مجله بیمه سلامت ایران
سال دوم شماره 4 (پیاپی 7، زمستان 1398)

Given the importance of health as a valuable asset and achieving universal health coverage, Enjoyment the benefits of health insurance are essential to achieving health for all. So identifying and analyzing the benefits of integrating health insurance funds can be an effective step in this regard. This study aimed to analyze the Systematic Relationship of Health Insurance Integration Benefits in Iran.

This descriptive study was conducted on 68 health insurance experts in two stages of systematic identification and analysis of the benefits of health insurance integration in Iran. Data collection tool was a 40-item Likert-type questionnaire in the Delphi phase and a paired comparisons questionnaire in the systematic analysis stage. Delphi phase analysis was performed using SPSS software and one-sample t-test and factor weighting were performed using FUZZY DEMATEL technique using MATLAB software.

In total, 40 benefits were identified for integration of health insurance in Iran, and 29 benefits were accepted through Delphi phase. The results of Systematic Relationship Analysis also showed that the component of Stewardship with coordinates (1.31 and 1.31) as the most influential component and the component of operational processes with coordinates (0.959 and -0.959) as the most influential component.

Considering the importance of the Stewardship component, cost control and improving the efficiency of the health system in the current conditions of the country can be considered through the implementation of infrastructure reforms in the Stewardship. Also, achieving service-based benefits, general population coverage, financing, and operational processes can be achieved through medium-term and
long-term plans.

In addition to the scientific requirements and limitations and medical advice, other influential factors are involved in choosing cesarean section, including economic, social and cultural factors. Given the disadvantages of cesarean delivery for the individual and society and in order to achieve a standard rate of cesarean section and naturally reach a healthy population, the aim of this study is to understand, and analyze the reasons for cesarean delivery, especially identifying the economic and social factors affecting cesarean delivery. It is a way of giving birth. In addition to the economic and social factors, the researchers also consider the cultural factors that influence the choice of cesarean section in addition to the necessity of research.

The required data and information were collected by questionnaire and cross-sectional in a sample of 600 in Tehran in 2019-2018. Cochran method was used to select the optimal number of samples and valid statistical databases and related articles were also used in the research. Given the zero or one dependent variable of delivery method (natural delivery or cesarean section), data analysis was performed
using Logit discrete econometric models and STATA14 software.

Research findings show that improving household economic conditions increases the probability of choosing cesarean delivery method. Also, among all the variables under study, cesarean delivery recommendation variable with numerical value (0.19) had the most final effect on probability of choosing and increasing cesarean rate. The least significant marginal effect on the likelihood of cesarean delivery belonged to variable “the number of hours of participation in prenatal periods” with a numerical value of - 0.003.

Overall, and as a final result, it can be concluded that the rate of cesarean section among women is influenced by a large number of individual, economic, social, cultural, medical and clinical variables, each of which has a small or incremental effect on the probability of cesarean delivery. But they all come together to form a large collection that can push the rate of cesarean beyond the international standard.

Length of stay in hospital is one of the effective factors in determining the cost of hospitalized patients and one of the high-cost departments is the pediatric intensive care unit (PICU). Knowing how long patients stay in hospital beds can be effective. The purpose of this study was to provide the most appropriate statistical distribution of patients 'stay in PICU wards to predict patients' hospital stay.

In this paper, in addition to investigating the diagnoses presented to patients admitted to the PICU ward, it has been attempted to use the best statistical models in survival studies such as the inverse Weibull distribution family or its combinations to determine the best statistical model for pediatric hospitalization. To determine the pediatric intensive care unit of three hospitals in Mashhad in 2018 based on these
distributions, the first, second and third quartiles of survival time are identified and the best statistical distribution is determined for patients' residence time. R statistical software version 3.5.2 was also used for data analysis and statistical modeling of the population. Finally, maximum likelihood, Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) were used to identify the appropriate model.

Based on the data from these three hospitals, several statistical distributions suitable for survival data were fitted to patients' survival times in the PICU wards studied, and the distribution parameters along with intermediate indices and first and third quartiles were reported. After fitting the composite statistical Weibull and Generalized Reverse Weibull statistical distributions to the length of hospital stay in the PICU ward, the best distribution was the logistic regression Weibull series distribution with the highest likelihood.

Generalized inverse Weibull logarithmic series and Inverse Weibull Geometric distribution had a good fit for patients’ bed time in PICU department of reviewed hospitals.

Investigating the effect of macroeconomic variables on health indicators can provide the ability to predict the effect of economic fluctuations on health in addition to health policy makers' awareness of the impact of economic variables on health level. The purpose of this study was to analyze the trend of the main variables of Iran's macroeconomics and their impact on Iran's health indicators.

The present study was a descriptive-analytical study. In this study, in order to identify the impact of economic fluctuations on public health, the trend of 4 decades (19712011-) fluctuation of macroeconomic and public health indices were analyzed. Health indicators were collected from the World Bank database and macroeconomic indicators from the Central Bank of the Islamic Republic of Iran and the Iranian Statistics Center. To identify the relationship between variables, the VAR model estimated and the Granger causality test used. Regression models and statistical tests run by using eviews7 econometrics software.

The growth of "per capita income", "income inequality", and "unemployment rate" had statistically significant effect on life expectancy and mortality in children under 5 years (P <0.05) and Granger causality test also confirmed the effect. Although the "exchange rate disorder" had a statistically significant effect on life expectancy (P <0.05), its effect on mortality of children under 5 years was not significant (P> 0.05). Among macroeconomic variables, the effect of income inequality on health indicators was more than other variables.

