مجله بیمه سلامت ایران
سال پنجم شماره 3 (پیاپی 18، پاییز 1401)

Despite the impact of theoretical approaches explaining the concept of social security on the social security system, often in Iran, this concept does not have an independent status in sociological analysis and its theoretical analysis is reductionist and is usually considered as an economic concept. After reviewing and explaining the existing theories, the formation of theories was presented based on the three models of welfare state, good governance and governmantality. Their review reveals differences around the two issues of perceiving the power and purpose of social security. In the approaches of welfare state and good governance, power is understood in a structuralist, non-historical and hierarchical way. It is responsible for the implementation of social security programs But in the governance approach, it is understood as a special way of exercising power and governing over oneself and citizens to optimize living standards.Also, the critical evaluation of these theoretical models implies that the approaches that have considered social security as a text and discourse, with a critical, historical and discourse approach, unveil the values, assumptions and ideological dimensions and political rationality of social security. And they have more explanation.

Diagnostic and curative services are a major source of healthcare expenditures, indicating their potential to control such expenditures. This study aimed to evaluate appropriateness of medical imaging services and to provide policy options to address this challenge.

Following a systematic review design, international (Elsevier, PubMed, Web of Science, and Scopus) and national (IranMedex, MagIran and SID) databases were searched from 1990 to November, 2021 using various combinations of the following keywords: Diagnostic imaging/Radiology, Medical Imaging, CT-Scan, Rational consumption, appropriateness, Health service misuse/Medical overuse, and services utilization. Google Scholar was also mined. STROBE checklist was used to evaluate the quality of articles.

Initially 605 articles were found, of which 22 were found as eligible. All studies mention various levels of inappropriateness of services (i.e., 21 to 76%), and mentioned different causes, including benefiting from complementary health insurance coverage, insufficient knowledge of providers, and various referrals of patients. The most widely mentioned solutions include training providers and establishment of a strong monitoring systems.

Inappropriateness of prescribed results in increased burden for health systems, health insurance funds, and providers. Also, this problem is not restricted to Iran and several high income countries with well-established health systems are also faced with this problem.

One of the most important factors that indicate hospital performance are hospital indicators. One of the fundamental developments and changes in the health system of Iran is the health system transformation plan, the effects of which should be examined from different aspects. The purpose of this research is to determine the performance indicators of hospitals affiliated to Zahedan University of Medical Sciences, Zahedan, Iran and compare them with the standards of the Ministry of Health and Medicine. Medical education was in 2018.

This cross-sectional descriptive study was conducted in 2018 in public hospitals covered by Zahedan University of Medical Sciences, Zahedan, Iran. In this study, the most important performance indicators of the hospital from 2015 to 2018 were investigated in a targeted manner. The entry criterion was the completeness of the indicator's information. In this study, to obtain accurate and reliable information, input data and output data were used as performance indicators. The data was analyzed using EXCEL software and descriptive.

In the present study, a total of 6 hospitals of Zahedan city under the coverage of Zahedan University of Medical Sciences were investigated. On average, 11,200 people were hospitalized and 11,003 people were discharged, which decreased to 11,086 people hospitalized and 10,450 people discharged after the transformation plan. The average number of emergency and outpatients was 71,600 and 124,571 respectively.

To evaluate the hospital, the use of performance indicators as a criterion can guide managers in understanding the current situation of their center as well as in planning and management decisions. The findings of the study showed that in terms of bed occupancy rate, the hospitals were in an average and poor condition compared to the standards of the Ministry of Health. But in terms of the average days of hospitalization, they were in an unfavorable situation.

Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of public awareness of its nature, services and benefits. The aim of this study was to provide a model for accepting the referral system from the perspective of patients.

This study was a mixed method that was conducted in three steps in 1400. The first step included the development of a questionnaire, the second step was a survey study, and the third step was the design of the acceptance model of the referral system from the perspective of patients. The statistical population included 384 patients covered by the Rural Insurance Fund referring to the Imam Khomeini Hospital Complex. The data were analyzed using SPSS v20 software. Also, Second-order Confirmatory Factor Analysis (S-CFA) was performed using LISREL v8.5 software.

Cronbach's alpha ratio for the whole questionnaire was 0.85 and intra-cluster correlation coefficient was 0.69. The results of confirmatory factor analysis showed that patient-centeredness, rules and regulations, responsiveness, coordination, security, accessibility, effectiveness, efficiency, personal beliefs and social influence significantly affected the acceptance of the referral system from patients' perspectives.

It is necessary for managers and policy makers before and during the implementation of the referral system to consider the factors affecting the acceptance of the referral system from the perspective of patients. For the appropriate implementation of the referral system, special attention should be paid to all the influencing factors so that patients can easy and convenient access health services anywhere and anytime.

