مجله بیمه سلامت ایران
سال ششم شماره 3 (پیاپی 22، پاییز 1402)

Health is one of the most basic needs of all humans, and the main function of the health system of any country is to provide services in this area. The purpose of this research was to answer the question of how health services are provided, by which institution and according to what principles. After the victory of the Islamic Revolution, the expansion of social security in the 29th principle of the constitution, based on the fact that all people enjoy the benefits of social security as a universal right, was put on the agenda. Based on this, the main institutions, organizations, institutions and funds in the fields of insurance, support and aid of this system were obliged to carry out their executive and business affairs in the field of production and provision of services and related legal obligations by means of contracts whose terms are proposed by the Ministry of Cooperatives. Work and social welfare and the approval of the Supreme Council of Welfare and Social Security will be assigned to brokerage institutions. Although in Iran’s legal system, various institutions are responsible for providing health services to different sections of the society, but the main institutions that provide insurance services are the Iran Health Insurance Organization and the Social Security Organization, and each of these organizations, according to the duties and obligations are responsible for providing health services in the community.

Economists have always sought to discover the factors that cause poverty, because by understanding these factors, they can plan to reduce poverty. The purpose of this study is to determine the poverty line and the factors affecting it in the year 2021.

In the present study, only the line and its indicators were estimated by the data of urban and rural households' expenditure and income plan in the year 1400 and using the linear expenditure system (LES), and the determining factors of poverty were investigated. Also, the impact of the probability of poverty on the characteristics of the households was investigated using the probit model with Stata17 software.

The poverty line for a household in 2021 was calculated as 73,980,000 Rials. The highest reduction in the probability of household poverty is related to the level of education of the head of the household. With the increase of each unit of education level, the probability of facing poverty in the household will decrease by 23.1%. After that, the number of working people in the household has the highest effect in reducing the probability of household poverty with a decrease of 19.9 percent. Among these variables, in terms of the household, having health insurance has the least effect in preventing the household from becoming poor.

The gender of the head of the household is effective in reducing poverty. Also, in households where the head is younger, the probability of poverty increases. More support for young people and creating more favorable conditions for their employment is necessary to reduce poverty. Increasing the level and depth of insurance coverage will also be effective in reducing poverty.

 Electronic human resource management includes electronic tools that enable human resource managers to manage human resource data and information and also provide the possibility for the beneficiaries to have access to specific information and tasks of human resources through the Internet. Therefore, this research was conducted to identify the effective factors of electronic human resources management in the Iranian Health Insurance Organization using the fuzzy Delphi approach.

 The current research, which was carried out in 2023, has a mixed approach and an inductive paradigm. The statistical population of the research in the qualitative and quantitative part are academic experts and (senior) managers of the health insurance organization in Tehran province, and 30 of them were selected as sample members based on the principle of theoretical saturation. The data collection tool in the qualitative part of the research is a semi-structured interview and in the quantitative part, a fuzzy Delphi questionnaire. In this research, to analyze the data in the qualitative part, the content analysis method and coding approach using MAXQDA software was used and in the quantitative part, the fuzzy Delphi method was used. The validity and reliability of the interview were confirmed using content validity and intra-coder inter-coder reliability and the validity and reliability of the questionnaire were confirmed using content validity and inconsistency rate.

 The results of the qualitative part indicate the identification of 15 factors as effective factors in electronic human resources management in Iran's health insurance organization. On the other hand, the results of the quantitative part using the fuzzy Delphi approach show that human resources architecture, structure and process reform, integration of human resources processes, reduction of administrative bureaucracy, the existence of financial support, and the creation of a suitable culture as the most important factors on the effective management of electronic human resources in Iran's health insurance organization.

 The application of electronic human resources management in the current changing conditions helps the health insurance organization more than ever in achieving its goals and agility.

The escalating costs of the social security system, coupled with the rising burden of expenses on income, represent some of the most significant economic challenges facing our country. Formulating a plan to address this issue necessitates an understanding of the factors that influence the expenses of the social security system. It is crucial to assess the impact of monetary and fiscal policies on social security expenditures.

In this study, the Autoregressive Distributed Lag (ARDL) model was employed to assess the impact of monetary and fiscal policies on the expenses of the Social Security Organization from 2010 to 2019. The ARDL model is a single equation approach that incorporates past lags of both independent variables and the dependent variable itself into the equation, providing a more accurate estimate. The data for this research were sourced from the statistical records and financial statements of the Social Security Organization. After standardization, these data were then incorporated into the study.

