مجله تحقیقات نظام سلامت حکیم
سال بیست و یکم شماره 4 (پیاپی 83، زمستان 1397)

From the first year of implementation, the Health Transformation Plan (HTP) has had many effects on the practice of health system actors. The present study was designed to investigate the effect of the HTP on the implementation processes, rules, and regulations of the basic health insurance organizations. This qualitative study was conducted using semi-structured interviews and document analysis. Data were analyzed using qualitative content analysis with an inductive approach. The interviews were analyzed using MAXQDA version 11 software. The research population consisted of experts and senior managers of the health insurance sector selected using purposive sampling. Four topics and 11 themes were identified, including population coverage, service coverage, cost of services, process of arranging and manipulating documents, the process of paying claims, the impact of HTP packages, the interactions of insurance companies with the Ministry of Health and hospitals, rules and regulations, structures, and workload of insurance agencies. They all constituted 75 subthemes. The experience of implementing the HTP in Iran shows that primary access to healthcare services for all is an achievable goal for any middle-income country although there are always questions about their sustainability and quantity. Major reforms in the financing of plans need changes that require government investment and long-term commitment to overcome challenges.

Tackling inequity in health is one of the main objectives of health systems. The aim of this study was to assess the achievements and challenges, as well as solutions, in reaching the equity in health in Iran. This study was conducted using a qualitative approach. Data were gathered by reviewing documents and conducting focused group discussions with the stakeholders. The analyzed data were categorized into three groups including achievements, challenges, and solutions. The Iranian health system has achieved many successes in the past 10 years including expanding the primary healthcare networks to city outskirts, implementing the family physician program (urban and rural), implementing the Health Transformation Plan (HTP) and subsequent decrease in catastrophic and impoverishing health expenditures, and increasing the public access to health information and subsequent responsiveness of policymakers. However, some factors hindered further achievements, including the absent or incomplete implementation of laws and practical policies, insufficient attention to the social determinants of health, and poor designing and implementation of the health annex for the policies. It seems that there are little problems in legislation and policymaking in the country and the laws are almost compatible with the recommendations of the World Health Organization, aiming at the inequity reduction in health. However, there is a gap between the policymaking/legislation and the practice. In other words, legislation is poorly practicable and the principles of good governance, including attracting the participation and cooperation of stakeholders, are not fully respected.

Utilizing information technology (IT) infrastructures can help managers and policymakers to achieve strategic goals. In this study, we investigated the IT infrastructures in medical sciences universities required for achieving the goals of the holistic scientific map on health as a strategic plan. This qualitative study was conducted using the Delphi method and purposeful sampling in 2017. MAXQDA V. 10 software was used for qualitative analysis and SPSS V. 19 for descriptive analysis. The results showed that from the viewpoint of experts, the most important IT infrastructures to achieve the goals of holistic scientific map on health included investment on and promotion of electronic health recording (691 points), enhancement of the internet speed and bandwidth (668 points), customer relationship management system (667 points), Telehealth (623 points), and disease registration systems (586 points). The use of information technology in health care organizations will be effective if it is consistent with the organization’s strategic objectives. Therefore, designers and managers should be ensured about the necessity of applying these technologies before investment and implementation.

The health reform plan was established in 2014 in Iran with the aim of promoting fair financial participation, increasing accountability, and promoting health status. Since the promotion of emergency departments was one of the goals of this plan, this study was conducted to evaluate the performance of the emergency departments of the selected hospitals in Tehran after the implementation of this plan. This descriptive - analytical study was conducted in the emergency departments of three public hospitals in Tehran in 2017. A random sample of 96 employees of the emergency departments was selected. To collect data, a researcher - made 38-item questionnaire was used based on the goals of the health reform plan. Data were analyzed using SPSS V. 19 software through descriptive statistics and analysis of variance. From the viewpoint of the staff working in the emergency department, the number of patients has increased since the implementation of the health reform plan, while the number of department staff required to provide services is not sufficient. Moreover, the health reform plan has improved the quality of services, hoteling, facilities, and amenities of the departments. The results indicated that the performance and quality of services have improved after the implementation of the health reform plan in the hospitals affiliated to Tehran University of Medical Sciences.

