HEALTH INSURANCE
Year:2021 | Volume: | Issue: |Papers Count:8

Introduction: The increasing costs of health care systems will be reduced significantly if preventive services are developed at levels of prevention. The experience of countries in the world in using preventive services and raising awareness of the related benefits can play a motivating role among the stakeholders in implementing such a policy in Iran. This study aimed to identify the most critical interventions covered by insurance organizations active in the world's health systems. Methods: This study is a systematic review of studies related to a diverse range of preventive services in the health system and insurance organizations and provides evidence-based information on the benefits of developing this category of services and interventions. The study was done by defining the search keywords in the main database between December 30, 2004, to January 2019, carried out in 2020. Results: Different categories of disease prevention services are being offered around the world that has brought significant benefits to communities. Among the most important benefits of developing such services are reducing costs, reducing health inequalities, increasing quality of life, and higher job productivity. In addition, different groups in the community, such as specific occupations or specific age and gender groups, while having specific preventive services, have developed their insurance policies that provide related preventive services. Therefore, insurance organizations play an essential role in the benefit and effective coverage of preventive services in communities, which has made the possibility of a person with insurance to use preventive services far more than people without insurance or with treatment-oriented insurance. Conclusion: The benefits of preventive services in the world health systems have been proven, and some countries have adopted a law requiring the provision of such services to insurance organizations. On the other hand, insurance companies are facing increasing health costs, which has led the attention of policy makers of insurance companies to control costs. With the relevant evidence documented, it is time to move to preventive services.

Introduction: Identifying factors affecting the financial aspects of hospital is an important step for its strategic control. Therefore, this study aimed to assessment the trend and determinants of inpatient and outpatient revenue in a COVID19 patient s’,treatment center. Methods: The present study was a descriptive-analytical research by applying time series analysis. Raw data on the hospital income (by inpatient and outpatient) and the potential factors were gathered monthly by referring to the administrative departments of the hospital, during 2015-2020. Dickey-fuller unit root test was used to measure stationary trend of the variables. The auto-regression distributed lagged model (ARDL) was used to study the effect of independent variables on hospital income. All analyzes were performed in Eviews software. Results: During the study period, on average 73. 65% of hospital revenues were related to inpatient income and the rest were outpatient income. The total revenue trend of the hospital at the current price has increased significantly from April 2015 to august 2020 ( P<0. 0001 ), while this at the fixed price has decreased significantly ( P<0. 0001 ). At the beginning of the admission of a COVID19 patient (February 2020 ), the hospital income has decreased significantly and after three months in May 2020, it has returned to its long-term trend. The results showed that inpatient and outpatient income was significantly affected by the variables of quantity of service, quality of care and hospital performance indicators ( P<0. 05 ). Conclusion: Hospital revenue was significantly declined at the commence of COVID19 pandemic. Increasing the capacity of intensive care beds, raising hotel service tariffs, changing insurance policies and supporting upstream organizations can be effective strategies to control the economic consequences of the COVID19 epidemic on hospitals.

Introduction: In recent years, sanctions have led to limitations in financial transactions, exchange rate fluctuations, and inflation rate rising in Iran. Under such circumstances, official exchange rate was allocated to essential goods such as pharmaceuticals, aiming to promote medicines’,affordability,but problems caused by the multiple-exchange-rate system have raised the idea of alternative policies development. After analyzing the current situation, this study examines the positive and negative impacts of implementing alternative policies on stakeholders as well as providing a framework for supportive policies to protect stakeholders against negative effects. Methods: The present study is of qualitative type that was conducted in 2021. Besides literature review and extracting main indicators, semi-structured interviews and a focus group discussion were conducted for qualitative data collection. Then the data was analyzed by “, content analysis”,approach using MAXQDA software. Results: By categorizing the 1686 primary codes, the main themes were obtained, including “, Depicting the policy background”, , “, Evaluating current situation”, , “, Identifying alternative exchange rate policies”, , “, Analyzing predictable conditions”, , “, Determining supportive policies”, , and “, Necessity of establishment a feedback system”, . Considering expert opinions, although allocating official currency to medicines has been successful in controlling pharmaceuticals’,affordability,the consequences such as increasing organizational corruptions, pricing challenges, growth of bureaucracy, supply chain disruption, and limitations on the pharmaceutical industry highlights the need for a change in this policy. Moreover, this change requires a supportive policy package, including performing “, multi-phasing”, pricing, and tax-offsetting to protect the pharmaceutical industry,as well as allocating recourses obtained from two currency differences to insurance systems, revising in “, Iran FDA-insurance organizations memorandum of understanding”, , and developing supplemental insurance plans for the lower deciles to protect the community. By depicting the exchange rate policy background and evaluating current situation, four alternative exchange rate policies emerge. Conclusion: It seems that switching pharmaceutical exchange rate to a fixed rate near “, Nima”, , would best improve the current situation. In this regard, considering special supportive policies for different stakeholders and development of a feedback system are considered as the requirements beside implementation of exchange-rate policies. Also, among the implementation methods, considering positive and negative consequences, the gradual method along with the establishment of an inspecting framework, is considered as a suitable mechanism.

