Hakim Journal
Year:2014 | Volume:17 | Issue:1 (64)|Papers Count:9

Introduction: This study aimed to determine and compare health care systems' components and national health insurance in selected countries and to present a suitable model for providing primary oral health care in Iran.Methods: It was a two-staged qualitative, comparative, cross-sectional study. Finland, UK, France, Canada, and Japan were selected as sample countries. The first phase, a review study to compare dental health systems of the countries, resulted in drawing tables including five characteristics: financing methods, setting, types of services, practitioners and reimbursement methods, and recipients of services. The tables determined the framework of the proposed model. In the second phase, to develop consensuses for the framework suitable for health care system in Iran, the Delphi consensus technique was used. Each Delphi round comprised a questionnaire, analysis, and a feedback report. A total of 25 senior oral and health experts agreed to participate and completed all questionnaires.Results: With considering dental treatment needs among Iranians, a basic package of services including primary care with emphasis on preventive services should be defined. To affordability of the services, the mentioned package should be covered by public health insurance for all Iranians. To accessibility and availability of the service at the first contact with dental hygienist or dentist, who provide regular check-ups and preventive services, defined clinics should be established. Reimbursement to practitioner could be arranged via capitation. If patients need more services, clinics will be responsible for the referral affairs to the private practitioners, through a fee-for-service contract with insurance companies. Tax and premium is the best way to financing the system. To continue health benefits, obligatory regular check-ups are required.Conclusion: Attempting to universal health insurance coverage; preparing a targeted dental service package with focus on preventive care; encouraging private practitioners to participate in public health insurance plan; financing services through government revenues, premium, and health taxes are essential components to establish a suitable model on oral health care delivery system in Iran.

Introduction: The advancement of technology and development of health information systems have promised to improve patient care processes including the process of requesting and collecting laboratory test results. This study assessed the viewpoint of nurses concerning this process, before and after implementation of Hospital Information System (HIS).Methods: This was a descriptive-cross sectional study. The study sample was composed of emergency department nurses who experienced both paper-based and computerized systems. The data were gathered through interviews concerning the process of requesting and collecting laboratory test results and studying the advantages and disadvantages of both methods. Moreover, the viewpoints of the nurses concerning the role of HIS in the improvement of this process were studied using a questionnaire. The validity of the questionnaire was confirmed through content validity.Results: The computerized process of requesting and collecting test results consisted of more stages than the paper-based process. Whereas, nurses enumerated more advantages and less disadvantages for the computerized process. From the nurses’ viewpoint, HIS can result in reducing workloads (85%), increasing the speed and preciseness (85%), facilitating activities (90%) and reducing the required time for the whole process of requesting and collecting laboratory test results (70%).Conclusion: Although in some aspects, the computerized system needs to be improved; generally HIS has improved the process of requesting and collecting laboratory test results compared to the pre-HIS implementation period.

Introduction: Global system was implemented in Iran in 1999. This system is currently used to pay for the second and third level health services. In the global system, patients are classified according to the 60 cases of common surgical procedures including kidney transplantation. Several years after implementing this system, the differences between actual costs and global costs of the operations raised many questions. This study aimed to compare actual cost and global cost of kidney transplantation in Imam Reza hospital in Tabriz.Methods: In this cross-sectional study, data on kidney transplant surgery were gathered via hospital HIS and all patients' medical records undergoing kidney transplantation during 2009-2010 (35 patients). Data were analyzed using descriptive statistics and paired T-test in the SPSS-17.Results: The findings of the study showed that there was a loss of 818, 665.45 thousand Rials in the hospital in 2009-2010 due to implementing global costs system. The mean and standard deviation of global costs was 32927.14±4040.66 thousand Rials; and mean and standard deviation of actual costs was 56317.58±3.53 thousand Rials. There was a statistically significant relationship between the actual and global costs of kidney transplantation. The real cost (non-global) was significantly larger than the global costs (P<0.001).Conclusion: Insurance companies are only obligated to pay the approved Tariff. The difference between the costs and the income has been reduced in recent years, which may have a negative impact on efficiency of hospitals. The differences between the global and actual costs of kidney transplantation are due to management issues and insurance organizations performance.

