مجله تحقیقات نظام سلامت حکیم
سال شانزدهم شماره 4 (پیاپی 63، زمستان 1392)

The aim of most countries in implementing varied models of public-private partnership within public hospitals is to improve performance indicators of hospitals and health sectors. The present study was carried out to prioritize public-private partnership models in public hospitals of various countries based on key performance indicators. In this descriptive-analytical study، we used literature review and expert panel method to identify various models of public-private partnership and performance indicators. We also used Analytic Hierarchy Process to prioritize performance indicators and various public-private partnership models based on performance indicators. The data were analyzed using the Excel 2007 and Expert choice11. The key performance indicators of public hospitals were as follows: in the quality-effectiveness area، the most important indicators were the rate of hospital infections، hospital incidents breakout rate، pure rate of hospital mortality، patient satisfaction percentage، respectively; in the accessibility-equity area، the most important indicators were average inpatient waiting time، and average outpatient waiting time، respectively; and in the financial- efficiency area، the most important indicators were average length of stay، bed occupation ratio، and private income to total cost ratio، respectively. Prioritization of the public-private partnership models indicated that the clinical outsourcing، management، privatization، the «Build، Own، Operate»، and non-clinical outsourcing models were the most important ones. Various models of public-private partnership can be used to improve public hospitals'' performance indicators. It is worthy noting that proper management of public-private partnership is to improve quality، efficiency and equity in hospitals.

In recent years، Iran''s scientific growth has been impressive. Despite increasing research outputs and number of researchers over the past few years، there are still several barriers in conducting research studies. This study aimed to investigate problems of and solutions to the research in dentistry in Iran. This qualitative study was carried out using nominal group technique in 2011. We invited 22 dentists، expert in managing academic institutes and research centers in local and national levels. The nominal group discussion was held in four stages: 1) listing the problems; 2) classification of the problems; 3) weighting the problems; and 4) presenting solutions. From 45 items outlined in the discussion group، 28 items were classified as internal policies and practices of the universities (weakness area)، and 17 items were classified as out of university problems (threat area). In the weakness area، the means of the problem weight in both importance and influence dimensions were 11. 73 and 12. 74 out of 20، respectively. In the threat area، the means of the problem weight in both importance and influence dimensions were 9. 89 and 10. 12 out of 20، respectively. From 115 solutions provided by the participants، 72 ones were related to the weakness area; and 43 ones were related to the threat areas. The results showed that establishing a research secretariat in order to identify dental research priorities (at national and local levels)، promoting community-focused health، and conducting goal-based research were the most applicable solutions. The results showed that weakness area problems were most important than the threat area problems from the participants point of views. It seems that university management should design appropriate plans to help academic members become familiar with problems of the society and publish their research studies. Appropriate infrastructure should be provided to empower academic members of the universities such as giving incentives and facilitating rese3arch study processes.

The way of spending resources affects operational costs of hospitals and efficiency of health care system. The performance of the CCUs has significant effect on reducing heart diseases mortalities. In addition، CCUs are important wards due to the nature of modern and advanced care they provide. In this cross-sectional study، all CCUs of hospitals of Tehran University of Medical Sciences were studied. First، data were imported into the Frontier 4. 1 software. After estimating the cost and production functions، economic efficiency of the SFA method was calculated. Then، data were imported into the DEAP 2. 1 software and economic efficiency was again calculated. The economic efficiencies calculated using the two methods were compared in the SPSS. The means of economic efficiency of the CCUs were 0. 59±0. 95 and 0. 95±0. 063 in the SFA and DEA methods، respectively. The economic efficiency was significantly more in the DEA method than the SFA method (P<0. 0001). The SFA and DEA efficiency measurement methods did not show similar results. The types of activities and samples affect the results of the measurements.

Infertility is a health problem steadily growing throughout the world. Infertility can cause several emotional، economic and social consequences. Accurate and precise estimation of infertility prevalence is necessary to define burden of the disease as well as to assess the need for health care services. This was a population-based study conducted among currently married women (n=888) aged 18-49 years. The participants were selected from four provinces using quota stratified cluster sampling. The custom-designed questionnaire was completed by trained interviewers. The mean age of the women participated in the study was 34. 8±6. 9 years old. The rate of primary، secondary and lifetime infertilities were 21. 1%، 7. 8% and 6. 4%، respectively. The most important cause of primary and secondary infertilities was menstrual dysfunction. The marriage age and education level of women had a significant statistical relationship with primary infertility (after adjustment) (P<0. 5). The prevalence of infertility varies depending on the definition. The socio-demographic factors can influence the prevalence. The high prevalence of infertility threatens women in our country. Providing information about influential factors on infertility can help women who postpone the age for marriage in decision-making on the time of childbearing.

