مجله بیمه سلامت ایران
سال سوم شماره 4 (پیاپی 11، زمستان 1399)

Human lifestyle is effective on their physical and mental health. Health care education can play an important role in improving peoplechr('39')s behavior and lifestyle. The aim of this study was to investigate the effect of using the health belief model in health care education based on Iranian medicine to the insured of the Iran Health Insurance Organization.

This quasi-experimental single-group study was performed in Tehran during 2017. Participants in this study were trained in face-to-face and virtual health preservation education according to Iranian Medicine resources based on health belief model. In this study, path analysis method, SPSS and AMOS softwares were used to analyze the data.

The study was performed on 51 people (23 men and 28 women). The results of this study showed an explanation of R2=59% behaviors based on model constructs. Also, the results showed that with increasing the time of the study, the behavior of observing the principles of health care in accordance with Iranian medicine increases and the training has an increasing effect on self-efficacy, benefits, sensitivity and perceived severity and has a decreasing effect on perceived barriers. The results of path analysis (RMSEA = 0.031) also showed that the constructs of perceived sensitivity (0.16), perceived benefits (0.29), perceived intensity (0.15), self-efficacy (0.59) and time (0.47) increased behavior and barrier constructs. Perceived (-0.30) decrease behavior (P<0.001).

According to the results of this study, hygiene training can increase the stability of behavior (i.e. observance of hygiene principles) by emphasizing the benefits, barriers, perceived sensitivity and severity and self-efficacy of individuals.

Participation is the most basic element in achieving the goals of the health system. The participation of elites and trustees in the health system is considered as a suitable tool to develop and improve health activities. The aim of this study was to Model the interpretive structural equations of participation of elites and trustees in the field of health.

The present study is an analytical and cross-sectional study that was conducted in 2020. To design a model of participation of elites and trustees in the field of health, 23 experts (8 professors of management and 15 elites) were used. In this study, interpretive structural modeling (ISM) and MICMAC analysis techniques were used to identify the criteria and express the relationships between the criteria, after studying the literature of related research and interviewing the elites and trustees.

After analyzing the data, the variables were classified into four different levels and plotted according to the ISM graph relationships. After MICMAC analysis, the variables were divided into three groups of independent or key variables, autonomous and dependent. Individual factors were among the independent variables; human resource management factors and organizational factors in the group of self-governing variables and the variable "environmental factors" were among the effective and dependent elements.

Determining the relationships between variables and the type of variables can lead to a better understanding of the issue and make appropriate decisions on the issue of participation of elites and trustees in the field of health.

Measuring and monitoring health costs will help health system policy makers choose appropriate policies to protect patients. The purpose of this study was to investigate the referral burden and cost of hospitalized patients covered by the Rural Insurance Fund before and after the implementation of the referral system program in Golestan province, Iran..

A cross-sectional descriptive study was performed based on the information of the first six months of 2017 and 2018 of all patients admitted to health insurance in all hospitals of Golestan province. The information systems and existing documents of the General Directorate of Health Insurance were used to collect data.

Compared to 2017, the number of hospitalizations of health insurance policyholders in the public sector in 2018 in total funds and rural funds decreased by 13 and 10 percent, respectively, and in the private sector, in all funds and rural funds decreased by 39 and 98 percent, respectively. The cost of hospitalization of health insurance policyholders in the public sector in total funds and rural funds decreased by 13 and 12 percent, respectively, and in the private sector by 24 and 99 percent, respectively. This reduction in referral burden and hospitalization costs in the public and private sectors in rural and public funds and in all funds has been significant (P <0.05).

According to the findings, in order to reduce the demand for hospitalization, it is recommended that the guidelines of the rural family physician program and the referral system at level one be fully implemented. By increasing the facilities and physical capacity of services in level one and providing comprehensive and timely services that continue in level two, the induced demand created in patientschr('39') hospitalization should be prevented.

The purpose of this study is to investigate the role of economic and social development in differences of regional disability prevalence patterns and the study of these patterns in order to identify and eliminate economic, social and health barriers to reduce the prevalence of disability is necessary. Therefore, the fundamental question is what is the most important determinant of disability at the individual level? What effect does urban characteristics (city development) have on disability?

The current study is quantitative and relies on secondary data. To achieve the objectives of the study, a multilevel model and HLM software were used. For the first level of this study, the personal data of the 2016 census and for the second level of the study, the information of the Ministry of Health or medical service centers of the provinces, the statistical yearbook of the country and the data of the 2016 census have been used.

