مجله بیمه سلامت ایران
سال پنجم شماره 2 (پیاپی 17، تابستان 1401)

Knowledge about health care utilization and its determinants are important for health care planning. Andersen’s behavioral model of health services use is one of the most widely acknowledged models identifying predictors of health care utilization is the. According to Andersen’s model, factors associated with utilization of health services include predisposing factors, enabling factors, and need factors (health status). The purpose of this study is to identify the factors related to the utilization of inpatients health services in Iran, according to the Andersen’s behavioral model.

The present study is a secondary analysis of two waves of the Utilization of Health Services Survey conducting in the years of 2007 and 2015. The samples were 8326 and 5684 in 2007 and 2015, respectively. The Logistic regression model was used to analyze utilization of inpatient health services.

It was found that women (OR=1/48, P-value≤0/01), older patients (OR=1/01, P-value≤0/05), referral patients (OR=1/98, P-value≤0/01), those living in a household with a head educated more than diploma(OR=1/65, P-value≤0/01), and patients living in deprived areas of the country (OR=1/42, P value≤0/01) were more likely to use inpatient services. Furthermore, the odd of using inpatient health services were higher in the year of 2015 (OR=2/15, P-value≤0/01).

Andersen’s Behavioral Model of Health Services can be a good theoretical framework to explain the determinants of inpatient health services utilization in Iran. These factors should be considered for making policies related to inpatient health services in Iran.

Awareness of benefiting from health services and its determinants is important for health care planning. In Andersen's behavioral model, predisposing and enabling factors and factors related to need explain the use of health services. The purpose of this study is to identify the factors related to the use of inpatient services in Iran based on the mentioned model.

The present study is a secondary analysis study that was conducted based on the data of the national survey of the use of health services in 2008 and 2015. The number of sampled people was 8326 in 2008 and 5684 in 2015. Logit regression was used to examine the factors related to the use of health services.

Female patients (OR=0.01, P≤1.48), older patients (OR=0.05, P≤1.01), patients whose needs were diagnosed by doctors or medical personnel (OR=0.01, P≤1.98), patients whose head of household had higher than diploma education (OR=1.65, P≤0.01), and residents of disadvantaged areas of the country (P≤0.05) (OR=1.42) were more likely to benefit from inpatient services. The chance of benefiting from inpatient services was higher in 2015 than in 2008 (OR=0.01, P≤2.15).

Andersen’s Behavioral Model of Health Services can be a suitablethe theoretical framework to explain the determinants of the use of inpatient health services in Iran. It is suggested that the 3 categories of factors cons

Analysis of mortality information helps in making better health policies. The present study discusses causes of mortality observed in Mashhad, Iran in 2017 using partitioning around medoids (PAM) and Clustering Large Applications (CLARA).

Data from 21838 subjects were collected from the “death registration system” of Mashhad University of Medical Sciences, Mashhad, Iran, and after data cleaning and dealing with incomplete data, individuals were clustered based on 4 variables: age, sex, leading cause of death and ​​place of residence using PAM and CLARA. The optimal number of clusters was determined before clustering using the mean of silhouette. Finally, the clustering performance of each algorithm was evaluated.

Based on the silhouette criterion, the highest difference among clusters was found when  five clusters were considered. In four of these clusters, which mostly included people aged over 65, circulatory, neoplasms, diseases of the respiratory system and endocrine, nutritional and metabolic diseases were the first to fourth leading causes of death, respectively. In the remaining cluster, the most common leading causes of death were congenital malformations, deformation and certain conditions originating in the perinatal period for children under 1 year of age.

Our results indicate that health policy makers should consider the importance of age distribution in clusters of a given population. Studying on death from cancer at the age of under 14 years and high percentage of death from diseases of the nervous system can contribute to health policies.

. The Social Security Organization, as the largest social insurance organization in the country, plays an important and decisive role in ensuring the health and dynamism of the society, and one of its most important goals is to provide various insurance and medical services to the covered people. But achieving this goal is possible when the sources and costs and the factors affecting them, which are the prerequisites for providing services and their costs, are known and analyzed in an accurate and transparent manner.

In this research, by modeling the resources and expenses of the social security organization with the system dynamics method, it has been investigated the effects of the corona disease, as well as forecasting the conditions of this organization in the coming years and providing suggestions to solve its problems.

