فهرست مطالب

Journal of Evidence Based Health Policy, Management and Economics
Volume:4 Issue: 3, Sep 2020

  • تاریخ انتشار: 1399/08/05
  • تعداد عناوین: 8
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  • Gholamreza Zakersalehi* Pages 150-153

    Recently, the coronavirus (covid19) outbreak has become pandemic which raised and highlighted many hygienic, managerial, economic and cultural arguments, however, with regard to legal arguments there has been little considerations. The purpose of this article is to explain the new legal conditions created by the crisis of Covid-19 in the legal system, (especially regarding the obligations and duties of governments). In this article the author tries to shed more lights on legal arguments: This outbreak once again necessitates the importance of the “Right to health”. This right is mentioned both in Human Rights Declaration and the International Covenant on Economic, Social and Cultural Rights, article twelve (1). It entails rights like: Having drinkable and clean water, nutritious and enough food, enjoying   a good public health, care and basic hygienic and treatment services and supports, health insurance, accessibility to essential medicine. Right to health is placed in the second generation of human rights resolution but it is closely related to the right to life and hence relevant to the first generation. On the other hand, this right is closely related to the right to healthy environment, we can conclude that it is also relevant to the third generation of human rights. All human beings must enjoy such right everywhere, anytime without any restrictions. In order to provide the opportunity for people to have these rights, "governments are under obligation of means" to provide the necessary means and pool all their resources to uphold that right (2). 2) Another vital and serious duty for all governments is “healthcare providing”. In the constitutions of many countries, having the right to enjoy proper welfare and health service are regarded as a public right. (For example, the Article 21 and 43 in Iran’s Constitution, Article 21 in Greek’s Constitution and article 34 in Korea’s Constitution). The Article 36 in Korea’s Constitution says: The government attempts to prevent disasters and protect the citizens from the likely damages caused by disasters (3). 3) In pandemic situations, all the international organizations and countries must come to the victim’s aid. In pandemic conditions all the countries must co-operate closely to overcome the disaster, they should work on exchanging information and experiences or provide medical and medicinal help to each other. The host country should call for help and accept any humanitarian help offered by the world community. States, due to their sovereignty, have the obligation to protect the people living in their territory and assist them during natural disasters. The reality, however, is that all States have not sufficient and necessary power to assist their citizens. Therefore, in many cases humanitarian assistance without the cooperation of other states and international organizations is impossible. International Law Commission, for the importance of this issue, has studied on this subject for some years and finally provided a draft article and sending it to the general assembly. Under ILC draft affected state has obligation to make available humanitarian assistance for its own people and its consent is the essential element for receiving humanitarian assistance, although the affected state has no right to object to the assistance arbitrarily (4). 4) We should welcome social, medical, logistics supports offered by NGOs as long as it is not regarded as interfering in the therapeutic and medical procedures. Article 9 (paragraph z) of the Iranian Crisis Management Law stipulates that the government is obliged to develop the participation of NGOs in crisis management and to use their potential (5). 5) Governments’ duties and actions are varied and include: immunization and vaccination of vulnerable people, educating people, helping to improve the nutrition, keep sick people and the ones in contact with them in quarantine, providing and preparing medical facilities and etc., … 6) Medical care should be provided in a way that the patient has the right to choose the method. If there is any supplementary medicine or alternative cure process, the government should value the patient’s right to choose (2,6,7) unless it helps the severe outbreak. 7) The main duty of the state authorities and managers before the crisis is to predict and warn, during crisis their duty is being present at the scene and provide reliable and precise information and reports to their higher-ups along with engaging in swift and necessary acts which they deem essential to tackle the crisis. After the crisis, they should help to find out the reasons behind the disaster and volatile situations caused by it to avoid such incidents in the future. 