Research on the factors effective in driving accidents has attracted the attention of traffic researchers in recent decades. Investigating these factors can eliminate the substantial causes of accidents. The main objective of the current study was to detect and evaluate the effective road defects in accidents in metropolitan Tehran. This practical - developmental study (in terms of nature and procedure) was conducted in Tehran city. The data on road defects and accidents were obtained from the Tehran traffic police and used in this study. The data had been recorded in the past three years and extracted from 2739 records. The technique for order of preference by similarity to ideal solution (TOPSIS) was used for data analysis and the analytic hierarchy process (AHP) was employed to develop weight matrices. In this study, the road defects effective in property damage only (PDO) and injury/fatal crashes were evaluated. The results of AHP showed narrow roads and defects in horizontal/vertical traffic signs were the most effective causes of driving accidents. In this study, districts 23 and 7 had the worst situations and district 10 had the best situation among the Tehran regions in terms of PDO and injury/fatal crashes.

It is essential to pay attention to the management of the service referral system and identification of the areas that can improve satisfaction and quality of services. The aim of this study was to identify barriers to the implementation of a referral system in hospitals in order to improve the quality of services and patient satisfaction. This was an applied study in terms of purpose and descriptive - analytic in terms of methodology. We only chose Shafa hospital in Kerman to reach a comprehensive understanding of the issue. Purposeful sampling was done and the data were collected using semi-structured questionnaires that were completed during interviews. The data collection was carried out during three months (August, September, and October 2015). During the study period, 115 referral services for imaging were identified and investigated in the hospital. The answers to open-ended questions were classified after coding and content analysis. In the study, four main themes and 13 sub-themes were identified. None of the patients claimed to pay for hospital’s ambulances and imaging services, and they were not asked to go outside the hospital to receive any health service. The issues of the crowd, delay in service delivery, and the shortage of ambulances in the domain of satisfaction and lack of effective communication in the domain of quality were the main findings of the research. The most important obstacles to implementing the service referral system in the hospital were related to uncertainty, the lack of coordination between different activities, and the human factors. Paying attention to factors such as human and non-human resources, organizational structure, information and communication technology, and development of appropriate indicators for evaluating performance is essential for the success of service chains and quality improvement.

This study aimed to investigate the relationship between hospital cost based on current procedural terminology and patients’ out-of-pocket payment by examining the most common surgical procedures in Oil Company retires, including cataract surgery, coronary angiography, total knee arthroplasty, and total hip replacement. This applied study utilized a descriptive - analytical design. The target population included oil company retires hospitalized in private hospitals in Tehran. The data were collected by examining the medical records archived in the Oil Industry Pension Fund from 2014 to 2015. In total, 920 samples were selected, 459 of which had been gathered before the implementation of Current Procedural Terminology and 461 after its implementation. In the end, the data were analyzed using SPSS V. 20 software by paired t-test and Wilcoxon test. The results of statistical tests showed a significant difference in the direct payment of patients undergoing angiography before and after the implementation of Current Procedural Terminology (P < 0.05). In addition, the Wilcoxon test showed a significant difference in the patient’s franchise for cataract surgery (P = 0.01; Z = -12.07). The health reform plan has increased the out-of-pocket payment in private hospitals. However, it can be reduced by proper monitoring and management.

Planning has been ineffective for dealing with problems associated with long traffic jams occurring due to atmospheric instability, crashes, and inappropriate road engineering in Tehran city. This has led to subsequent pollution problems, faced the citizens with many daily challenges, and eliminated the opportunity for appropriate measures to manage urban transportation and traffic. Today, comparative studies are used to achieve optimal transportation management in most countries. The aim of this study was to improve the transportation and traffic management in Tehran city by understanding the concept of transportation and traffic management, studying related literature, formulating effective factors on the transportation and traffic management in 22 districts of Tehran, and ultimately ranking them based on their weights. The state of transportation and traffic management in the 22 districts of Tehran was evaluated by descriptive - analytical methods using the analytical hierarchy process (AHP) and Delphi techniques. The statistical population included experts in various areas of traffic and urban services. The results showed that the 13th district was better than the others in terms of urban transportation and traffic management, with a final weight of 3.93. It is suggested that in order to optimize the management of transportation and urban traffic in Tehran, weights of components be taken into account for each urban region and be considered in the planning and management of transportation and traffic.