HEALTH INSURANCE
Year:2022 | Volume:5 | Issue:3|Papers Count:8

Despite the impact of the theoretical approaches explaining the concept of social security on the social security system, in Iran, this concept does not have an independent dignity in sociological analysis and the existing theoretical analyses in a reductionist way often consider it as an economic concept. Therefore, examining the theoretical foundations of this concept, as a missing link in social security studies, is necessary to reveal the dimensions that influence policy making, why and how policies in this field are made. After examining and describing the existing theories in the way of a review according to the topic, their formulation was presented based on three models of the welfare state and good governance, which review indicates the difference between these models around the two issues of perception of power and the goal of providing socially formed. In the approaches of welfare state and good governance, power is understood in a structuralist, nonhistorical and hierarchical way, which is responsible for the implementation of social security programs, but in the governance approach, social security is a special way of exercising power. And the government over itself and the citizens is understood to optimize the living standards. This critical evaluation indicates that the approaches that consider social security as a text and discourse and from a historical and discourse point of view, reveal its values, presuppositions and ideological dimensions and political retionality, have more explanatory power.

Introduction: Diagnostic and therapeutic services are the biggest source of health spending and therefore have high potential for expense control. The present study aims to examine the appropriateness extent of administration of imaging services and identify the possible causes of the excessive administration of these services and provide corrective solutions in this area. Methods: The present study was implemented using a systematic review method. International databases (Elsevier, PubMed, Scopus and Web of Science) and National (SID, Magiran and IranianMedex) were searched. The Google Scholar database was also searched. International database search was performed using different combinations of Diagnostic Imaging/Radiology, Medical Imaging, CT-Scan, MRI, Rational Consumption, Appropriated, Imaging, Health Service Misuse/Medical Overuse and Services Utilization. The search was also selected at the time of 1990 and November 2021. The quality of the identified studies was evaluated using the Strobe checklist. Results: Out of 605 studies identified in the first phase of the search, 22 had the study requirements. All studies have pointed to the unnecessary part of most of the prescribed services and have mentioned various reasons (21 to 76 %). The high rate of unnecessary imaging services have been attributed to various factors, including supplementary insurance coverage, lack of learning of physicians, and patient references to various physicians. The most important corrective strategies include physicians training and creating a powerful monitoring and evaluation system. Conclusion: The unnecessary use of freight health services is on the health system, insurer organizations, health services centers and insurers. It should be noted that this is not limited to Iran, and many high-income countries whose health system has high regulatory power is also facing this problem.

Introduction: One of the most important factors that indicate hospital performance are hospital indicators. One of the fundamental developments and changes in the health system of Iran is the health system transformation plan, the effects of which should be examined from different aspects. The purpose of this research was to determine the performance indicators of hospitals affiliated to Zahedan University of Medical Sciences, Zahedan, Iran and compare them with the standards of the Ministry of Health, Treatment and Medical Education in 2019. Methods: This cross-sectional descriptive study was conducted in 2018 in public hospitals covered by Zahedan University of Medical Sciences. In this study, the most important performance indicators of the hospital from 2016 to 2019 were investigated in a targeted manner. The entry criterion was the completeness of the indicators information. In this study, to obtain accurate and reliable information, input data and output data were used as performance indicators. The data was analyzed using EXCEL software and descriptive tests. Result: In the present study, a total of 6 hospitals of Zahedan city under the coverage of Zahedan University of Medical Sciences were investigated. On average, 11, 200 people were hospitalized and 11, 003 people were discharged, which decreased to 11, 086 people hospitalized and 10, 450 people discharged after the transformation plan. The average number of emergency and outpatients was 71, 600 and 124, 571 respectively. Conclusion: The findings of the study showed that in terms of bed occupancy rate, the hospitals were in an average and poor condition compared to the standards of the Ministry of Health. But in terms of average hospitalization days, they were in an unfavorable situation. These results show that the transformation plan of the health system in this province has not yet reached its goals.

Introduction: Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of public awareness of its nature, services and benefits. The aim of this study was to provide a model for accepting the referral system from the perspective of patients. Methods: This study was a mixed method that was conducted in three steps in 2021. The first step included the development of a questionnaire, the second step was a survey study, and the third step was the design of the acceptance model of the referral system from the perspective of patients. The statistical population included 384 patients covered by the Rural Insurance Fund referring to the Imam Khomeini Hospital Complex. The data were analyzed using SPSS v20 software. Also, Second-Order Confirmatory Factor Analysis (S-CFA) was performed using LISREL v8. 5 software. Results: Cronbach's alpha ratio for the whole questionnaire was 0. 85 and intra-cluster correlation coefficient was 0. 69. The results of confirmatory factor analysis showed that patient-centeredness, rules and regulations, responsiveness, coordination, security, accessibility, effectiveness, efficiency, personal beliefs and social influence significantly affected the acceptance of the referral system from patients' perspectives. Conclusion: It is necessary for managers and policy makers before and during the implementation of the referral system to consider the factors affecting the acceptance of the referral system from the perspective of patients. For the appropriate implementation of the referral system, special attention should be paid to all the influencing factors so that patients can easy and convenient access health services anywhere and anytime.