8) If a patient is diagnosed with Covid19, reporting the case should be in an urgent priority. Notifiable diseases are those which their occurrence is so important that must be reported through telephone, fax, or letter to medical authorities so they have to immediately record this case and report it to higher authorities. 9) During disastrous situations, governments set some limits for the people like quarantine or limited commuting. The origin of these restrictions and laws are government cabinet or a decree. In these dipterous situations, The Decree will replace the usual rules and regulations and must be obeyed and enforced. It is noteworthy to say that the restrictions must be for the betterment of the people and it must be temporary. According to Article 79 of the Iran Constitution, although the establishment of martial law is prohibited, in the event of a war or emergency, the government has the right to impose restrictions temporarily. Imposing restriction should be with the approval of the Islamic Consultative Assembly and its duration cannot be more than thirty days. If the urgency persists, the government is obliged to obtain permission from the parliament again )8). 10) In many countries and based on their Constitutions, in time of such disastrous situations the Government can use the army and their facilities to help people. So, using these facilities is not just a good advice but a duty and a must (8). 11) After the crisis, there can be fact finding investigations to find out any probable negligence or recklessness by authorities or responsible agents. In cases related to executive organizations, people can sue in administrative courts and demand compensation. (Article 173 Iran constitution)Public courts of Law will take care of nongovernmental cases, that administrative authorities are not involved. 12) For suing authorities who neglected their duties towards people and the society in international law forums, the UN in May 5, 2013 amended a protocol to human rights social laws that makes it possible for people to pursue their complaint in international commissions, however many countries have not adopted this additional protocol yet. 13) At time of crisis, there will be changes to contracts between legal persons for example terminating the contracts of the employees by the employer based on force majeure (unforeseeable circumstances that prevent fulfilling a contract). In such situations, the government must act as a mediator, stabilizer or even assume a compensatory role to ease the situation, provide unemployment insurance or offer the employers to keep their employees in exchange for receiving  special aids by the government. Bayat believes that sometimes the crisis - covid-19 crisis - does not make the fulfillment of obligation impossible, make it difficult. In some legal systems, alongside the force majeure debate, the issue of hardship is raised. This means that obligation is difficult but possible. In the framework of Iranian legal system, this issue has not been fully introduced and has no general rules (9).  Bayat (9) states that an issue in order to be a force majeure, three characteristics should be existed together:1- Externality: This means being outside the will of the committed parties. In other words, an accident has occurred and has nothing to do with the parties (seller, contractor, etc.). 2- Unpredictability: This means that an ordinary human being in that area cannot predict it. In fact, it is unpredictable. 3- Irresistibility: This means that the committed party cannot fulfill his obligation due to the existing circumstance and the fulfillment of the obligation becomes impossible, so that it cannot be done in any other way. Therefore, it is not possible to issue a general verdict on the force majeure of the Corona crisis. Rather, it should be considered whether Corona has impeded your commitment or not (9). According to Article 9 of the Iranian Civil Code, the treaties concluded by the government with other states are binding (in accordance with the law) (10). Therefore, all international conventions signed by Iran and containing requirements for the right to health are binding. The government must mobilize all its potentials and accept the assistance of other governments and NGOs, except in very rare cases. Regarding the introduce of any restrictions on traffic and business, the government should consider two important factors: 1- It is in the public interest. 2- It is temporary and not permanent. Regarding the contract between the employer and the employee, the force majeure rule should not lead to the permanent dismissal of workers due to the crisis conditions. At the same time, the interests of employers who are the cornerstone of economic production should also be taken into account. Here the government can maintain a balance.