Among macroeconomic variables, the effect of income inequality is larger and long lasting than other variables. By adopting income redistribution policies, the government can control the effects of economic fluctuations on the society's health through reducing income inequality.

Financial and economic constraints are among the most important barriers to accessing health care services. Therefore, protecting the recipients of health services against the cost of health by using the insurance mechanism is one of the main strategies for achieving universal health coverage in societies; accordingly, the present study was designed and implemented to explain the status of health insurance coverage and its effect on catastrophic health expenditure among Iranian households.

This cross-sectional study was conducted in 2015-2018 using the Household Expenditure Survey data by Statistics Center of Iran. After data extraction and data cleaning, data on 37962 households were included in the study. Catastrophic health expenditure index was calculated based on WHO definition. Data were extracted by MSAccess2013 and MSExcel2013 and analyzed using Logit regression technique
with STATA v.14.1.

The results of this study showed that insurance coverage in rural areas (77.66%) was more than urban areas (71%). In rural areas, urban and countrywide, respectively, health insurance, social security and health insurance covered the most of the population. There was no positive effect of insurance coverage on probability of households facing catastrophic health expenditures. Factors such as increasing number
of elderly in households, being rented, being rural, income, unemployed were identified as contributing factors to the increased probability of facing catastrophic health expenditures.

According to the results of the present study, it seems that health insurance has not been able to prevent Iranian households with catastrophic health expenditures. While other socioeconomic factors may also be contributing to catastrophic health expenditures, what seems to be clear is that Iranian households with health insurance have not been exposed to the risk of being exposed to catastrophic health expenditures. Therefore, along with insurance policy reforms, other socioeconomic factors affecting the health of the household should also be considered.

Policy change is one of the most popular areas in public policy, and the establishment of justice in the health sector is one of the most important goals of government - oriented governments in this field. Accordingly, the present study aimed to explain the effective factors in promoting justice in health with centrality of Iran health insurance organization.

the present study is applied in terms of the practical purpose and the method is implemented in two qualitative and quantitative sectors in 1397. in the qualitative section after reviewing the literature, the delphi method and expert panel were used with the help of six experts who participated in the mixed sampling method and the snowball sampling in this study, the objective was evaluated and the conceptual model structure was constructed with four constructs and 20 variables. After examining the formal validity and content validity, 16 questions were finalised with a five - point Likert scale to examine in the quantitative section. in the quantitative part, structural validity was evaluated by cronbach's alpha by factor analysis and reliability. at this stage of the research, 190 members of the target community who had
sufficient information on the subject of research were conducted. SPSS and excel software were used for data analysis.

In this study, 65.7 percrent of male participants were male and 43.3 percent female. 57.3 percent of them are official employment and 57 percent have more than 20 years of work experience. More than 56 percent of the participants have master degrees and doctorate degrees. Reliability of the questionnaire proved to be 83 percent in this study. Validity was assessed and confirmed (Face validity, Content validity and Construct validity). All four constructs in this study were the reliability of over 70 percent. Confirmatory factor analysis also showed that construct validity was approved by the whole questionnaire.

The results of this study indicate that the Iranian health insurance organization has a key role in health with the support provided by the government and the adoption of reason Influence in the study to satisfy the people of the society and ultimately in health.

Having an insured population of 39 million, Iran Health Insurance Organization is one of the largest entities in health insurance sector of Iran. The organization needs to monetize in order to equate its resources with its costs due to economic conditions imposed on the country following sanctions as well as the aging trend of the society. That is, the organization needs to take appropriate measures to finance the coverage of health insurance for every Iranian, for which it is responsible in accordance with current law. This study aims at studying modern monetizing methods in Iran Health Insurance Organization.

First, the new monetizing methods were extracted using grounded theory and employing field’s experts’ opinion. Given the lack of finance experts in health insurance sector, the statistical population was consisted of 21 academic and administrative experts of health and insurance economy. Then the analytic hierarchy process was employed to analyze and rank findings.

The nine main monetizing methods for Iran Health Insurance Organization were compared based on absorption rate, and revenue volume, sustainability, and endogeneity. According to the paired comparison matrix, the monetizing from individuals was ranked 1 with a weight of 0.314, internal monetizing was ranked 2 with a weight of 0.264, monetizing from subsidiaries was ranked 3 with a weight of 0.221, business and non-insurance activities was ranked 4 with a weight of 0.209, training and knowledge transfer was ranked 5 with a weight of 0.199, funding from other organizations was ranked 6 with a weight of 0.188, receiving public funds was ranked 7 with a weight of 0.176, and public donations and other monetizing measures were ranked last with weights of 0.165 and 0.163, respectively. For monetizing from individuals, receiving direct payments from recipients of services revealed to be far more significant than other options including selling a variety of insurance policies, introducing complementary insurance, and selling services to regional customers.

Results show that the insured need to carry the main burden of health insurance costs. The government and other relevant agencies are no longer able to finance Iran Health Insurance Organization. This is somewhat different from what other researchers suggest. However, experts believe that the Health Insurance Organization should be financed by service recipients. In order to prevent too much pressure on the insured clients, the organization can take various measures, which are of equal significance to receiving direct fees from service recipients. These include selling various insurance policies, introducing supplementary insurance policies, and selling services to regional clients as an insurance and investment organization.