مجله بیمه سلامت ایران
سال یکم شماره 3 (پیاپی 2، پاییز 1397)

From a social point of view, insurance is an economic tool for reducing and eliminating risk factors via integrating a number of identical risks to predict the probable losses of a group as a whole. Social insurance is based on the belief that there are people in the community who face major risks that they cannot afford it lonely. The purpose of the Social Security Insurance Scheme is to distribute the income to those people who cannot deal with these risks. The principles governing social insurance are such that the failure to comply with any of its three principles, including social solidarity, cross subsidy, legal coercion, undermines the structure of this kind of insurance, and diverts society from the its goals that is “social justice”. Health insurance systems have completed three transition periods in their life history, based on the location of financial risk. Insurance is a trilateral relationship between the patient, the provider and the insurer. In historical systems: there is a direct relationship between the patient and the services provider and the location of the financial risk is the patient himself. In traditional systems: a person pays a sum to an insurance institution during the healthy life period and insures himself against the financial risk arising from it, and therefore the place of occurrence of the financial risk is the insurer. In modern systems: the place of financial risk is insurance company and the provider of services together, and it prevents the appearance of information asymmetry phenomena, moral hazard and induced demand. In conclusion, based on the documents and upstream laws, priority actions are being proposed to reform the insurance system.

The fourth industrial revolution that is currently taking place requires policy decisions and responses. Political will, as one of the important variables studied in public policy, is the subject of this paper. The management will requires that policymakers first become familiar with the knowledge, appropriate to the various dimensions of this revolution and have policy concern about it; Secondly, They should have the ability to formulate this policy discourse in the country’s managerial body and thirdly, they must develop the ability to spread this discourse in the community level. This paper, analyzing upstream documents and health policy-makers discourse, shows that such three conditions have not been yet met.

One of the most important measures to ensure achieving Universal Health Coverage (UHC) is expanding health insurance coverage to all population. Accordingly, the present study was conducted with the aim of investigating the effect of having health insurance on the utilization of outpatient services provided by physicians using the data of the utilization of health services survey (2015).

This study is a secondary analysis of the utilization of health services survey data that was conducted in two groups of the insured and uninsured to examine the differences between these two groups in outpatient healthcare utilization provided by physicians. The variables were insurance status as an independent variable and the number of physician visit as a dependent variable. This analysis was disaggregated by place of residence and income.

The visit per capita for outpatient services was lower in all uninsured groups. The visit per capita in insured people was almost two times more than that of uninsured individuals, which was 4.25 and 2.61 among insured and uninsured individuals, respectively. Therefore, the lack of basic health insurance decreased the utilization of outpatient services by 50 percent. General physician visits per capita for insured people living in urban and rural areas were 11.2 and 0.35, respectively.

Based on the results of this study, the visit per capita is directly related to the insurance status of the individuals. Therefore, it is necessary to ensure the equity in utilization of outpatient services provided by the physicians among various groups of population.

Because of organizations must to have a clear perspective of continuing profitability to be accepted in the capital market, researchers survey efficiency evaluation of the Iranian Public Hospital, so that select qualified hospitals for admission to the capital market by separating efficient and inefficient hospitals

It is a descriptive, analytical and retrospective study. Data envelopment analysis technique, CCR model and BCC input-axis, were used to measure efficiency. Data includes input and output of public hospital operations, as the inputs include the number of active beds, the number of physician personnel, the number of non-medical personnel and output include the number of hospital admission, the number of outpatient admissions and the bed occupancy rate. The statistical population consisted of 592 public hospitals. According to available data, 558 hospitals were selected. The DEA Solver Pro and SPSS software were used.

In the CCR model, 123 hospitals were efficient (22%), and in BBC model, 183 Hospitals (33%). The average efficiency of hospitals in the CCR model were 0.66 and in the BCC model were 0.75.

According to the data envelopment analysis model (input-axis) inefficient hospital can achieve efficient unit by changing their inputs. But it seems to make sustainable changes, Macro policies and strategies in the health sector should be changed, which can include the autonomy of hospitals, the integration of efficient and inefficient hospitals, Or the formation of hospital cooperation and accept in the capital market.

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.

