مجله بیمه سلامت ایران
سال سوم شماره 1 (پیاپی 8، بهار 1399)

Health insurance literacy is a fledgling concept that emerged largely after the Obama Care law in the United States. This study, through a narrative approach and by examining related literature, discusses various aspects of this concept and the definitional and instrumentation requirements in this field for other countries, including Iran. What is certain, given the substantial differences in the US health insurance system with other countries, any use of this concept and its operationalization requires the redefinition of a native and applicable insurance system and an effort to understand its operation to complement coverage. It has health insurance.

 Demand for health in the sense of providing unnecessary services with the intention of benefiting  to patients or clients has always been challenging with the exercise of power and order by stekeholders. The present article aims to identify factors for controlling induced demand in cardiovascular diseases with basic and supplemental insurance with the help of experts and experts, to provide strategies for controlling it to be used in macro-level policy and planning and implementation levels.

 This research was a mixed method. In the first part of the narrative review and consensus of experts a researcher-made questionnaire was prepared and its validity and reliability were confirmed. Shahid Chamran data were collected and analyzed in SPSS 20 software.

 The highest and the lowest mean score of induction-related factors in cardiovascular patients were social (3.36 ± 0.76) and stakeholders (2.90 ± 0.76))respectively. Among the social factors sub-factors, community health literacy (3.38 ± 0.81) and among the sub factors, stakeholders, physicians, and professional ethics (3.13 ± 0.97) had higher average insurance coverage (Insurers showed a lesser role in stimulating consumption and possibly inducing demand).

 According to the findings of this study, it recommends to policy makers adopted and communicated their to prioritize appropriate policies for fundamental and structural change focusing on changing the knowledge and attitudes of people at all levels of education in the country, including people, physicians, insurers and stekholders.  It advises executives to provide the necessary infrastructure for the development of insurance in the country by following these policies.

The main purpose of the present study is to investigate the relationship between government expenditures on health care and economic growth in Iran.

 the present study was an analytical descriptive that used modeling methode and Eviews 10 software has been used in the short and long term of the VECM4 (co-test test and parent test) method in this research. The realm of research was from the years 1382 to 1397 and the season.

The results of the research show that all of the variables of this study were static with once differentiation and government spending in the health insurance organization is affected by GDP in the short and long term.

the conclusion of this article says that the impact of health sector spending on GDP and economic Growth was unclear.

Selecting human resources for accomplishing tasks in organizations is one of the most critical and fundamental functions of the organization, which has direct effect on success or lose of the system. Regarding new challenges in selecting the employees, it seems re-designing general- and specialty-based selection model is unavoidable

This research has a qualitative approach and has used the data theory method (Grounded theory) as the research method. The data gathering method was the study of upstream documents and open interviews with 15 elites. The validity was confirmed by interviewers and experts. Reliability also using assessed using test-retest, which were 66 % and 86 % respectively. Continuous comparison and three - step coding (open, axil, selective) were used to analyze the data.  Confirmatory factor analysis was used for general model, Boyatzis model was employed for determining special requirements.

The general competency – based selection model include components such as the use of modern tool in the evaluation of competencies, change the rules and regulation and guidelines, modifying the selection structure, the use individual, administrative, and social components along with beliefs , ethics and politics in assessing competencies. Recognition special competencies needs employing effective and precise model (s).

Selecting human resources in administrative organizations requires reviewing the paradigms, approaches, methods, and tools when determining general and special competencies. Using special competencies in selection and also in appointments, is strongly recommended.

Donors participation in the health sector is one of the sources of financing in the healthcare system. According to rising costs of the healthcare system in recent years and consequently increase in out of pockets of people, more attention has been paid to the charitable donations. In order to maintain and increase good support and participation in the health system, the need to identify and remove the barriers they face is essential for Efficient and effectiveness participation.

the present study according to purpose is applied, Descriptive research in terms of data collection and In terms of type of research data is qualitative. Required data were collected through semi-structured interviews with 41 health experts and beneficiaries using snowball sampling method.Conventional Content analysis was used to analyze the data.

