مجله تحقیقات نظام سلامت حکیم
سال بیست و دوم شماره 1 (پیاپی 84، بهار 1398)

This study was conducted via a systematic review of causes and solutions to reduce insurance deductions of hospitals in Iran. This study was conducted via a systematic review. The researchers reviewed studies that investigated the causes or solutions to hospital deductions or both of them up to 2017, based on keywords that included deductible, hospital, bill of insurance, and hospital records through databases, search engines, and related journals. The extracted data form for each article was completed and finally, the data were categorized, summarized, and analyzed. In the initial search, 114 articles were found. After reviewing the inclusion and exclusion criteria, 21 articles were analyzed. The main categories of the reasons for deductions were comprised of 15 areas that were classified into the two main areas of documentation flaws during the provision of services and the difficulties with the preparation, adjustment, and sending documents. Analyzing the articles for the reduction of deductions showed that these solutions were classified into 9 main areas of reforming the planning, training, monitoring, reforming the registration process, governance issues, reforming the documentation process, reforming the structure, complying with the rules of the insurance organization, and modifying the process. Computational errors, lack of hospital supervision, and errors related to the date and time of the documents constituted the main causes of deductions, and the reform of planning, education, and supervision were among the most important suggested ways to reduce deductions. Reviewing professionally related papers showed that specialist doctors and nurses are professionals who are more involved in making deductions. In terms of the type of offered services, the surgery, paraclinical services, and the drug were at the top of the reasons for deductions. The hospitals affiliated to the Ministry of Health, which are faced with the problem of inadequate hospital revenues, as well as chief executives, can benefit from the results of this study to understand the financial performance of these centers.

The health sector is one of the most important economic sectors in any society and has an interactive relationship with other sectors. Given the importance of the government involvement in the health sector, this study examined the economic and welfare implications of increasing the government healthcare expenditures in Iran. This applied research was conducted by utilizing the Social Accounting Matrix of the year 2011 prepared by the Iranian Parliament Research Center constructed based on the data such as the national accounts, the household budget survey of the year 2011, and updating of the I-O table of the year 2001. Estimates and data analysis were conducted using Excel 2013 software. The results showed that most of the demand for the government health sector is in the form of final demand (99%) and most of the payments are paid to employees (67%). Moreover, after implementing the study scenario, the total output increased by 0.95% and the welfare of urban and rural households increased by 0.933% and 0.89% while the changes in their social welfare were 0.93% and 0.87%, respectively. Because of its nature, the government health sector has a slight direct role in other economic sectors. However, high final demand and huge wage payments in this sector have caused that the increasing demand creates widespread effects on the economic production and welfare. However, the improved income of employees in this sector, which are mostly included in the high-income deciles, will worsen the distribution of income to the detriment of the lower deciles. Therefore, the government should provide supportive policies to remove this problem.

Iran’s health system faces rising costs and resource scarcity. Donors’ financial contribution is one of the ways to strengthen the country’s health system financing. The purpose of this study was to explore the ways of donors’ participation in financing Iran’s health system. This qualitative study was performed using semi-structured interviews with 38 donors and 26 managers in Social Affiars Deputy of the Ministry of Health and universities of medical sciences in 2017 - 2018. In addition, document analysis was performed using related laws, regulations, policies, plans, etc. Content analysis was used to analyze the data. Donors are involved in collecting charitable funds and spending them in the health system. They participate in collecting charitable funds through health charity organizations and councils, distributing donation boxes among the community, crowdfunding in social networks, and holding purposeful events. Donors spend the collected money for developing and expanding healthcare organizations, purchasing healthcare technologies and equipment, paying employees, and paying for poor patients’ healthcare bills. Donors have a significant role in financing the health system. Hence, healthcare policymakers and managers should plan, organize, direct, and supervise donors and charities to maximize their participation.

Iron deficiency anemia in adolescence and adulthood, especially in girls, has a high prevalence. One of the strategies for reducing anemia is the implementation of iron supplementation programs. The aim of this study was to determine the knowledge, attitude, and practice of high school girl students about iron supplementation. This cross-sectional study was performed on 399 female students. A cluster random sampling method was used in the northern, southern, eastern, western, and central parts of the country. Data were collected using a valid and reliable researcher-made questionnaire and analyzed using SPSS V. 20 software. In this study, only 15% and 17% of the students had a proper level of knowledge and a positive attitude toward iron supplementation. Moreover, 77% of the students reported taking iron supplementation and 89% used iron supplements distributed in schools. However, Only 38% of the students stated that used iron supplements in the classroom or after class (at school). There was a significant relationship between the use of distributed pills in schools and knowledge (P = 0.026) and attitude (P = 0.016). In addition, there was a statistically significant relationship between the place of supplements use and the knowledge level (P = 0.032) and attitude (P = 0.003). Based on the results, students’ knowledge and attitude are not sufficient and the rate of use of distributed pills in schools is relatively low. Therefore, it is necessary to carry out revisions in the implementation process of the iron supplementation program.