According to the findings of this research, increasing the insurance premium received from 30 to 35%, as well as increasing the retirement age by 5 years, can increase the resources of this organization and prevent its bankruptcy.

The adoption of the policies proposed in this research, despite their sometimes very high impact, alone cannot provide a useful approach to prevent the bankruptcy of the social security fund.It is suggested that in addition to the proposed policies in the field of changing the social security system, as well as adopting more efficient long-term and medium-term policies, some changes should be made to choose a suitable approach to get out of the current situation.

The present study seeks to design an empowerment model for health insurance policyholders to achieve an acceptable level of capability. The reason for choosing this group of insured is their large and considerable population including about 50% of Iranian. The methodological approach is qualitative and of the grounded theory, deep and semi-structured interview data retrieval techniques. For data mining, theoretical coding method was used, which aims to achieve the main and sub-categories to set the theoretical model. The sample number is 15 specialists and experts in the field of health insurance and empowerment who have been purposefully selected. The results show that the central phenomenon is community-based empowerment, which is based on causal conditions, contextual conditions, intervening conditions and strategies. The most important strategies are the right of the insured to access insurance services and opportunities. In discussing the underlying conditions, important components such as: agency, sense of equality and inclusion (integration) and capacity building are emphasized. Findings also show that components such as protecting the rights of the insured, empowering and efficient resources and the quality of insurance services are considered as causal conditions. According to the findings of the present study, the three main categories of education and information, social participation and social support have been proposed as intervening conditions. Complementing the chain paradigm model of the present study is based on the data theory method of the Consequences Foundation, which has examined empowerment in four main sections: social empowerment, cultural empowerment, economic empowerment and psychological empowerment of the insured

Health, as an inherent value for humans, plays an important role in improving the happiness of society and the prosperity of individuals, and is often considered as a key component of human capital that leads to greater economic growth. The concept of social capital shows how the social structure of a group can act as a valuable resource for its people to achieve their goals at a lower cost. Considering health as an asset means the decentralization of policies from risk factors to a more comprehensive perspective based on social factors, including social capital, and the upcoming research was conducted on this basis.

This research was descriptive and correlational. Data analysis was performed through canonical correlation and multiple regression using secondary data collected by Legatum Institute in 2021 and data related to Iran in the period from 2007 to 2020, with the 24th edition of SPSS software.

According to the significance of Pillais and Wilkes tests at a significance level of 5%, the correlation coefficient of social capital and health was determined to be 0.89. According to the structural coefficients, elements of longevity, physical health, mental health, care systems, preventive interventions, and high-risk behavioral factors had the greatest impact on the canonical variable of health, respectively. Based on the standard coefficients, it was found that interpersonal trust has the greatest impact on health, and institutional trust, social networks, civil and social participation, and personal and family relationships as elements of social capital, were placed in the next priorities of impact on health.

Social capital plays an important role in understanding the determinants of health, and it is inevitable to pay special attention to it by policymakers in order to eliminate health inequalities. This is the basis in Iran’s health policy process, which is still facing many challenges, in addition to paying attention to hardware and treatment-oriented strategies, social capital can and should be given special importance as one of the most important determinants of health.

Basic and supplementary insurances play an important role in achieving universal health coverage. In developing countries, complementary insurances have many structural and organizational problems and inadequacies. The present study was conducted with the aim of investigating the factors affecting the service packages of supplementary medical insurance.

The current research is of a qualitative type with a framework analysis method that was carried out in 1400. 11 experts of the insurance organization and experts in the health system were selected as the research samples by the purposeful sampling method. MAXQDA software was used for data analysis.

The dimensions of the complementary insurance model of treatment in Iran based on the analysis of the opinions of experts and experts in Iran include five main dimensions: "laws and regulations, coverage of services, strengthening and creating a competitive market, developing standards for the use of services and treatment guidelines; Development of complementary insurances.

Based on the findings, efforts to develop a comprehensive package of complementary treatment services in the country in order to increase people's access should be considered by policy makers and the financial capacity to manage and finance universal health coverage should be increased. It is expected that with the scientific development of supplementary medical insurance, it will contribute greatly to universal health coverage in the country.