Background: Aiming to enhance quality of care and increase efficiency, public hospitals have undergone several reforms in the course of last two decades in Iran. This paper reports the result of a national research that aimed to measure... more
Background: Aiming to enhance quality of care and increase efficiency, public hospitals have undergone several reforms in the course of last two decades in Iran. This paper reports the result of a national research that aimed to measure the technical efficiency and productivity change of public hospitals during 2012-2016 in Iran. Methods: We used Extended Data Envelopment Analysis (Extended-DEA) (an innovative modification to conventional DEA) to measure technical efficiency and productivity of 568 public hospitals. Nationally representative data were extracted from the official annual health reports. Data were analysed using GAMS software 24.3. Results: The average efficiency score of all hospitals was 0.733. 10.1% of all hospitals were efficient while 2.68% of them were under 0.2. The Malmquist Productivity Index (MPI) progressed in 49.3% of hospitals, remained constant in 2.3%, while 48.2% of hospitals regressed during 2015-2016. The average of MPI was 1.07 over the period of ana...
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Due to the lack of a constant Willingness to Pay per one additional Quality Adjusted Life Years gained based on the preferences of Iran’s general public, the cost-effectiveness of health system interventions is unclear and making it... more
Due to the lack of a constant Willingness to Pay per one additional Quality Adjusted Life Years gained based on the preferences of Iran’s general public, the cost-effectiveness of health system interventions is unclear and making it challenging to apply economic evaluation to health resources priority setting. We have measured this cost-effectiveness threshold with the participation of 2854 individuals from five provinces, each representing an income quintile, using a modified Time Trade-Off-based Chained-Approach. In this online-based empirical survey, to extract the health utility value, participants were randomly assigned to one of two green (21121) and yellow (22222) health scenarios designed based on the earlier validated EQ-5D-3L questionnaire. Across the two health state versions, mean values for one QALY gain (rounded) ranged from $6740-$7400 and $6480-$7120, respectively, for aggregate and trimmed models, which are equivalent to 1.35-1.18 times of the GDP per capita. Log-li...
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Background: The importance of paying attention to improving productivity in different departments of health system become increasingly evident due to increased costs of health care goods and services, limited resources and production... more
Background: The importance of paying attention to improving productivity in different departments of health system become increasingly evident due to increased costs of health care goods and services, limited resources and production facilities. The aim of this study was to measure the productivity of medical records departments of hospitals affiliated with Urmia University of Medical Sciences (UUMS) in order to provide a comprehensive analysis of their performance.Method: In this study, total productivity and total factor productivity changes of medical record department in hospitals affiliated with UUMS were calculated by Kendrick-Creamer and Malmquist indexes in 2016-2020 and has examined the trend of each One of them.Results: The results of Malmquist index showed that average total productivity changes of medical record departments of hospitals during the study period was equal to 1,096 which is greater than one, therefore it can be concluded that productivity has decreased by a...
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Background Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and... more
Background Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. Methods In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting the...
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BACKGROUND Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age.... more
BACKGROUND Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. METHODS TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). RESULTS In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between co...
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BACKGROUND AND AIM: Dental caries is still one of the most common chronic diseases among children, although it can be prevented through early and regular professional services. This study aimed to analyze cost-effectiveness of fluoride... more
BACKGROUND AND AIM: Dental caries is still one of the most common chronic diseases among children, although it can be prevented through early and regular professional services. This study aimed to analyze cost-effectiveness of fluoride varnish therapy intervention to develop and implement appropriate strategies in order to reduce incidence of tooth decay. METHODS: This study modelled the cost-effectiveness of fluoride varnish therapy plan to prevent dental caries in elementary students with age range between 7-12 years, in Urmia, northwestern Iran. All costs and benefits were measured from a provider perspective in order to obtain the cost-effectiveness analysis (CEA). We estimated the direct medical costs of fluoride varnish in a school-based setting and compared this to the benefits of reducing the incidence of dental caries, as measured by the disability-adjusted life year (DALY) index. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to...
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The importance of drug as a valuable export product in the global economy becomes clearer every day. Understanding the problems of exports and factors affecting it, can be an important step to keep Iran’s position in the world markets and... more
The importance of drug as a valuable export product in the global economy becomes clearer every day. Understanding the problems of exports and factors affecting it, can be an important step to keep Iran’s position in the world markets and further export development of this product. In this study, Iranian pharmaceutical exports’ supply and demand functions were calculated using co-integration and error correction techniques through time series quarterly data of 2000-2014 in order to identify the factors affecting pharmaceutical exports (short run and long run relationships among the variables) and price and income elasticities. The long run price elasticity of demand of -2.28 indicates that an increase in Iran’s export price relative to competitor′s export price will have a negative impact on pharmaceutical export volume. Also, the long run income elasticity of foreign demand for pharmaceutical exports of Iran is 1.11. That is an increase in income of foreign countries will have a po...