The prevalence of COVID-19 disease has added additional job stress to medical staff around the world and exacerbated the psychological problems of specialists. On the other hand, creating conditions for creating a synergistic passion for work and family can be a good solution to maintain the health of employees and provide better services to patients in medical centers. The aim of this study is to present a model of Deterrent and Promoter Affecting Synergistic Enthusiasm for Work - Family among Medical Married staff of medical centers under the supervision of Tehran University of Medical Sciences.

The present study was conducted qualitatively using grounded theory. In order to present the model, in-depth semi-structured interviews with the treatment staff were used. The selection of individuals was purposeful. Theoretical saturation was obtained after 12 interviews.

Data analysis led to finding 6 promoter factors (intrinsic and behavioral characteristics of the individual; core and main family characteristics; characteristics related to work and work environment) and 7 deterrent factors (internal factors Psychology, behavioral habits; family environment, common destructive behaviors; work characteristics, managerial factors, organizational environment) were divided into 3 categories of individual, family and job factors.

Promotion of productivity, human capital and quality of health care services that are affected by the psychological problems of medical staff should be considered by the Ministry of Health and relevant organizations. Hospitals can improve the quality of services provided to the insured by using the presented model, while paying attention to specialists.

Implementation of performance-based payment system is considered as an important and effective factor in improving work productivity, which will increase organizational satisfaction and justice. Performance-based payments actually link material rewards to individual, group, or organizational performance, or a combination of the three. The aim was to explain and prioritize the challenges and solutions of the performance-based payment system to the staff of hospitals.

This study is a qualitative study that was conducted with content analysis approach in 2020 in teaching hospitals of Lorestan. The statistical population was 14 medical and staff members using purposive sampling. The sampling method was purposeful and sampling continued until data saturation. Data analysis was performed using conventional content analysis.

After the process of continuous comparison of data and open, pivotal and selective coding, in 2 main dimensions (organizational factors, individual and internal factors) and 6 sub-dimensions (fair payment system; work quantity; work quality; work based payment And effort; motivation and interest; commitment and commitment) were organized.

Considering the effectiveness of the implementation of performance-based payment plan on the income of hospitals, it can be stated that this plan has a positive effect on the performance of hospital staff and causes them to be more active in hospitals, provide better services and Total improved effectiveness. Therefore, the officials and implementers of the performance-based payment plan in the Ministry of Health and Medical Education are suggested to follow its implementation more widely in other provinces.

Medical tourism industry is one of the most lucrative industries in world. Insurance increases the comfort of tourists. The development of the tourism industry is accompanied by the growth of insurance services. Increasing the country's foreign exchange earnings through the medical tourism industry; is essential. In this research, we intend to present all the effective components of insurance in the marketing model of medical tourism of the Social Security Organization.

This research is based on the purpose of applied research, in terms of how to collect data is descriptive-survey and in terms of research approach, is a mixed exploratory method. Which was done in 2021. In qualitative approach using Delphi technique, effective components in medical tourism are identified. In quantitative approach, the research model was finalized using exploratory and confirmatory factor analysis.

The insurance factor affects the marketing of medical tourism. And this factor has five components; Fast and effective redemption of insurance, Full health insurance coverage, Other supplementary insurance services such as travel and theft and Acceptance of international health insurance and the transferability and validity of health insurance in other countries were identified.

Results of this research help the health policy makers of the country to increase their foreign exchange earnings by using this research model. And with regard to the insurance components of the model and effective measures by the government, Insurance companies will reduce the financial and security threats of tourists and ultimately increase the attraction of medical tourists from other countries.

The COVID-19 caused many changes in the performance and productivity of health service providers. The purpose of this study was to investigate the effects of the COVID-19 pandemic on the financial and performance indicators of one of the hospitals in Tehran.

This historical cohort study was conducted in the first 6 months of 2018 as the pre-pandemic period and the first 6 months of 2019 as the post-pandemic period. 13 performance indicators of inpatient departments; 9 operational indicators of the whole hospital and 3 financial indicators were included in the study. The data were received in a pre-designed Excel form from the statistics unit and quality improvement unit of the hospital, and after entering SPSS and checking their normality, they were analyzed with Wilcoxon's non-parametric test.

Average indices of bed circulation (P=0.028), discharged patients (P=0.028) and hospitalized patients (P=0.046) were significantly reduced. The index of death before 24 hours (P=0.027) and after 24 hours (P=0.028) and ED discharge (P=0.028) also increased significantly. The average profit of the hospital at the current price and the actual price had increased significantly (P=0.028). Total current income increased, but real income decreased, which were not significant. Current and real costs were also reduced, only the real cost reduction was significant (P=0.028).

The COVID-19 had a significant impact on the hospital's financial and performance indicators. It’s necessary for hospital managers to have an appropriate model for the development of services and the sustainability of resources during a crisis.