Liquidity and the ratio of government expenditures to gross domestic product (GDP) exert a negative impact on social security expenditures. This could be attributed to the short-term effects of these variables on business prosperity and the temporary reduction of unemployment. The correlation of unemployment, interest rates, and exchange rates with the organization’s expenses was found to be positive. Additionally, the life expectancy index and support ratio positively influenced the organization’s expenses. This was one of the advantages of the Social Security Organization, as it led to an increase in the benefit period for pensioners. In the long term, an increase in liquidity, coupled with the effects of inflation and wage growth, can lead to a rise in social security costs. Similarly, an increase in the support ratio and life expectancy exerts the same effects.

The government’s monetary and fiscal policies significantly influence the financial status of the Social Security Organization. Considering the organization’s impact on the well-being of over 45 million individuals, it is crucial to consider its role as a non-governmental public institution when making macro-policy decisions in various fields. These decisions should consider their effects on all aspects of the macroeconomics and institutions, especially non-governmental public institutions, such as the Social Security Organization.

Risk assessment is one of the important issues in insurance industry that can lead to better performance of insurance companies. The aim of this study is to provide a risk assessment model for the coverage of fetal malformations of supplementary insurance in the Iranian insurance industry in order to identify the effective factors and the extent of the impact of each with a mixed approach.

This research is exploratory-descriptive based on the way of data collection and is developmental-applied in terms of purpose. The qualitative section was conducted with in-depth interviews with 14 insurance industry experts and specialized physicians using the data method of the foundation in three stages of open coding, axial coding, and selective coding in MAXQDA software. In the quantitative section, the data collected using a questionnaire from 67 insurance industry experts were measured by the structural equation modeling method using SMART-PLS software. The reliability and validity of the quantitative method were calculated and confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, respectively.

In the qualitative section, six main factors including parental characteristics, insured group characteristics, environmental factors, scientific and technological factors, cultural and social factors, and factors related to the insurance industry were identified, and 36 indicators as factors affecting risk of coverage fetal malformations insurance. Findings showed that 32 indicators out of 36 indicators are statistically confirmed and all six identified factors have a positive and significant effect on fetal malformations.

The results confirm that the insured group characteristics have the greatest impact on the risk of insurance coverage for fetal malformations. Therefore, in order to cover the mentioned risk, insurance companies should pay special attention to the indicators of education, geographical status, demographic composition, and gender composition of the members of the insurance group.

In recent years, one of the key innovations in the field of health and treatment has been the use of health information technology, resulting in cost savings, easy access, efficiency, and ultimately improved patient treatment results. One of these technologies, whose use has received attention in the field of health and treatment, is telemedicine technology.

In this research, after the qualitative analysis of experts' opinions and previous research, the classification of factors was conducted based on the PESTEL technique, and applying the DANP method, the intensity and direction of the influence of the challenges and drivers of the diffusion of this technology were determined and the criteria were prioritized. Afterwards, the conceptual model of technology acceptance was created. In order to evaluate the proposed conceptual model and whether to prove or reject the proposed hypotheses, information was collected through a questionnaire and having analyzed the results, the final conceptual model was presented.

The results of this research show that the challenges affecting the diffusion of telemedicine in Iran are the lack of training, loss of (raising) people’s awareness about telemedicine and negligence of the health system to this technology. Factors such as reducing human errors, increasing patients' knowledge about their diseases, promoting self-care, eliminating geographical distance, and increasing access to specialized services are the drivers that can have a positive impact on the diffusion of telemedicine in Iran.

In order to expand the use of telemedicine technology and benefit   from its advantages in the therapeutic/medicinal system of the country, it is essential to pay serious attention to the issue of culture (raising awareness) and appropriate policy making of the health system. Providing quality medical services through this treatment method and presenting the results will have a significant impact on the acceptance of this technology in our country.

This study was conducted with the aim of evaluating the dimensions and components of health insurance policies in the field of recruitment and recruitment.

The current study was descriptive-analytical and cross-sectional, which was conducted in 2023. The statistical population included managers and consultants of Iran Health Insurance Organization. 10 people were selected as study samples in a purposeful way and the data were collected using a researcher-made questionnaire and analyzed using the 22nd edition of SPSS software.

Descriptive indicators related to the importance coefficient show the degree of conflict and ambiguity of policies from legal documents (policies). Also, the average obtained from the samples in most of the subjects (policies) was higher than the theoretical average (2.5).

By creating a comprehensive evaluation system of human resource development policies and understanding the extracted factors and using them in a valid evaluation system, the efficiency and effectiveness of the organizations can be improved.