مجله بیمه سلامت ایران
سال پنجم شماره 4 (پیاپی 19، زمستان 1401)

In recent decades, due to the increasing health expenditures and resource constraints, the economic evaluation studies results have been increasingly used to prioritize health interventions and resource allocation in most countries, especially in high-income countries. Economic evaluation studies allow health system policymakers and decision makers, including physicians, to select the most appropriate intervention scientifically and systematically by comparing the costs and consequences of different treatment interventions. In Iran, The results of economic evaluation studies are used to decide on the arrival of new drugs in the country as well as insurance coverage for medical interventions since a decade ago. However, many researchers and clinical professionals still do not have enough information about the types of economic evaluation studies and the principles of conducting these studies. In this article, while defining economic evaluation studies, the difference between these studies and other studies in health sector is stated. Then the main types of economic evaluation studies including cost-effectiveness, cost-utility and cost-benefit are described and the differences between these methods are expressed. Finally, the general principles of conducting economic evaluation studies in the health sector are explained.
 Understanding these principles and their implementation by researchers, while improving the quality of economic evaluation studies, provides the opportunity for policy makers and decision makers in health system to compare the results of these studies with each other and their findings to make decisions about the allocation of resources between different health interventions

Evaluating the state of health financing of countries helps to check the efficiency of the health system and the optimal use of the limited resources of their health system. This study was conducted with the aim of reviewing health financing evaluation tools and the functional area of each of them so that more effective and efficient reforms can be applied in the path of achieving universal health coverage.

This study was a systematic review that used Scopus and PubMed databases and World Health Organization and World Bank databases to find tools and articles related to health financing evaluation. Articles and tools published in English have been reviewed without time limit. Data analysis was done by content analysis method.

A total of 35 articles and 9 tools were included in the study. After a complete review, finally, 6 tools (national health accounts, health system assessment approach, health sector situation analysis, organizational assessment to improve and strengthen health financing, health system review, health financing progress matrix) were analyzed. And all of them were examined from 9 dimensions of health financing assessment.

In this study, the evaluation tools of health system financing were identified and their characteristics were stated. Among the health financing evaluation tools during the last few decades, the health financing progress matrix can provide a more complete and comprehensive road map to identify the dimensions and performance of the health system financing area in the path of achieving universal health coverage.

As a strategic commodity, medicine has a fundamental role in the economy and health of the family and society. This study was conducted with an action research approach in order to design and implement a comprehensive method to prevent possible abuses and improve the distribution cycle of medicines for hemophilia patients in the Iran Health Insurance Organization of Tehran Province, Iran.

The current research is a qualitative study based on the action research approach. The participation of 12 experts was used to diagnose and explain the problem, choose a solution/create change and analyze the results. The research population included all patients with hemophilia type A and B covered by the Iran Health Insurance Organization of Tehran Province, Iran. Sampling was done by census (n=553). The required data were extracted from the system of hemophilia patients covered by the General Directorate of Health Insurance of Tehran province in 2018 and 2019. The data collection tool was a checklist made by the researcher. The findings were analyzed using Excel software.

The amount of consumption (drug dose) of Factor 7 decreased by 36.4%, Factor 8 by 35.9%, Factor 9 by 52.3%, VONWILLEBRAND by 20.8% and FEIBA by 43.6%. The paid share of Factor 7 organization is 36.4%, Factor 8 is equivalent to 31.3%, Factor 9 is equivalent to 51.1%, VONWILLEBRAND is equivalent to 20.3% and FEIBA is equivalent to 43.4%. The comparison of the costs in two stages before and after the implementation of the program shows the changes of 33.5% - the total costs of the patients Iran Health Insurance Organization of Tehran Province. The most changes (-51.1%) are related to factor 9 and the least related to VONWILLEBRAND (with -20.3%). The expenses of the General Administration show a total decrease of 157,223,071,000 Rials.

Conducting targeted interventions with an action research approach, in addition to helping to correct and improve the management of the drug distribution cycle, will lead to optimal management of resources, improvement of insurance coverage and satisfaction of the insured.

The outbreak of the Covid-19 pandemic has had a devastating effect on the provision and receipt of health services around the world. The present study was conducted with the aim of investigating the effects of this disease on referrals and services of one of the hospitals in Tehran.