    Keywords: None
  • Rahim Khodayari Zarnaq, Gita Alizadeh, Gisoo Alizadeh* Pages 154-158

    The emerging infectious diseases and their number one causes pose a challenge to international stability worldwide. The epidemic of emerging and re-emerging diseases causes many problems for health systems, especially for the medical staff, which require global action in this regard. Emerging infectious diseases are a growing problem for the global community that accompanies the increasing danger of severe health, environmental, economic, and social impacts. An ideal emerging disease preparedness and response environment would strive for collaboration among all sectors impacted by the area unit as a business and social commitment to enhance the capacity of nations and communities to respond to threats as they arise. This article highlights the significant issues that should be considered in emerging and re‐emerging diseases, which could help the policymakers to set effective policies for dealing with the diseases and to evaluate the impact of previous health interventions better at the community level.

    Keywords: Emerging diseases, Re-emerging diseases, Health policy, Strategies, Future
  • Somayeh Panahi, Hasan Ashrafi Rizi* Pages 159-161

    COVID-19 is considered to be one of the crises that occurred at the end of 2019. It seems that the chain of crises never ends, and the occurrence of events is unavoidable. Normally, declaring an emergency for the hospital’s medical staff is the first reaction from the health authorities in each country concerning all crises. Thus, the medical staff will start their activities to rescue, transfer, hospitalize and release of the injured people. According to health regulations, the surveillance system must promptly expand its activity based on crisis recognition, including the continuous and regular collection of data related to public health, aggregation, analysis, and assessment of the health status (1). A common element of crises is the lack of time to make accurate and timely decisions (2). Although some commentators believe that the social nature of COVID-19 is different from other crises (3), the experience gained from other crises can be useful. World Health Organization (WHO) has currently faced a major challenge in confronting COVID-19. So, their only reference to deal with this crisis is using previously recorded experiences about other similar coronaviruses, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome(MERS) and some of the published information from other countries involved in the crisis. There is some documentation available in databases,but the vast experience of medical staff has been neglected. There is a chance that each medical staff had valuable experiences that would be forgotten over time. Indeed, medical staff is one of the main groups involved in dealing with the crisis and certainly gain much experience inthis area. Therefore, health practitioners canuse the experience of medical staff as tacit knowledgerepositories to manage crises during them or in case of facing future ones because their experiences are considered as primary information sources.In this regard, in order to reduce the extent of damages, costs, and human casualties, the approach of recording and sharing their experiences should be taken into consideration at the national and even global levels. Authors have tried to address this important topic as well as the features of this database to encourage health managers to design it and to encourage medical staff to record and share their experiences.

    Keywords: None
  • Ahmad Sadeghi, Peivand Bastani, Omid Barati* Pages 162-171
    Background

    In recent years, public-private partnerships (PPPs) have been used to expand hospital services in many countries. Despite the achievements and implications, there have always been many challenges in implementing it. The purpose of this study was to identify the barriers and challenges in the development of public-private partnerships in hospital services in the country of Iran.

    Methods

    This is a qualitative study conducted in 2015- 2016 by the content analysis method. The research population included experts and health professionals and those who have contributed to the development of PPPs model in hospital services (public and private). Of these, eighteen were selected using a purposive sampling approach and were interviewed semi-structured. The MAXQDA10 software was used to analyze the transcribed interviews.

    Results

    Four main themes and sixteen sub-themes were identified concerning the barriers to developing public-private partnerships in the provision of hospital services in the country. They are cultural and social barriers, political and legal barriers, financial and investment barriers, and structural and process barriers.

    Conclusion

    Officials and policymakers should identify the obstacles facing participatory patterns and then provide a suitable platform for nongovernmental organizations. This action can lead to an increase in the level of readiness of hospitals in Iran to implement this model.

    Keywords: Public-private partnership, Hospital services, Barriers, challenges, Qualitative study
  • Roohangiz Taheri, Rohollah Kalhor, Bahman Ahadinezhad, Mohammad Zakaria Kiaei* Pages 172-180
    Background

    A significant amount of revenues and deductions exist in the hospitals each year. This study aimed to determine the number of deductions applied and identify its causes. Furthermore, we aimed to provide management strategies to reduce these deductions in Shafa Takestan hospital.

    Methods

    This applied and interventional study was conducted with a cross-sectional design. The data collection tool was a checklist from the previous studies. Data were analyzed using descriptive statistics such as mean, percentage, and standard deviation as well as analytical statistics of the Wilcoxon test.

    Results

    Before the intervention, among 405 non-global inpatient cases, about 323 (80 %) contained subtractions. After the intervention, among 555 non-global hospital admissions, about 264 (47 %) included deductions. Most deductions were related to health services insurance (75.38 %). Concerning each hospital ward, most deductions were related to surgery ward (38 %). Before and after the intervention, service deductions were included in 5.59 % and 4.57 %, respectively.

    Conclusion

    Therefore, medical personnel should pay more attention to documenting patientschr('39') records and minimizing documentation errors. Moreover, to reduce patient record deductions, the health care staff should be familiarized with proper documentation procedures by conducting training sessions.

    Keywords: Hospital deductions, Cost Management Interventional Approach, Six Sigma, Insurance Organizations
  • Masoud Ferdosi, Behnaz Nikkar Isfahani*, MohammadShayan Kolahdozan Pages 181-188
    Background

    Since lifestyle is a multi-dimensional concept and various dimensions of health or disease are affected by each other, the measures taken to promote health should pay attention to all aspects of individual physical, mental, spiritual health, as well as the general health of society. The present study aimed to investigate the relationship between psychological components including personality factors, social support, and regulation with lifestyle among obese individuals.