One of the main implications of social justice in a society is actualizing equal basic rights such as equal access to health services and minimum income level. Since social disparities among the individuals are affected by their health status، profound social inequalities can have adverse consequences on health and socio-economic situations of the individuals. Hence، monitoring households'' health expenditures، which can reflect socio-economic inequality، can provide valuable information for the health policy makers. Using the Extended Concentration Index and the Health Achievement Index، which both have been introduced by Wagstaff (2002)، this study measured the households'' health expenditures in Iran disaggregated into expenditure quintiles of the Iranian households. To this end، Iran''s annual Household Survey data produced by Iran Statistic Center during 1984 to 2011 was used. The least inequality has been occurred in 2011; while the highest inequality varied between 2007 and 1991، depending on the value assigned to inequality aversion parameter. Nevertheless، in overall، the trend of inequality in the studied period has generally been increasing. The average of the concentration extended index and the achievement index during the study period was 0. 59 ± 0. 03 and 101884. 1 ± 3231. 56، respectively. Findings of the study confirmed on one hand، households'' expenditure inequality in favor of the higher income groups، and on the other، that the public policy in health has not been as effective as expected. Moreover، the results of the study indicated that the higher degree of inequality aversion parameter، the lower was the disparity between the average households'' health expenditures and its average at the «perfect equality». This result showed that the capability of the individuals، and particularly the lower income groups، has been weakened.

Induced demand is resulted from various factors influencing physicians and patients'' behaviors. It is also affected by rules and regulations of markets and organizations of medical services. This study aimed to investigate main factors that affect the induced demand using experts'' opinions at Isfahan University of Medical Sciences. This was a qualitative study. Semi-structured interviews were used for data generation. 17 Known experts who had valuable experiences in the issue were invited to participate in the study using purposive sampling. Data were gathered until data saturation was obtained. Reliability of the information and stability were confirmed. The anonymity of the interviewees was preserved. The data were transcribed، categorized and used for thematic analysis. In this study، three themes and 77 sub-themes were extracted. The three main themes included infrastructural factors، social factors، and organizational-structural factors. These three main themes had 77 subthemes. The results of the present study have presented a framework for analyzing the major causes of induced demand. The causes identified here included complexity of medicine، information asymmetry between service providers and consumers، clinical uncertainty، false beliefs، advertisements، insufficient supervision، scarcity of clinical guidelines، weakness of education system، and ignorance of medical ethics. These findings help policymakers to investigate the induced demand phenomenon clear-sightedly. It is suggested that in order to control induced demand، people’s awareness be increased and financial motivations of health service providers be controlled through proper policies، and clinical guidelines be used as a strong tool to monitor doctors’ performance.

Congenital anomalies are of main reasons of neonatal mortalities. Although most of the symptoms can be detected immediately after birth، some are mild enough to be ignored. Failure to diagnose of the disease may result in irreversible physical and mental problems in neonates. In most of the countries، there are screening programs for detection of the Phenylketonuria. This study aimed to assess cost- effectiveness of neonatal screening program for Phenylketonuria in Fars province. Implementation costs of the screening program and the cost of the disease management were calculated and compared using Decision Tree model. The health related quality of life of the two mentioned groups and incremental cost-effectiveness were also estimated. Results showed that the Phenylketonuria screening cost was about 34727047 Rials for every individual. The screening program was cost-effective. The Phenylketonuria screening program was beneficial for both patients and society. It increased quality of life of the patients and might have long-term financial gain for the society.

