Hakim Journal
Year:2013 | Volume:16 | Issue:1|Papers Count:13

Introduction: Financial accessibility of households to health care services is a major concern for policymakers and planners in health systems. The aim of this study was to assess the status of Iranian households' financial accessibility to health care services during 1983-2008.Methods: In this descriptive-analytical study, data of the national survey of households' cost and income conducted by the Iranian Statistics Center were used and studied in 2011. We calculated the trend of proportion of health care expenditures to households' income and regression estimation of health care expenditures function in logarithmic form to assess the status of households' financial accessibility to health care services. The Excel 2007 and the Eviews 5 were used to present descriptive statistics and regression estimations.Results: Findings of this study showed that the proportion of health care expenditures to average income had permanent and significant increase during the study period. Coefficient of impact of income on health care expenditures in urban and rural households were 1.07 and 0.91 (P<0.05), respectively. Coefficient of impact of social health insurance expenditures on health care expenditures in both urban and rural households was not statistically significant.Conclusion: In recent years, the proportion of health care expenditures to households' average income has been increased and financial accessibility of households to health care services has been significantly decreased in Iran. Moreover, development of health insurance coverage and prepayment mechanisms has not significant impact on decline of the proportion of health care expenditures to households' income.

Introduction: A main goal of health systems is to provide financial security against diseases by which catastrophic expenditures and poverty can occur. The cost of health care services is high and households are main bearers of financial loads rather than health insurance companies in Iran. Moreover, due to inadequate access to health care centers and inadequate coverage of health insurance services, households who have been covered by insurance services have the same problem too. Increasing health care costs in households' consumption basket result in increasing households' expenditures that might lead to misidentification of the poor households. The aim of this study was to assess the impact of health care expenditures on poverty among Iranian households.Methods: In this study, we used households' micro data provided by the income-expenditure household survey conducted by the Iran Statistics Center. The FGT index (1984) was used to measure poverty and assess the impact of out of pocket payments in health care services on the households’ poverty status.Results: Out of pocket payments by the households have increased health expenditures and have led households to poverty in both rural and urban areas. In rural areas, household poverty incidence increased by 4% due to increase in tariffs of health care services in 2009. The highest increase in poverty incidence in urban areas was 3.4% which was occurred in 2000. In general, increase in out of pocket payments resulted in increase in poverty incidence in the country as follows: in 1984: 2.1%, in 1989: 1.6%, in 1995: 2000, in 2004: 3%, and in 2009: 3.6%.Conclusion: Increases in health care expenditures have been led to poverty increase from 1 to 4 percent in different urban and rural areas during period of the study. Every year, a significant number of individuals in both rural and urban areas have been dragged below poverty line due to catastrophic health expenditures.Meanwhile, due to registration of high expenditure for the households, they were not identified as the poor.

Introduction: Equity is an important index in resource distribution and access to health services. Human or equipments may be distributed inappropriately if decision-makers do not pay attention to need indices.This not only creates obstacles in access to health services, but also results in an inefficient allocation of resources. This study aimed to assess equity in distribution of dialysis beds and nephrologists in Iran, 2009.Methods: In this cross-sectional study, we gathered the data including number of dialysis beds, number of patients and nephrologists from all provinces. Data were entered into the Excel and were analyzed using the Lorenz curve and Gini coefficient.Results: In 2009, 18586 patients underwent dialysis in Iran. Most of the patients were hospitalized in Tehran (n=3991). Ilam had the least number of the dialysis patients (n=83). The total number of dialysis beds was 3722 in Iran mostly located in Tehran (n=666). The Kohgiluyeh and Boyer Ahmad had the least number of beds (n=23) in Iran. The total number of nephrologists was 335 in 2009 in Iran from whom 151 individuals worked in Tehran. On average, there were 25 dialysis patients, five dialysis beds and 0.44 nephrologists per 100000 populations.Conclusion: Although, according to the Lorenz curve, dialysis beds have been distributed appropriately, distribution of the nephrologists was not appropriate. Regarding the role of the human resources in delivering adequate health services, appropriate distribution of nephrologists can result in high efficiency of resources in health system in Iran.