Surveying and categorizing the interviews showed that Efficient and effectiveness participation of Donors in the healthcare system involves four main barriers: Lack of legal mechanisms, Lack of proper and continuous communication with the beneficiary, barriers in the field of management and effective allocation of resources, Lack of awareness of Donors from needs and barriers of the healthcare system and 18 subtheme.

By recognizing and solving these barriers, it has channeled the funds and contributions of the Donors towards the needs of the healthcare system with maximum effectiveness. Can be enhanced by strengthening institutions, structures and processes, Developing facilitator laws, Correct and constant communication with beneficiary and identifying priorities and needs and transferring them to the beneficiaries of health, can be facilitated and encouraged maximum donation.

 The Poisoning occurs with a variety of motives, including wrongdoing, litigation or suicide. Consumption of spoiled food, inappropriate drug use, agricultural pesticides, etc. are the causes of poisoning. Regardless of the motivation of the person being poisoned and the type and amount of substance consumed, this group of patients incurs significant costs for health insurance. This article was conducted to investigate the frequency and cost of health insurance policyholders hospitalized with poisoning at Shahid Mostafa Khomeini Hospital in Ilam during the second trimester of the 2019.

 The present study is a cross-sectional study that conducted to investigate the frequency and cost of health insurance policyholders hospitalized with poisoning at Shahid Mostafa Khomeini Hospital in Ilam during the second trimester of the 2019. The population consisted of 73 health insured persons in the province that were hospitalized and treated in the second trimester of the 2019 at Mustafa Khomeini Hospital in Ilam due to poisoning. Data were collected by census method by extracting and studying patient records, describing data was conducted by SPSS 21 and Excel 2007 and the results were presented in frequency tables and graphs.

 Findings showed that each insured was hospitalized for an average of 2.3 days and spent 1668/682.595 Rials. Rural insured persons with 52.05% had the highest rate and the insured of other classes with 5.48% had the lowest frequency rate. Insured of employees government had the highest average cost with 41/663/114 Rials and insured of Iranian insurance had the lowest average cost with 12/899/663 Rials. The 68.49% of the samples were poisoned by drug and 16.44% were poisoning by poison.

 Toxicities are one of the cost-maker factors for the health insurance organization. Easy access to medicines and agricultural pesticides are effective in exacerbating this phenomenon.

Demographic rates, such as mortality rates, have an important role in the calculations and policymaking of insurance (social and commercial) and funds. Since TD (88-90) Mortality Table, which is prescribed by the Central Insurance of Iran and overestimates the mortality rates,  is still used in actuarial calculations in Iran, it is important and useful to construct a life table that provides an accurate estimation of the mortality of the Iranian population. Due to the importance of this issue, the purpose of this paper is to estimate the mortality rates of insured of the Social Funds of Farmers, Villagers and Tribes in 2016, which actually is a sub-population of 1.5 million people in Iran.

In this paper in order to minimize the effect of data’s few-counting of death, the target population has been limited to active insured members in the year 2016. For each age x, the raw mortality rate is obtained by dividing the number of x-year dead by the x-year exposures. The smoothing of the raw rates is done by the Makeham model with A = 0.0001, B = 0.0001521 and c = 1.073 parameters which have been estimated by the least-squares error method.

The mortality rates for active insured male members of the fund for ages between 30 and 80 have been estimated. The resulting rates for ages between 30 and 71 are higher than rates which obtained by insured people of the Social Security Organization and lower than rates of TD (88-90). The fund rates in comparison with the rates presented by the United Nations, are higher up to age 60 and lower at age 60 up to age 71.

 The results and comparisons show that the estimated rates for the fund are largely reasonable and reliable. According to the comparisons, it can also be said that the estimated rates for the fund and the rates which were presented by the United Nations are the closest among the rates presented by the four sources listed.