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Ensuring of specified physicaland organizational terms and conditions in health facilities, has undeniable effect on performance. Equipments layout is one of issuses that Ministry of Health had communicated its Instructions.A before-after... more
Ensuring of specified physicaland organizational terms and conditions in health facilities, has undeniable effect on performance. Equipments layout is one of issuses that Ministry of Health had communicated its Instructions.A before-after study was conducted in health houses affiliated with Urmia District Health Center, Iran in 2014 to determine the association between equipments layout and performance inhealth houses. Tewenty health houses subject to the equipment’s layout revision plan were studied. Data about performance and equipment’s layout compliance with standards were collected using valid checklists before revision plan and six months later. Analyses were performed through SPSS statistical software (version 16.0), using paired t-test and regression.Maximum and minimum people covered by a health house were 2730 and 366 persons respectively. Most of community health workers had secondary education. There was not full compliance with layout standards in none of health house...
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Iran`s pharmaceutical products market has faced fluctuations over time. Suitable market selection is necessary for stability of pharmaceutical exports. This study aimed to determine the structure of the world pharmaceutical market and to... more
Iran`s pharmaceutical products market has faced fluctuations over time. Suitable market selection is necessary for stability of pharmaceutical exports. This study aimed to determine the structure of the world pharmaceutical market and to identify the target of Iranian pharmaceutical export. T do so, concentration ratios and Herfindahl index were used to address the world pharmaceutical market from 2001 to 2012. Also, a composite index was used to identify the target markets of Iran’s pharmaceutical industry. The results showed that the export side of world pharmaceutical trade has shifted to open oligopoly, thereby decreasing the monopolistic power of exporters. The import side, however, follows monopolistic competition. It has been observed that the structure of Iran’s pharmaceutical export is shifting to open oligopoly; though, pharmaceutical importers from Iran have not been stable. Moreover, 27 countries were identified as target markets. Due to significant differences between t...
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Purpose Investigating the import of pharmaceutical products, as one of the essential goods of the country to improve health and medical conditions, is important in accelerating the economic growth and enhancing the welfare of the... more
Purpose Investigating the import of pharmaceutical products, as one of the essential goods of the country to improve health and medical conditions, is important in accelerating the economic growth and enhancing the welfare of the community. This paper aims to estimate the income and price elasticity of pharmaceutical import demand in Iran. Design/methodology/approach In this research, the function of Iran's pharmaceutical import demand was estimated and calculated using the co-integration method and error correction techniques with the seasonal data of 2005–2016 to identify factors related to import, as well as relevant price, and income elasticity. Findings The research results showed that the price elasticity of Iran's long-term pharmaceutical import demand was 0.04; that is, the rate of pharmaceutical import demanded by Iran was not sensitive to change in relative price. Additionally, the long-term income elasticity of Iran's pharmaceutical demand was 0.69, meaning th...
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Background The structure of the Iranian health system has raised this hypothesis that a part of the Knee Replacement Surgery (KRS) services are provided due to Physician-Induced Demand (PID). Methods This paper used an unbalanced... more
Background The structure of the Iranian health system has raised this hypothesis that a part of the Knee Replacement Surgery (KRS) services are provided due to Physician-Induced Demand (PID). Methods This paper used an unbalanced individual panel data covering the steady-state 15,729 KRSs performed by 995 surgeons provided by the Armed Forces Insurance Organization at the provincial level over the 60 months (2014–2018). We use a generalized method of moment’s system (GMM-SYS) to obtain consistent and asymptotically efficient estimates, which provide a vital instrument for our dynamic panel data. Results The outcomes show that with unequal increasing orthopedic surgeons to population ratio, both the number and size of KRS services were increased significantly at a 1 % level. Given that the positive elasticity obtained for the service size was significantly larger than the number of services, the findings give strong support for the existence of PID in the Iran system for KRS care. Al...
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Objective Primary Health Care has determined the path to the goal of "Health for All". Defining standards in health facilities play a crucial role in achieving acceptable performance by Community Health Workers. The study aimed... more
Objective Primary Health Care has determined the path to the goal of "Health for All". Defining standards in health facilities play a crucial role in achieving acceptable performance by Community Health Workers. The study aimed to assess the relationship between physical Work environment factors and performance in primary healthcare facilities named health houses in Urmia district health network in North West of Iran. Thirty-five health houses were selected and studied with simple random sampling method. Data collection instrument were a standard checklist. Results The results highlighted a statistically significant and positive correlation between technical equipment layout (P = 0.01, r = 0.641) with the performance of CHWs and the area of workplace (P = 0.05, r = 0.359) in health houses. Correlation between office equipment layout and performance was negative (P = 0.01, r = − 0.44). Multiple linear regression analysis showed that the performance level was influenced by t...