Introduction: The expansion of public sector capacity in public health is difficult due to legal limitations and limited financial and staff resources. Outsourcing services to the private sector provides opportunity to provide health services to public. This study aimed to assess and compare the capacity and services in publicly run and outsourced urban health posts.Methods: This cross-sectional study was carried out in all health posts affiliated to the university. Data were collected using a 26-items questionnaire and were analyzed using the univariate analyses.Results: Among 74 health posts, 48 health posts (64.9%) were outsourced and 26 (35.1%) were managed by the public sector. Medical doctors managed 43.7% and midwives 45.8% of the outsourced health posts.Midwives managed 73.0% and health officers 23.0% of the public sector posts.61.5% and 77.1% of the outsourced and publically managed health posts were located in appropriately structured buildings. Over 92% of the clients walked to the health posts. On average, public health posts covered 8954 individuals and outsourced health posts covered 12158 individuals. No differences were observed in health program related knowledge of the staff in two centers.Conclusion: Supervision approaches has a direct effect on behaviors of the private sector. Since the supervisors mostly noted the physical structure and standards of equipments, these had adequate standards.There were no differences between public and private health posts in health care indices and those services that had been provided by similar staff from the two health post groups.

Development and application of an appropriate hospital performance assessment system leads to accountability, increased quality of healthcare, and increased customer satisfaction. Until today, hospital performance assessment was considered to be a purely innovative practice, while, development of a performance assessment system is now a necessity and a compelling immediate action. However, measurement, assessment and improvement of hospital performance are not easy tasks. Most of the hospital performance assessment systems either have a narrow focus or measure different aspects of performance. Some have focused on structures, some on processes and the others on outcomes of care, a balanced set of measurements can hardly be found. Participation of expected stakeholders is important in evolution of hospital performance assessment system, therefore, performance assessment system should be developed by their active participation. Although, development of hospital performance system is essential, it is faced with huge challenges. This paper tries to uncover these challenges by reviewing available literature.

Introduction: Positive psychology is a new approach in the psychology science to move from psychopathology treatment to optimization of life quality. Optimism, a subset of positive psychology approach, is a positive human characteristic. During the last decade, optimism had a special place in the field of developmental psychology, family psychology and mental health. This study aimed to assess the effect of optimism on mental health and life satisfaction.Methods: In this cross-sectional-descriptive study, 178 teachers (86 males and 92 females) were selected using randomized cluster sampling from Ramshir schools. All participants completed the Life Circuit Questionnaire (LOT-R), General Health Questionnaire (GHQ), Satisfaction with Life Scale (SWLS) and Demographic Inventory. Data was analyzed using the Multiple Stepwise Regression analysis.Results: The mean (SD) age of the participants was 32.16 (5.70). Results of the Hierarchical Multiple Regression method showed significant intermediate role of mental health in relationship between optimism (p<0.001) and life satisfaction (p<0.001).Conclusion: Optimism could positively affect life satisfaction through increasing mental health.Moreover, resilience had indirect effect on life satisfaction.

Introduction: This study aimed to investigate male participation in reproductive health and family planning in Zanjan in 2011.Methods: This was a qualitative study conducted among married men resided in rural and urban areas of Zanjan. A conceptual model was considered for the study based on the literature and existing theories of reproductive behaviors to guide the interviews and direct the queries. The deductive content analysis was used as the main approach for this study. Purposive sampling with maximum variability was used to select the participants. Data were collected via 33 semi-structured and in-depth interviews during July-Aug 2011. Topics discussed included knowledge, attitude (towards family planning and gender roles), risk perception, behavior and environmental factors. Data were analyzed using conceptual framework and conceptual mapping approach.Results: The data of this study was categorized into three main areas: 1) Nature of male participation, 2) Facilitators of male participation, and 3) Barriers of male participation. Nature of male participation included verbal communication with spouse about contraception, mutual understanding of spouse’s reproductive health needs and use of male contraceptive methods. Facilitators of male participation included education and living in urban areas, knowledge about contraceptives and access to media, positive attitudes towards family planning and gender issues. The barriers of male participation included inappropriate working hours of health clinics which provide contraceptive and counseling services, lack of access to male health care providers in such clinics, negative gender beliefs, and complications related to some male methods and low risk-perception towards sexually transmitted diseases.Conclusion: Although men's attitudes towards participation in reproductive health and family planning in Zanjan seems to be appropriate, there were some barriers prevented men from participating in family planning actively. These barriers included inappropriate working hours of family planning clinics, lack of access to male health care provider, some gender beliefs and complications and inconvenience of using male methods and lack of knowledge on contraceptive methods. Appropriate interventions based on the results of this study might enhance male participation in family planning.

