مجله بیمه سلامت ایران
سال چهارم شماره 4 (پیاپی 15، زمستان 1400)

Accurate funding in order to better manage costs is one of the main concerns of managers. The Health Insurance Organization of Iran, as one of the largest basic insurance organizations, is no exception to this and certainly needs to identify and accurately predict the costs of treatment in order to provide financial resources and obtain the necessary funds in its field of treatment. Using machine learning methods to create a model for predicting treatment costs can be a great help in accurately financing.

This study has provided a model and method for predicting the costs of the organization by using the cost data available in the medical documentation systems of the provinces of the organization during the years 2007 to 2020 and using the SARIMAX and LSTM methods. This method can help to more accurately predict the costs of the organization.

Determining the method with better performance based on the MAPE index alone did not meet the desired model; therefore, by creating a combined method and using the criterion of percentage of realization of the forecast, the optimal model for cost forecasting is presented.

Due to the need for a scientific method to more accurately predict the costs of the organization, the proposed method and model was able to predict the costs of the organization with minimal errors compared to the errors accepted in manual processes.

Given the high expenditure of universal long-term care for elderly and the challenge of financing it for most countries, this article intends to examine leading countries to provide solutions for Iran.

The present study is a comparative study using domain review and examines the evidence related to the insurance for long-term care in the selected countries in six dimensions: type of insurance, type of membership, contribution rate / premium, inclusion criteria for coverage, the scope of services covered, and ultimately cost sharing through studies reviewed in the electronic databases.

The results in the six countries showed that long-term care insurance requires public sector support in full or partly in combination with the private sector. This insurance’ being consistent with basic insurance coverage, its mandatory nature, the combination of government and individual financing (deduction from salaries or taxes) and the existence of a limited user fee to receive services, have saw in all these countries. The type of coverage is defined either universally or only for the elderly, and finally the scope of services in these insurances is graded based on the degree of dependence, the time required and the place of receiving the service.

In all studied countries, compulsory insurance coverage for long-term care was designed to allow for cross-subsidization. Consolidation and reduction of fragmentation of resources and expansion of integrated risk sharing is an important prerequisite for designing long-term care insurance in Iran. It is necessary to implement of the law requiring supplementary insurance to only cover services outside the basic insurance package and redesign both the basic and complementary insurance packages to determine what can be defined in the form of long-term care insurance package.

Health is one of the main dimensions of social policies that governments adopt with the aim of reducing social inequalities. The economic and political structure in Iran has made the importance government's approach play a more important role in determining health policies. The present study aimed to identify the reforms, laws and policies adopted by the Iranian health system after the Islamic Revolution and the impact of each on the functions of the health system. 

This is a review study that identified the policies of the Iran health system between 1357 and 1399. Data collection was done by manual search on the websites of the relevant organizations. The documents were selected based on Jupp's four dimensions, and 101 documents were finally included. To classify the documents, the six-building block framework of World Health Organization was used.

The findings of this study are categorized according to the approved policies in the field of health in the 3rd to 12th governments after the Islamic Revolution. Of the 26 policies approved during the years 1360 to 1368 and 31 policies approved from 1369 to 1376, the most cases were related to the service delivery dimension. However, the policies related to governance and leadership had the highest number among the 29 policies approved during the years 1377 to 1384 and 11 policies approved during the years 1385 to 1392.

 An overview of the five periods of the development program shows that the attention of health policymakers has shifted from service delivery to governance and leadership; Meanwhile, other functions, especially the health information system, have been neglected during the years 1385 to 1395.

Intermediate Care Unit is for patients who do not need intensive care but cannot be admitted to normal wards. The aim of this study was to evaluate the frequency of patients in need of intermediate care in Al-Zahra Hospital, Isfahan, Iran in 2020.

This research was applied and descriptive. Patients admitted to some normal wards and intensive care units of Al-Zahra Hospital were considered as the study population. To determine the sample size, 240 samples were obtained, which were randomly distributed in 14 checklists in each section. The data collection tool was a researcher-made checklist that the reliability of the checklist was 0.8 using Cronbach's alpha test. The collected data were analyzed by STST software.

Of the 31 patients who died, 5 patients (2.44%) were admitted to the intensive care unit, 12 patients (12.09%) were admitted to the intensive care unit, and 14 patients (19.23%) were admitted to the intensive care unit. Due to the size of the gamma effect (0.96), the formation of the intermediate care unit in Al-Zahra Medical Center has a strong effectiveness (gamma between 0.8 to 1.19 indicates strong effectiveness).

Examining the demographics of patients in need of transfer to the IMCU ward and also the feasibility of its establishment, the findings indicate the existence of hospitalization criteria for a number of patients in the interstitial care ward and confirm the effectiveness of its establishment. The desired infrastructure will be able to improve care and mortality outcomes while reducing hospitalization costs and overall patient care.

Dental insurance package provided with health system is related to promotion of dental health, and reduction of burden of dental diseases. The purpose of this study is to investigate the willingness to pay of households for children's dental insurance coverage with using the open-ended question technique.

The present study is a cross-sectional survey. Sample size included 496 head of household or their spouses who had at least one 6-12 years old child and visited to selected dental clinics in Isfahan city in the year of 2020. An online /paper & pencil self-completion questionnaire was filled in by each respondent.The open-ended question technique was used to estimate the willingness to pay of respondents. Stata11 software was used to process the data.

The mean of monthly WTP per each child in the scenarios with ceiling reimbursement was 285782.2 Rial. The highest and lowest WTP for those scenarios averaged 44365.8 Rial and 195819.7 Rial, respectively. The mean of monthly WTP per each child in the scenarios without ceiling reimbursement was 246926.2 Rial. The highest and lowest WTP for these scenarios averaged 345319.2 Rial and 165629 Rial, respectively.

The findings indicated that households value pediatric dental insurance packages differently considering the attributes of each dental package. Thus, policy-makers and health insurers need to pay special attention to households’ valuation for pediatric dental insurance coverage.

The health sector is one of the key sectors of any countries and the value added created in it is one of the criteria for economic growth and development of countries. Therefore, the ultimate goal of all health systems in the world is to achieve public health coverage as one of the most basic economic sectors of any society. Since achieving universal health coverage depends on appropriate financing, aim of this study is to investigate the effect between Iran's human development index and Health system financing model (government, health insurance, people and the private sector).

This study is a retrospective and analytical study. To describe the long-term relationships between the variables under study, seasonal data from the time series of 2001 to 2018 and the aggregation technique using the Engle-Granger and Johansen -Joselius methods have been used.

The results of model estimation based on the Engle-Granger method confirm that there is a long-term relationship between variables. Also, results of the Johansen -Joselius method show the existence of two cumulative vectors, which overall confirm the positive effect of changes in government share, health insurance share, private sector share of Gross domestic product (GDP) and the inverse relationship of changes in the share of people in GDP to changes in Iran's human development index.

Recent health sector policies, including the implementation of the country's health transformation program, public insurance coverage policies and health tariffs, have been resultful and effective. Therefore, for the further and permanent growth of Iran's human development index and increase the country's development in the region and internationally, special attention should be paid to the country's health insurance sector and its importance in the health system financing model by reviewing basic health insurance packages and improved the quantity and quality of basic and supplementary health insurance.