Introduction: The spread of the COVID-19 disease brought additional occupational stress to the medical staff all over the world and brought the severity of the psychological problems of the specialists to a peak. In the meantime, creating conditions to create a synergy between work and family can be a good solution to protect the health of employees and provide better services to patients. The present study was conducted with the aim of providing a model of deterrent and promoter affecting synergistic enthusiasm for work-family among married employees of medical centers under the supervision of Tehran University of Medical Sciences. Methods: The current research was conducted using a qualitative method using grounded theory. In order to present the model, in-depth semi-structured interviews with the treatment staff were used. People were selected purposefully and theoretical saturation was achieved after 12 interviews. Results: The data analysis led to finding 6 driving factors (intrinsic and behavioral characteristics of the individual, core and main family characteristics, characteristics related to self-employment and work environment) and 7 deterrent factors (intrapsychic factors, behavioral habits, family environment, destructive common behaviors, work characteristics, managerial factors, organizational environment) in the form of 3 categories of individual, family and occupational factors. Conclusion: Prevention of loss of productivity, promotion of human capital and quality of health care services which is affected by psychological problems of the medical staff, should be considered by the Ministry of Health and relevant organizations. Covered hospitals and organizations can improve the quality of services provided to the insured by using the provided model while paying attention to the health of the medical staff.

Introduction: The implementation of the performance-based payment system is considered as an important and influential factor in improving the productivity of employees, which will increase the level of satisfaction and organizational justice. Performance-based payments actually link material rewards to individual, group, or organizational performance, or a combination of these three. The study was conducted with the aim of explaining the medical staff’, s view of performance-based payment in selected hospitals of Lorestan province. Methods: This study is a qualitative study that was conducted with content analysis approach in 2021 in selected hospitals of Lorestan province. The statistical population consisted of 14 medical and staff members which was conducted by purposive sampling. Sampling continued until data saturation. Data analysis was done using conventional content analysis. Results: After analyzing the data, 2 main dimensions (orgazinational factors, individual and internal factors) and 6 sub-dimensions (fairness of the payment system, quantity of work, quality of work, payment based on work and effort, motivation and interest, commitment and adherence) were extracted. Conclusion: Considering the effectiveness of the implementation of the performance-based payment plan on the income of hospitals, it can be stated that this plan has a positive effect on the performance of hospital staff and causes them to be more active in hospitals, provide better services and in general effectiveness has been improvede. Therefore, it is suggested to the officials and implementers of the performance-based payment plan in the Ministry of Health, Treatment and Medical Education to follow its implementation in other provinces.

Introduction: The medical tourism industry is one of the prominent income-generating industries in the world. Insurance services increase the peace of mind of tourists and the development of the tourism industry is accompanied by the growth of insurance services. Increasing the country’, s foreign exchange earnings through the medical tourism industry,is essential. The current research was conducted with the aim of investigating the effective components of insurance in the marketing model of medical tourism of the Social Security Organization. Methods: The current study is a descriptive-analytical and cross-sectional type, which was carried out quantitatively-qualitatively in 2021. In the qualitative approach, the effective components in therapeutic tourism were identified using the Delphi technique, and in the quantitative approach, the model was verified and fitted using exploratory and confirmatory factor analysis and structural equations. Results: The insurance factor has an effect on medical tourism marketing and this factor has five components,fast and effective insurance redemption, full health insurance coverage, other supplementary insurance services such as travel and theft, acceptance of international health insurance and the transferability and validity of health insurance of other countries were identified. Conclusion: The result of this study help the health policy makers of the country to increase their foreign currency incomes by using the medical tourism marketing model and according to the insurance components of the said model and the effective measures taken by the government, insurance organizations. It will reduce the financial and security threats of tourists and ultimately increase the attraction of medical tourists from other countries.

Introduction: The COVID-19 crisis caused many changes in the performance and productivity of health service providers. The purpose of this study was to investigate the effects of the COVID-19 pandemic on the financial and performance indicators of one of the hospitals in Tehran. Methods: This study was a historical cohort study that was conducted in the first 6 months of 2019 as the prepandemic period and the first 6 months of 2020 as the post-pandemic period. 13 performance indicators of inpatient departments,9 operational indicators of the whole hospital and 3 financial indicators were included in the study. The data were received in Excel format from the statistics unit and quality improvement unit of the hospital and after entering into SPSS software and checking their normality, they were analyzed with Wilcoxon’, s non-parametric test. Results: the average indices of bed circulation (P=0. 028), discharged patients (P=0. 028) and the number of hospitalized patients (P=0. 046) decreased during the pandemic period, which was found to be significant. The average index of death before 24 hours (P=0. 027) and after 24 hours (P=0. 028) and ED discharge (P=0. 028) also increased significantly. The average profit of the hospital at the current price and the actual price had increased significantly (P=0. 028). The total current income increased but the actual income decreased, which were not significant. The total current and real cost was also reduced, only the real cost reduction was significant (P=0. 028). Conclusion: The COVID-19 pandemic had a significant impact on the financial and performance indicators of the hospital. After analyzing the hospital’, s situation, it is necessary for hospital managers to have an appropriate model for developing services and sustaining resources during a crisis, while compiling and designing a plan to deal with similar crises.