In this historical cohort study, the number of referrals and services in 26 hospital departments in the first 6 months of 2018 and the first 6 months of 2018 were investigated and analyzed. The data in the form of a pre-designed Excel form received from the statistics unit and quality improvement unit of the hospital were entered into SPSS software version 26 and analyzed using non-parametric Wilcoxon test.

The load of referrals and services of the studied hospital was reduced by 30 percent during the Covid-19 epidemic. The highest rate of decrease was related to clinics and clinics (55/07 percent) and the lowest rate of decrease was related to emergency services (7/67 percent). CT scan services and referrals increased by 84/5 percent on average. These changes were statistically significant.

The reduction of the burden of referrals and services of the studied hospital is evaluated as medium to high. Healthcare providers should monitor hospital activity and develop strategies to mitigate the indirect effects of the COVID-19 pandemic resulting from reduced overall hospital activity

Lack of financial protection in health is known as a disease of health systems. Households suffer not only from the burden of disease but also from the burden caused by the destruction and economic poverty, in other words, facing back-breaking costs and poverty caused by financing their health. The aim of the current research is to investigate the impact of different dimensions of inequality on the financial financing of household health.

This is a descriptive, cross-sectional, and applied study, which examines the impact of inequality on the financing of household health expenses. The research tool is the financing inequality questionnaire (2008) by Saito. All out-of-pocket costs related to inpatient care, outpatient care, diagnostic tests, and medical expenses due to illness have been estimated for one year. Experts have confirmed validity and reliability.

The dimensions of inequality among households in Tehran are higher than the average (1.329), which has a significant impact on the financing of household health expenses. The direct effect of justice on the financing of household health expenses is rejected. With the increase in the back-breaking cost, equal opportunity, economic status, insurance coverage, and financing of household health expenses increases. According to P<0.001 and P=0.005, the age of the head of the household is not related to justice and gender in the financing of household health expenses.

There is a direct relationship between back-breaking expenses, equal opportunity, economic status, insurance coverage, and financing of household health expenses.

For a long time, challenges related to hospital management have been one of the most important concerns of governments. These challenges involve the medical staff and health policy makers more than ever during crises such as the Covid -19 pandemic and seasonal influenza. Lack of hospital beds, lack of special care facilities, lack of medical staff and rapid reduction of drug stock are among the most important problems that occur in critical situations. Designing and implementing management approaches based on snow processing and using the existing potentials to evaluate the condition of hospitals on a macro level can greatly reduce the incidence of such problems.

In this research, an attempt was made to avoid the aforementioned problems by using a new and technological approach in hospital information management and a macro view in evaluating the facilities and limitations of medical centers on the one hand and the electronic health record architecture on the other hand. Setting up an online system for sending and receiving the status of hospital beds live in the hospital management systems and the central headquarters of the Ministry of Health in the context of the electronic health record is the first step and adopting macro management approaches to use the available treatment capacities for optimal patient coverage is the second step.

This system was launched nationally based on the current platform of Iran›s electronic health records and was done at a low cost. Collecting patient data in the 3 stages of admission, treatment and discharge, while facilitating the monitoring of the utilization of hospital beds, helps to enrich the content of the electronic health record, as well as the launch of online management-supervisory dashboards.

The monitoring of the status of hospital visits, full and empty beds, as well as the daily discharge rate of hospitals could be monitored offline and with a delay, which was improved by presenting a new model compared to previous resource management efforts.

One of the effective ways to improve the quality-of-care services is to prevent the wastage of resources in health-treatment centers and hospitals by identifying the relevant causes. This study was conducted with the aim of investigating the type, causes, and amount of health insurance deductions in the teaching hospitals of Ferdows city.

The current descriptive research is a study that was conducted in 2021 in two teaching hospitals in Ferdows city. The research population included the inpatient and outpatient medical records of these two hospitals. The data collection tool was a checklist made by the researchers, confirming its validity. The collected data were analyzed using Excel software and descriptive statistics.

Most deductions and their causes in the reviewed cases are respectively related to the laboratory (due to the absence of a technical officer), and consumables (due to the lack of insurance commitment for some equipment and price increase requests). The lowest deductions in the investigated cases are related to medicine (due to the request for an excessive amount of medicine), anesthesia (due to the demand for an additional amount of anesthesia), and prosthetics (due to the request for an additional price). Findings showed that in both hospitals, the highest number of deductions are related to inpatient cases.

Correct information in medical files and also the presence of the technical officer in different hospital departments play important roles in reducing hospital deductions. Therefore, a proper decision and policy should be made in this regard.