The results showed that in the first level, age has a positive and significant relationship with disability, so that, with increasing one year of age, disability increases by 2.6%. Gender also has a significant relationship with disability and women are 41.1% less likely than men to have disabilities. The relationship between economic well-being and disability is negative and significant, and with increasing economic well-being, disability decreases by 3.6 percent. There was no significant relationship between residence and disability. In the second level of the study, it was observed that inter-regional differences in the prevalence of disability do not only originate from socio-economic development, but the main cause of the prevalence of disability should be sought in differences within the region.

Due to the increase in the elderly population in Iran, it is expected that the number of disabled people will also increase. On the other hand, due to the importance of economic welfare of individuals in society and the existence of inequality of facilities and services at the individual level, it is necessary to achieve basic welfare, to do basic and purposeful planning, and in this regard to reduce inequalities Intra-regional is more important than inter-regional inequalities.

Life insurance is one of the risk management tools that has a positive effect on reducing the financial risk of individuals, and is a cover for short-term and long-term losses and acts as a kind of long-term investment. It also has a direct impact on economic growth.

The current study intends to present the demand systems, extract the life insurance demand function of Iran and to make an analytical evaluation of the factors affecting life insurance demand in the period 2004-2018, using Eviews 10 software. The selected indices used in the life insurance demand function of Iran are life insurance penetration coefficient, income variables, financial development, real interest rate, inflation rate, dependency rate, education and life expectancy, which are the factors affecting Iranchr('39')s life insurance demand. In the period under review, shows.

The findings of estimating the life insurance demand function show that, Economic indicators, dependency rates and barter are the most important factors in Iranianschr('39') low interest in life insurance. The variables of per capita income, life expectancy, dependency rate, education and financial development have a positive effect on Iranchr('39')s life insurance demand and a negative effect on inflation and interest rates. The variables of per capita income, inflation rate and dependency rate, respectively, have the greatest impact on the demand for life insurance in Iran.

The results show that economic indicators are one of the most influential factors in the demand for life insurance in Iran.

Humans are always at risk of various diseases and inevitably incur high medical costs and hospital costs for recovery and treatment. In order to help people in such cases, various health insurance plans are provided as a basis and complementary, but due to the lack of a single insurer in the presentation, problems have arisen in the field of health insurance. The purpose of this study is to identify the consequences of providing supplementary insurance along with basic insurance by the Social Security Organization of Iran to solve these problems.

This research was applied in terms of purpose with a combined approach, which was conducted in the qualitative part with a focus on semi-structured interviews in the quantitative part based on exploratory and inferential methods. Its statistical population includes managers and experts in the field of insurance-treatment working in the countrychr('39')s social security organization in 1399, which sampling is done purposefully and in the qualitative section until the categories are saturated (15 samples).

Based on the calculated data, extraction concepts (95 concepts) were classified into 27 sub-categories. The sub-categories were also classified into 5 main categories and thus the consequences of providing supplementary insurance by the Social Security Organization were identified. In the quantitative part, due to the fact that the value of the factor load is above 0.5 and the value of CR indicators is less than 0.7, so the data had a good fit with the factor structure of the theoretical basis of the research and were consistent with them.

According to the findings, the implementation of this plan leads to the possibility of special individual insured and no employer with supplementary health insurance, reducing the treatment costs of the insured and the organization, the possibility of discounts on supplementary premiums and consolidation of health insurance will be.

The purpose of this study was to investigate the existence of two phenomena of adverse selection and moral hazards in the Iranian supplementary health insurance market.

First, a demand model for the use of complementary health care services was defined under the least assumptions about how the insurance companies repay the policy, the distribution of the hidden health status of hospital clients and also the type of their supplementary insurance despite the two phenomena of unfavorable choise and moral hazards. The main model was estimated from GMM method and the existence of these two phenomena was tested using non-parametric statistical methods. The data used in this study were collected through a questionnaire and randomly from clients of 11 hospitals in the two groups of supplementary and uninsured treatment in Tehran.

The results showed that risk aversion for the consumption of health services is more than the consumption of composite goods and this amount is more for the insured than the uninsured, which indicates the low health status of the insured compared to other people. The Kolmogorov-Smirnov test also confirmed the different health distributions of the two groups. In addition, according to the results, there are small moral hazards in the insurance market. Moral hazards are lower for people with higher incomes, and the more insurance is demanded from people with higher incomes, the lower the moral hazards will be, and the lower the health of a person, the greater the moral hazards.

The results confirm the existence of adverse selection and moral hazards in complementary health insurance in Iran.