Due to a strong correlation between maternal mortality rate (MMR) and developmental indicators, MMR is regarded as a development index in communities. One of the deficiencies in the MMR data registries is the under-reporting due to the rare incidence of maternal mortality in the target population and the diversity of information resources. This study used a three-source capture-recapture method to estimate the MMR. This method can be used to calculate the under-reporting of different data registries. The sample size included all maternal mortality cases registered between 2010 and 2014 in the National Maternal Survey System, National Organization for Civil Registration, and National Death Registration System. Population estimation models including log-linear models, sample coverage approach (SCA), and the Akaike’s information criterion (AIC) were employed by the capture-recapture method. The MMR was estimated to be 22.15, 21.49, 19.55, 19.77, and 18.97 per 100000 live births from 2010 to 2014, respectively. The coverage rate of the three sources of data was estimated at 73%, 83%, 82%, 80%, and 83% between 2010 and 2014, respectively. The results of the study indicate that the capture-recapture method using three sources of data can be utilized to estimate the MMR with higher validity than using only one data source.

Mammography screening is associated with considerable risks. In addition to the advantages of mammography, women need to be aware of the possible disadvantages of this method to determine the real price of mammography. In this study, women’s willingness to perform mammography was studied in two groups receiving basic and complementary information. This study is a cross-sectional, which was conducted in Tabriz City in 2017. Data were collected via questionnaire, contingent valuation methods, and techniques of open-ended questions. Women were randomly divided into two groups containing 225 participants; a group only received general information and the other received both basic and complementary information. The average willingness to perform mammography in the group 1 (basic information) was significantly higher than the group 2 (complementary information) ($19.33 vs. $15, P < 0.01). Statistical analyses for robust regression showed that women with a history of receiving mammography screening, a history of family cancer, the education, income, age, and job indicated significant effects on women’s willingness to perform mammography. Although providing information on the risks of mammography screening significantly decreased women’s willingness to pay for such tests, these findings suggest that women can balance the potential disadvantages of mammography screening against its effectiveness in saving lives.
Keywords: Willingness to pay; Breast Cancer; Screening

In the age of sustainable development, paying attention to the quality and quantity of health information is important for designing interventions. The burden of mental disorders has been increasing over the last decade. Therefore, the development of information-gathering systems in this field is necessary. The aim of this study was to evaluate the status of population-based national surveys conducted to assess the status of mental disorders in Iran. This is a review study. The data were obtained from published reports and articles on population-based surveys in international and national databases in both Persian and English. Surveys conducted to assess the status of mental disorders were retrieved and their target groups, used tools, sampling methods, and sample sizes were evaluated and compared. In Iran, four population-based surveys were conducted to assess the status of mental disorders in 1999, 2001, 2011, and 1394. These surveys were performed using different tools and target populations, and among these four surveys, only two studies were similar. According to the results, evaluating the trends in mental disorders in society is currently associated with difficulties. Performing future surveys with similar tools is essential.

Malaria is an infectious disease infecting 200 - 300 million people annually. Environmental factors such as precipitation, temperature, and humidity can affect its geographical distribution and prevalence. The environmental factors are also effective in the abundance and activity of malaria vectors. The present study aimed at presenting a model to predict the type of malaria. This cross-sectional study was conducted using the data of 285 people referring to a health center in Saravan from June 2009 to December 2016. Clementine 12.0 was used for data analysis. The modeling was done using classification and regression decision trees, chi-squared automatic interaction detector, C 5.0, and neural network algorithms. The accuracy of classification and regression decision trees, chi-squared automatic interaction detector, C5.0, and neural network was 0.7217, 0.6698, 0.6840, and 0.6557, respectively. Classification and regression decision trees performed better than the other algorithms in terms of sensitivity, specificity, accuracy, precision, negative predictive value, and area under the ROC curve. The sensitivity and area under the ROC curve were 0.5787 and 0.66 for classification and regression decision trees. Applying data mining methods for the analysis of malaria’s data can change the current attitude toward malaria type determination. Faster and more precise identification of malaria type helps determine the proper cure and improve the performance of health organizations.