Women''s health is a broad concept that includes physical، psychological، social، cultural، and spiritual aspects، and is influenced by social، political، economic and biological factors. This definition offers a conceptual framework for an effective and relevant approach to women’s health promotion and disease prevention. Understanding women’s health is not only an emphasis on influences of biological factors and health care but also in a wider range of determinants of health such as education، culture and economy. There is no known national women’s health model to identify influencing factors، show their relationships and correlations in a schematic collection، and able to be used as a tool in defining indicators of health status، health promotion strategies and priorities for Iranian women. Women’s Health Scientific group in IRI Academy of Medical Sciences recognized this need and attempted for a theoretical model to explain the factors affecting health of Iranian women. This paper reviews and evaluates existing theoretical frameworks and models for health، and introduces a designed women’s health model (Farmehr) regarding aspects of the national، local، religious and cultural life of Iranian women. In this qualitative study، authoritative medical information were searched and collected from national and international databases. Documents were content analyzed by holding 23 expert meetings and based on concepts from existing models by which the content analyzed matrix was designed. Analyzing was used to facilitate the understanding and conceptualization of the findings; and preliminary model was developed. Then in two stages of six deep interviews and one focus group discussions with 15 key health experts and policy makers، their comments were considered and applied to the model. The women’s health model for I. R. I. Academy of Medical Sciences (Farmehr) was finalized. The constituent elements in Farmehr women''s health model include 53 elements، in which 17 elements are in individual level، 8 elements are in family level، and 24 elements are in social level. They all are divided in four subject groups. There are also four basic and fundamental elements affecting women’s health in an underlying subject group in the model. The Farmehr conceptual framework and model can be used as a tool for better understanding of women''s health، its affecting factors، data analysis and evaluation. In this model، relations between different aspects of women’s health، their multiple roles in life and external affecting factors are considered in one collection. It can be used to describe gender relations in the family، community، and to define appropriate health indices compatible with the conditions. So it makes possible to compare and evaluate women‘s health care and status more sustainable and credible in national and international levels.

Cancer is responsible for an important part of health care costs. Policymakers need to be aware of the costs of cancer to allocate resources properly in health systems. In this paper، we explain the methods of estimating economic burden of cancer. We searched published articles and reports related to estimating costs and economic burden of cancer in known databases including Ovid Medline، Scopus، PubMed، and Google scholar. Then we reviewed the methods of selected studies. The economic burden of cancer is measured by cost، the monetary valuation of resources used to treat cancer، or the loss of economic opportunities related to cancer occurrence and treatment. There are two main approaches for estimating the economic burden of cancer: prevalence-based approach and incidence-based approach. The prevalence-based approach is more applicable; and policymakers are mostly interested in using this approach. In economic burden studies، many perspectives are used for calculating costs; however، the social perspective is more common. In the most studies، costs are categorized in three group including direct costs، indirect costs and intangible costs. Approaches to measuring the direct costs include top-down approach، bottom-up approach and the econometric approach. Human capital approach and willingness to pay approach are used for measuring indirect costs; the human capital approach is more popular. Despite the importance of calculating the economic burden of diseases for resource allocation، few studies have been conducted on this issue in Iran. Researchers can use the methods presented in this paper to calculate the economic burden of cancer and other diseases in Iran.

Given the need of doing researches related to patient safety، conducting applicable studies in this field، and making evidences، this study aimed to recognize and define the research priorities in patient safety fields.

This study was carried out using Modified Classis Delphi technique in 2013. The study participants were all policy-makers، planners، managers and officials of healthcare organizations as well as faculty members involved in patient safety issue. Purposive sampling was employed to select 45 participants. Data was gathered using three questionnaires. The first questionnaire was prepared on the base of the review literature; and the other questionnaire was designed on the base of the previous results. The validity of used questionnaire was confirmed by experts. Collected data were analyzed using SPSS-16.

Four themes were identified including «epidemiology of threatening factors of patient safety» (with 14 subthemes)، «root analyzing of threatening factors of patient safety» (with 5 subthemes)، «patient safety improvement» (with 5 subthemes) and «evaluation and feedback of patient safety solutions» (with 21 subthemes). The most important subtheme (first priority) was the study of medical errors in using drugs (drug errors) and the less important subtheme (last priority) was the study of educational and non-educational healthcare centers and patient safety.

Our findings indicated the Iran’s research needs in patient safety field. This could help policy-makers، researchers and related organizations to choose suitable and applicable topics to investigate on the patient safety issues. Also، it makes possible utilizing available capacities to satisfy patients and society needs. It is suggested that the identified research properties to be given to relevant stakeholders in order to organize efforts of providing sufficient evidence in patient safety field.