The health insurance organizations in Iran are an important part of the health system. However, they are not conscious to many unnecessary costs incurred by providers and recipients, and the health system suffers from a lack of an efficient health insurance system. Therefore, it is essential to assess the performance of insurers and implement appropriate measures. This study aims to investigate the performance of Iranian health insurance organization and present solutions to the challenges.

This study employed an explanatory sequential mixed method. The quantitative part of the research is a descriptive cross-sectional study and the qualitative section is conducted through qualitative content analysis. Quantitative data were collected by a researcher-made tool and analyzed based on descriptive statistics. For the qualitative section, the focus group discussion method was used for collecting data.

Quantitative results show an increase in the population covered, especially in Self-employed fund, and increase in the number of contracting providers except physicians and dentists. The analysis of indicators related to utilization of health services indicates that the distribution of health facilities varies in different provinces which Sistan and Baluchestan Province has the lowest ranking. Also, financial indicators show that overhead costs and medical expenses of health insurance organization have been rising significantly since 2014. The analysis of qualitative data led to identification of three themes including: factors affecting budget deficit, suggested solutions for health insurance organization and suggested solutions for the health system. Based on the findings, the increasing of tariffs, population covered and benefit packages coverage are the most important factors in increasing costs, which strategic purchasing and revising of basic benefit package can play a significant role in meeting challenges.

In recent years, the population covered by the health insurance organization and the number of contracting providers have risen, and the utilization of health services has increased. On the other hand, the costs of this organization experiencing a significant increase for various reasons. Therefore, it is vital to design and implement appropriate strategies to manage the costs.

Skin cancer is one of the most common types of cancers in the United States of America and can be prevented in most cases. Skin cancer significantly affects the quality of life of people and can cause disorder or even death. A review of the aging process of cancer patients, its modeling with physiological age and comparison with normal people is conducted in this paper by using phase-type distributions.

In this model, it is assumed that the length of any physiological age follows an exponential distribution in a Markov chain environment. In the continuous-time Markov chain, a state is assumed to represent death, and n_x transient states, where x is the patient's age at the time of diagnosis of cancer. Each transient state represents a physiological age and aging is a process of change from a physiological age to the next physiological age to reach the end of the process. There is also an absorbing state that the transition from any state to the absorbing state can take place. In this study, using data of skin cancer patients in the United States, the unknown parameters associated with the aging process were estimated.

The study was conducted on patients with melanoma-related cancer in the United States during the years 1973 to 2014, with aged 60-65 years old. The registered number of melanoma cases was 1,882, of which 1,251 were male (66.5%) and 631 were female (33.5%). A table of parameters for estimating survival probability and related charts for the whole population in the age group and gender is presented.

The fitting results of data modeling are very satisfying. The physiological age parameters were estimated in general that could be useful in estimating the distribution of the phase-type parameters and to calculate the function and the moments. And also the effect of gender on the survival rate of patients was determined which indicates that the survival of males is higher than that of women. On the other hand, the life expectancy of cancer patients has been compared with the entire population of the United States, which was less it was expected.

The performance of employees has an important role in productivity of organizations. The performance of employees is affected by a wide range of individual and organizational factors. Recognition of the effective factors has an important role in improving the performance of employees. The aim of this study was investigating the relationship between provision of welfare facilities and performance of health care network of Rey City.

This was a cross-sectional study. The study population were employees of Rey health network. All the population were selected for the study. 100 employees were studied. The data collection tool was a researcher made questionnaire. The questionnaire contained three main components: demographic questions, performance investigation questions and welfare facilities question. The questionnaire validity and reliability was tested and confirmed. The data of this study were analyzed using SPSS statistical software.

The results of the current study showed that there is no significant difference in employees’ performance between sexuality, different age groups, education, marriage, employment condition, work experience, and job position. Investigating the relationship between the performance of employees and provision of welfare facilities including health insurance, cultural and sport facilities, transportation facilities, tourism facilities, and welfare benefits showed that there is a significant relationship (P < 0.05).

The results of the study depicted that the performance of employees is not influenced by factors such as population and income level of the participants. However, provision of welfare facilities can be effective on employees’ performance improvement. However, in order to gain the maximum performance of the employees, it is necessary to consider welfare matters so that they work with higher motivation in order to improve the health condition of the community.