    Methods

    This study was analytical in terms of purpose and cross-sectional in terms of time and was conducted in 2018. In this study, the individuals referring to the health centers of Isfahan were considered as the research population. A number of 357 individuals randomly entered the study. Data collection was based on the perceived social support questionnaire of Zimet et al., health promoting lifestyle questionnaire of Walker, the CERQ emotion cognitive regulation questionnaire, and Neo five-factor inventory. Data were analyzed by SPSS18 using independent T-test, Pearson correlation, and ANOVA.

    Results

    In the final model, a significant relationship was found between gender, nervousness, extroversion, openness, conscientiousness, social support, and health promoting lifestyle (P-value < 0.05). In addition, a significant relationship was observed between marital status, nervousness, extroversion, openness, agreement, and social support (P-value < 0.05). A significant relationship was observed between personality factors and health promoting lifestyle. Such a relationship in nervousness was inverse and significant while it was positive and significant in extraversion, openness, and conscientiousness (P-value < 0.05). Based on the results, there was an inverse relationship between social support and lifestyle and also between regulation and lifestyle (P-value < 0.05).

    Conclusion

    In order to take motivational measures for changing the lifestyle of obese individuals, it is recommended to regard the psychological factors and their relationship to increase the effectiveness of interventions.

    Keywords: Lifestyle, Psychological components, Personality factors, Social support, Regulation
  • Roohollah Askari, Masoomeh Pishehvaran*, Maryam Arabi Pages 189-196
    Background

    Today, there are hospitals called “Magnet Hospital” that are renowned for attracting and retaining expert nurses. These hospital have designed a set of work environment standards to support professional nursing practice. The present research aimed to investigate the feasibility of magnet (attractive) hospital components.

    Methods

    This descriptive cross-sectional study was performed in 2019. The sample included 200 nurses working in educational hospitals of Shahid Sadoughi University of Medical Sciences in Yazd; the samples were selected by stratified sampling. Data collection was done by using a standard questionnaire whose reliability and validity had been approved. The questionnaire included four dimensions (personnel strategies, management style, professional progression, and autonomy). Data analysis was done by SPSS22 and T-test statistics.

    Results

    The average scores of personnel strategies, professional progression, management style, and autonomy in the studied hospitals were respectively obtained as 2.94 ± 0.78, 3.29 ± 0.85, 3.01 ± 0.81, and 3.36 ± 0.59. The mean score of feasibility was obtained as 3.1359 (± 0.61491) in control group; these scores were significantly higher than the cutoff point (3) (P-value ˂ 0.05). In general, the studied hospitals were at an optimal level in terms of magnet hospital components.

    Conclusion

    Regarding the potential capacities of the studied hospitals and their movement towards acquiring the magnet hospital components, promotion of magnet properties such as strong leadership, employee empowerment, respect, cohesion, cooperation, recognition and recruitment of the nursing staff should be paid attention.

    Keywords: Magnet hospital, Nurse, Educational hospital
  • Yasaman Herandi*, Shekoufeh Nikfar, Hossein Bouzarjomehri, Akbar Abdollahiasl Pages 197-208
    Background

    Improving good governance in the pharmaceutical sector is a valuable priority for improving access to essential medicines. Transparency as a means for good governance was the focus of this study. The objective was to evaluate different sectors of the pharmaceutical regulatory sector of Iran from the aspect of transparency. Awareness of the current situation may assist policymakers in making the right decisions.

    Methods

    The aim of this methodology was to present only quantitative measurement but to gather qualitative information as well. The study was carried from November 2016 to July 2017. The questionnaires of the assessment instrument, which the World Health Organization (WHO) produced for measuring transparency in the public pharmaceutical sector, was used. The interviewees were among managers and staff at different levels of the Food and Drug Administration (IFDA) of Iran and its clients.

    Results

    Medicines registration and distribution of medicines’ scores in the 10-point rating system means that they are minimally vulnerable to corruption. Besides, medicine promotion control and procurement of medical products got an acceptable score, which means that they are marginally vulnerable to corruption. On the other hand, qualitative findings and observation of the evidence presented by key informants proved the sufficient legal capacity for transparency in almost all sections. The controversial issue was the ‘conflict of interests,’ which was not anticipated in some cases.

    Conclusion

    It is valuable to know if Iran’s medicine regulatory sector is transparent In order to improve good governance, transparency should be maximized in all sectors, and this is possible by implementing mechanized actions and online tools.

    Keywords: Pharmacy administration, Drug, narcotic control, Evaluation, Pharmacoeconomics, Iran