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Abstract The basic health insurances cover more than 90% of the Iranian population but have failed to organize the referral system and created favorable conditions for the ex-post moral hazard. Five hundred fifty people older than... more
Abstract The basic health insurances cover more than 90% of the Iranian population but have failed to organize the referral system and created favorable conditions for the ex-post moral hazard. Five hundred fifty people older than 15 years were randomly selected in five districts of Urmia city and completed the questionnaire to study the existence of Ex-post moral hazard in utilizing the high-consumption laboratory services (blood and urine tests). In this population-based cross-sectional study, utilization of the services in two groups of insured and uninsured people was analyzed using odds ratio statistics and logistic regression. The findings showed that being female (OR: 2.38) and having health insurance (OR: 2.03) played a very determinative role in obtaining selected laboratory services, and about 9% of the laboratory services provided were caused by ex-post moral hazard. The predicted size of ex-post moral hazard is significant, so its control requires modifying health insurance policies in determining the premium and cost-sharing schemes and controlling physicians' behavior as the principal applicants for these services.
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Obesity imposes considerably high economic costs on the health-care system. It is proposed that 10% of health-care costs belong to direct and indirect effects of obesity. Taking measures to prevent, manage, and treat obesity is costly.... more
Obesity imposes considerably high economic costs on the health-care system. It is proposed that 10% of health-care costs belong to direct and indirect effects of obesity. Taking measures to prevent, manage, and treat obesity is costly. However, some benefits can be obtained by reducing economic costs and by improving health in the future. This study aimed to systematically review the costs caused by obesity. We systematically searched the English language literature indexed in PubMed, Scopus, and Web of Science databases (January 2000 to September 2017). Articles were included if direct and indirect costs of obesity were assessed among participants at the age of more than 18 years. Key terms including economic burden, medical cost, nonmedical cost, and obesity were used for this search. From a total of 20 studies, 9 papers found to be relevant for reviewing. According to these papers, obesity accounts for 31.8% of direct costs (health-care costs related to obesity) and 68.1% of indirect costs (costs related for reducing productivity and production value). Therefore, obese people spend 32% more for medical costs compared to people with normal weight. Due to great number of short-term and long-term complications of obesity and its potential economic impact, efforts are needed to be taken to facilitate health interventions and social policies. Nationally, as obesity imposes high costs on people and health-care system which should fund most of these costs, developing plans to decrease these costs are needed.
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BackgroundDrowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively... more
BackgroundDrowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study’s objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.MethodsUnintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning.ResultsGlobally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0...
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Background: Equity in access to health care services is one of the main goals of health systems, so that inequality in the geographical distribution of health resources will make it difficult for individuals to access the health care... more
Background: Equity in access to health care services is one of the main goals of health systems, so that inequality in the geographical distribution of health resources will make it difficult for individuals to access the health care facilities. This study aimed to determine the distribution status of hospital resources and inequality coefficient in the West Azarbaijan province before and after implementation of the health system reform plan. Methods: This cross-sectional and descriptive-analytic study aimed to investigate inequality in the distribution of health resources in cities of West Azarbaijan province before and after health system reform plan using concentration ratio and Hall Tiedman indices. The required data for estimating these indices were the number of specialist physicians and hospital beds, which were extracted from the data base of treatment deputy in Urmia University of Medical Sciences. Data analysis was conducted by Excel software. Results: The results indicat...
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Background: Iran government launched the targeted subsidy plan (TSP) in December 2011 to reduce inequality and poverty. In addition, Health Transformation Plan (HTP) was implemented in ministry of health to reduce people out of pocket... more
Background: Iran government launched the targeted subsidy plan (TSP) in December 2011 to reduce inequality and poverty. In addition, Health Transformation Plan (HTP) was implemented in ministry of health to reduce people out of pocket payment. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. Method: In this longitudinal study, data on 413,201 households were collected using household surveys during 11 years (2007-2017). The Fairness in Financial Contribution (FFCI) index and Catastrophic Health Expenditures (CHE) index were calculated.Also Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of TSP and HTP policies and other socioeconomic characteristics of households on their exposure to CHE.Results: The FFC index was 0.829 and 0.830 respectively in 2007 and 2017. The trend analysis did not show significant changes in FFC index between 2007 and 2017. TSP and HTP implementat...