the present study was conducted to evaluate the satisfaction of patients in university hospitals from hospital services after the implementation of healthcare reform in Yazd.
This cross-sectional study was conducted in June 2015. The study population included all patients referred to university hospitals in Yazd province that were referred to hospitals before HTP (Period 1392- 1389). A total of 162 patients were randomized and participated in this study. The data collection tool was a questionnaire that was analyzed with the SPSS 21 software.
During the survey, 91% of patients were more satisfied than before the implementation of HTP of the hospital environment, 95.7% of nurse’s behaviors and services, 85.4% of emergency services, and 88.3% of improving health and quality of services. Also, 100% of patients stated that they have paid no money as complementary to their insurance services and kickbacks to doctors. Ultimately, 96.9% of the patients were not sent out of the hospital to purchase their medication or medical equipments.
According to the results, it can be evaluated that patient satisfaction of hospital services after the implementation of health transformation plan is high.

The transformation of the health system will achieve their main goal time in patient satisfaction, where the new structure in the area of treatment is acceptable. This study aimed to evaluate the satisfaction of women after the delivery of healthcare reform plan to promote labor.
This cross-sectional descriptive study was conducted in the first half of 1394. The study population included patients in public hospitals in Tehran. Multi-stage sampling was performed (200 patients). The data collection tool was a valid and reliable questionnaire, which was approved. Analysis of the data by factor analysis and Friedman test was performed using the SPSS software, version 22.
Based on the results, it can be concluded hat the physical space of the maternity ward and fitness classes for pregnant women to promote the process of pregnancy and labor are the main factors of satisfaction natural packs is the promotion of labor in public hospitals.

Insurance companies do not reimburse all patients’ bills if they find any breach in the agreed contract. Implementing the new hospital tariff increased hospitals’ bill deductions. Reducing bills’ deductions increases hospital income. This study aimed to examine the impact of education on reducing bill deductions in a hospital in Tehran, Iran.
This descriptive and cross-sectional study was conducted using the data collected from bills issued by the hospital for social security insured patients in the second half of 2013, 2014, and 2015. Necessary education was delivered to the staff on how to reduce deductions. Data was analyzed using the SPSS software.
The average of deductions in the second half of 2013, 2014, and 2015 were respectively 2.9%, 11.1%, and 7.3%. The average of deductions in these 3 years were 315138 (9.1 US$), 1876417 (54 US$), and 1645237 (47.2 US$) Rials per inpatient and 5437 (0.2 US$), 66797 (1.9 US$), and 55803 (1.6 US$) per outpatient. In 2013 most deductions were applied to surgical and clinical laboratory services and in 2014, most deductions were related to radiotherapy and chemotherapy services. Hospital bill deductions increased by 282.8% after applying the new tariff. However, it has decreased by 34.2% after providing the education.
Bill deduction has increased after applying the new tariff. However, informing the hospital staff about the reasons for bill deductions’ and training them accordingly could reduce it significantly.

Given the importance of access to information and the need for reliable data, systematic approaches to evaluation of national surveys such as NCD risk factor surveillance system (STEPs) is a priority. Benefiting from partnership of all of stakeholders, present paper provides a practical framework of the strengths and weaknesses of planning and conduction of vast investigation. In addition, it can offer solutions for improving operational and scientific protocols.
The aim to the comprehensive review and analysis of 6 rounds implementations of STEPs, related documents, along with the findings of a qualitative study of the expert opinions were analyzed. The results were presented corresponding to the strengths, weaknesses, and challenges, with proposed approaches.
The results of this study show that in the years of 2004 - 2009 as well as 2011, the same questions have different codes in the questionnaire and in the data files. Based on the results, over the past 6 years, there are more than 240 distinct options in the questions. Accordingly, under 2 main axes of content and implementation, the findings were presented in accordance with the strengths, challenges, and suggested solutions, which includes the areas of questions, anthropometric, biological measurements, and sampling.
Development and standardization of administrative and scientific protocols of STEPs, along with the management of levels of security and availability of data proposed as long-term policies for better conduction and promotion of the study.