Introduction: Delivery, as a phenomenon leading to childbirth, is an inseparable part of human life and has an ascending trend worldwide. By medical developments, human beings have always endeavored to improve the quality of delivery processes. Annually, approximately 600000 women die from pregnancy and childbirth complications from which more than 99 percent occur in developing countries. The quality of midwifery care influences birth results and functions of health care providers in labor. Birth has considerable effect on physical and emotional health of mother and child. The present study aimed to assess the rate of implementation of "The national guide of labor and delivery cares" and its related factors in selected educational- therapeutic hospitals in Tehran, 2011.Methods: In this descriptive study, using quota sampling, the function of 40 health care providers regarding 200 pregnant women who were admitted for normal vaginal delivery was evaluated. The tools for data collection included a demographic sheet, an observational checklist and three questionnaires. Content validity was assessed beforehand. Reliability of the observational care checklist and questionnaires were assessed using concurrence observation method (r=0.93) and test re-test method (r=0.9). Data were analyzed in the SPSS version 17.Results: The followings show the compatibility of the performances of the care providers with the national labor and delivery guide: history taking 88.3%, vital sign control 64.6%, Leopold maneuver 38.5, initial assessment 83.4%, caring measures during labor pain 22.5%, pain relief methods 63.5%, labor progress 71.5%, vaginal delivery 89.5%, and postpartum management 89.5%. The knowledge score of 57.7 percent of care providers was leveled as medium, and 10 percent of them had negative attitudes towards the national care guideline. There was statistical difference between knowledge with attitude scores (P=0.001), and between knowledge score with the rate of care implementation (P=0.03).Conclusion: Results showed that the rate of implementation of labor and delivery care in several assessment criteria was not desirable. Improvement in quality of cares and supervision on performance of health care providers are recommended.

Introduction: The main purpose of businesses is to achieve the most output with the use of the least input. This leads to the importance of effectiveness and efficiency. While the main part of capital in health systems is spent in hospitals, there are a few numbers of studies conducted on effectiveness and efficiency in hospitals before 1980. In recent years, this issue has attracted a great attention. The aim of this study was to evaluate the productivity in general hospitals of Iran's social security organization in 2006-2009.Methods: In this study, productivity of 64 general hospitals affiliated to Iran's social security organization was analyzed using the Malmquist index, with an input-based approach and with the assumption of variable returns to scale. Four main inputs included number of beds, nurses, physicians, and other personnel, and four main outputs included number of surgeries, occupied bedrooms, and inpatient and outpatient admission. Data were gathered using an accepted check-list and were analyzed in the DEAP2.Results: Our findings showed that mean (SD) of productivity in the hospitals was 1 (0.059). The mean change in technical efficiency, change in technology change, pure technical efficiency (managerial), and scale efficiency were 0.998, 1.002, 1.007 and 0.991, respectively. In addition, the range of total factor productivity based on the Malmquist in the hospitals was 0.827 to 1.22.Conclusion: Technology changes as well as changes in managerial efficiency had negative effect on total productivity, while changes in scale and technical efficiency had positive effect on productivity.

Introduction: Patterns of the diseases distribution can be affected by the climate changes. Several studies on climatic conditions in different areas of Iran have presented useful information on patterns of diseases. The aim of this study was to assess the relationship between climate changes with the gastroenteritis rotavirus (GE) frequency in children in Bandar Abbas area.Methods: In this study, the climate data were provided from the Bandar Abbas Weather Station. Data of the gastroenteritis disease were extracted from medical records of all children less than five years old referred to the hospital during 2006-2008. Using statistical analysis and Pearson regression, monthly and weekly correlation between two types of data were calculated. Using a multiple regression equation, a general model was presented to predict the frequency of the disease.Results: The findings showed that the lowest prevalence of the disease was for 2008 with 78 cases and the highest prevalence was for 2007 with 403 cases. The maximum correlations belonged to temperature factor and relative humidity, respectively. Monthly distribution indicated that the gastroenteritis had high frequency in cold weather comparing with hot weather, the maximum frequency belonged to the December. The study of the zones of the disease showed that Jask and Bandar Lengeh had low frequency of the disease. Along with decreasing temperature from south coast to north areas, the frequency of the disease increased. The coefficient correlation between minimum, average and maximum temperature with the gastroenteritis were 0.791, 0.752 and 0.7, respectively (P<0.0001). The coefficient correlation of minimum, average and maximum humidity with the gastroenteritis were -0.3320 (P=0.073), 0.0169 (P=0.371) and 0.054 (P=0.775), respectively.Conclusion: One degree decrease in temperature caused the gastroenteritis in 10 more individuals. The results showed the disease frequency begins in 13 degree Celsius.