Introduction: Introduction: The COVID-19 pandemic unprecedented risks to the health system as one of the main pillars of development and social welfare has emerged around the world and in Iran, and in the last 20 months, the world has witnessed new paradigms of human life, including the need to observe social distance to deal with this pervasive and global disease. The aim of this study was to determine the factors affecting the production and accumulation of social capital and its effects on the process of observing social distance as one of the non-pharmacological policies to deal with the prevalence of COVID19 pandemic, in line with research from other countries and filling the gap available in Iranian research. Methods: Extracting, quantifying and determining the equations of variables and determining the boundaries of the system in the process of production and accumulation of social capital in this study by summarizing the views of theorists, experts by conducting semi-structured interviews and combining it was done by fuzzy Delphi method. Modeling and data analysis was performed with a systemic approach and methodology of systems dynamics and the use of Wensim software. Results: After simulating the model and performing tests to confirm its validity, it was found that there is a gap between social capital and the process of observing social distance as one of the nonpharmacological policies of the health system to control the COVID19 pandemic. There is a causal and positive relationship. By performing tests for model structure, system behavior and policy sensitivity analysis, optimistic, pessimistic and realistic scenarios based on 8 selected policies, the optimal policy for long-term reforms and changes were selected and proposed. Conclusion: The findings of this study, while explaining some unknown aspects of people’, s behavior and the effects of social capital on the observance of social distance to control the COVID19 pandemic, provide strategies for health policymakers that if implemented, we will see more and more public confidence as the main factor in the reproduction and accumulation of social capital and the support of people to transition from the current unfavorable situation to better conditions.

Introduction: The coverage status of pension funds and supportive institutions of the elderly is one of the most important and fundamental issues in social welfare studies. The present study aims to compare and evaluate the status of insurance and support for the health of the elderly at the national and provincial level during the years 2015-2018. The main questions in this research are: how is the share of the coverage of pension funds and supportive institutions for the elderly in the country? , in which provinces the elderly benefit from more coverage? , and in which provinces the pension coverage and support is less for them? Methods: The present study is a descriptive-analytical research and the method used is based on the secondary analysis method. The data used for insurance and support coverage were obtained from statistical and information sources of pension funds and supportive institutions and the Statistics and Information Office of the Ministry of Labor Cooperation and Social Welfare. Data related to changes in the age structure of the country's population have been obtained from the Statistics Center of Iran. The statistical data extracted after processing and drawing tables and graphs by Microsoft Word & Office Excel software, at the national and provincial level in terms of pension coverage and support for the elderly. Results: In 2015, the ratio of elderly pensioners covered by pension funds was 36. 2% and the ratio of elderly pensioners covered by supportive institutions equaled in 33. 7%. In 2016, the ratio of elderly pensioners covered by pension funds was 33% and the ratio of elderly pensioners covered by supportive institutions equaled in 30. 2%. In 2017, the ratio of elderly pensioners covered by pension funds was 34. 9% and the ratio of elderly pensioners covered by supportive institutions was equaled in 31. 1%. In 2018, the ratio of elderly pensioners covered by pension funds was 37 percent and the ratio of elderly pensioners covered by supportive institutions was 27. 4 percent. In other words, the trend of insurance and supportive pension coverage for the elderly has decreased from 70% in 2015 to 64. 4% in 2018. This situation is lower than the average of this coverage on a global scale (67. 9). Conclusion: The results of the study showed that the supportive coverage of funds, pensions and supportive organizations for the elderly in Iran is not widespread and in accordance with the growth of the elderly population, it has not only had a significant increase, but a decline.

Introduction: The Internet revolution in recent decades and the emergence of smart technologies have changed all aspects of business and the health industry is no exception to this rule. Despite of significant advances in recent years, this field has been facing serious challenges and the use of smart technologies can address many of them. Therefore, this study aimed to provide an interpretive structural model for the establishment of smart services in the Iranian health sector. Methods: This research in terms of purpose was development-applied and based on method and nature was descriptive-survey. It has also been done using Interpretive-Structural Modeling technique and penetration-dependence analysis in 2020. Data collection tools were document references, semistructured interviews, and paired comparison survey forms. Results: Based on the research findings, national preparedness, deployment planning, stage-setting, execution management, task organization framework, organizational interventions and resistance management were identified as dimensions of the model. “, National preparedness”,dimension was settled at the third level of the model as an independent variable. The dimensions of “, stage-setting and deployment planning”,were also included as independent variables and other dimensions were included as related variables. Conclusion: The results of the current study help policymakers in the health sector to use the proposed model as a framework for promotion and continuous improvement in this field and also, achieving the goals of the legal duties of the fifth and sixth development plans of the country in the Health field based on the establishment of an Electronic Health Record System for Iranians with the aim of providing Electronic Health Services, including the Electronic Prescription project.

Introduction: The aim of this study was to assess financial performance of 260 clinic's laboratories affiliated to Social Security Organization (SSO) from 2012 to 2019. Methods: Step-down cost accounting was used. At first, the proportion of laboratory cost separated from the total clinic cost for each clinic, then four groups of indicators were measured including: ratio of laboratory cost to total clinic current cost, ratio of direct, overhead and support cost to total laboratory cost, the average cost and revenue per laboratory prescription and total revenue to total cost ratio. Results: Ratio of laboratory cost to total clinic cost has been 11 % on average from 2012 to 2019 and its trend has not changed significantly. Ratio of direct, support and overhead costs to the total laboratory cost was 61 %, 33 % and 6 % respectively. The average annual growth of cost and revenue per laboratory prescription was 28 % and 26 % respectively. In studied years, the revenue of laboratories covered an average of 48 % of their costs with a declining trend. Conclusion: There is a significant gap between the costs and revenues of the SSO clinic’, s laboratories and a wide variation in financial performance of laboratories even in similar environment as well. To conclude, the results of this study demonstrate opportunities to optimize financial performance of laboratories.