Introduction: Civil registration records are the best sources of vital statistics; however, such systems are often weak or incomplete in developing countries. The aim of this study was to assess the registration situation using rapid assessment of national civil registration and vital statistics systems (death and birth) in Iran based on the WHO Framework.Methods: The rapid assessment tool consists of 25 questions about function of the civil registration and vital statistics systems. The questions are grouped into 11 areas. Each question allows countries to select one of four scenarios describing a typical range of hypothetical situations.Results: Registration infrastructure and resources, organization and functioning of the vital statistics system, storage and transmission had the highest score (100%). The score of the ICD coding practices was 33%. The coder qualification and training, quality of coding and practices affecting the quality of cause-ofdeath data had the lowest score (50%). The total score was 61; equivalent to 83% of scores. This meant that, although registration and vital statistics systems in Iran are functional, it seems to be inadequate.Conclusion: According to the assessment results, most weaknesses were attributed to the quality of death and cause of death coding. It is necessary to design appropriate policies and planning to resolve the weaknesses.

Introduction: In recent years, Iran's scientific production growth pattern indicates a constant increase.Currently, Iran possesses the fastest growing trends in all fields of science including medical sciences in the world. This study aimed to present main achievements of Iran in the field of medical sciences, and based upon information obtained, compare the situation with high-ranked countries in the Middle Eastern and global patterns; and determine appropriate strategies to promote it.Methods: This study was conducted in three phases: data collection, data analysis based on selected indicators, and presentation of appropriate strategies to promote science and technology production in the field of medical sciences. To collect necessary information, we used science and technology databases including Scopus, the World Bank annual report and World Health Organization (WHO). To calculate evaluation indexes of science and technology, we used the standard formulas provided by other sources. In order to provide practical solutions to improve the science and technology production in the country, we devoted special attention to strategic document's goals and plans.Results: At the beginning of 2013, medicine allocated the largest share of the total science production of Iran with 7015 articles (nearly 23.6%). It was approximately 22.66 percent of Middle East and 1.06 percent of world’s articles published in medicine field. Studies showed that Iran's international rank at the beginning of 2012 compared to the previous year, had growth in more than 81 percent of medicine-related sub-majors and nearly 22.15% of country's science production related directly to major health problems and burden of disease in the community. Based on the foresight studies, we can predict that in case of maintaining current growth rate, Iran will achieve first place of medical sciences and health publications in the Middle East.Conclusion: Iran's remarkable growth in scientific productions, particularly in the applicable areas such as medicine, has created an appropriate ground in order to improve the quality of scientific productions and convert them to technology. Increasing research and educational budget and facilities, organizing research projects in line with the priorities and improving scientific productions indexing resources, are the most notable strategies for doing so.

Introduction: One of the challenging issues in family physicians program is dropping out of physicians from the program. The aim of this study was to determine factors influencing desertion of family physicians in rural areas with deprivation index less than 1.4 (Prosperous) in 2010.Methods: This health system research was a cross-sectional study. The study covered all healthcare centers implementing family physician program as well as the physicians working within the family physician program on contracting based throughout the first half of 2010. Data were collected through directed interviews and questionnaires. Data were analyzed using the Chi-squared test in the SPSS-15.Results: The first five reasons to giving up the program in this group of physicians included: improper payments, insufficient salary, excessive working hours, misbehaving of patients, and high patient visit loads.Conclusion: There was an increasing trend on dropping out of family physician program. To seize this trend, some actions could be done, including: to promote authorization for hiring family physicians, to reform the amount of payments, to ensure timely payments, to develop residency program on family physicians and dedicate an admission priority to active family physicians to enroll in the program, and finally to set a higher salary for family physicians practicing in rural areas.

Introduction: Research is a major element for development of countries. Nowadays, budgets and financial allocations are directed by research and development (R & D) issues. Investment in research and development units is considered as a competitive advantage. Scientific gap between developed and developing countries is measured based on the contribution of research and development activities in various economic, social and political issues. As there is no limitation for development, many developing countries try to follow developed countries and employ some indicators and instruments to measure the goals. The purpose of this study was to assess some important indicators of research and their trends through websites of the World Bank, UNESCO Institute for Statistics and other sources websites.Methods: In this study, using the latest available data in time series charts of the websites of the World Bank, UNESCO Institute for Statistics and a number of internal resources, the main indicators of research and development, including the research and development gross domestic product share of credits index, human resources index, and the number of published articles were considered. Moreover, contribution of various sectors in research and development funding was assessed.Results: Iran is in the first place among the Middle Eastern countries, regarding the share of research and development funds from GDP. The index has been increased from 0.34 in 1970 to 0.8 in 2008. The number of researchers per million individuals has been increased more than twice from 2001 (335 researchers per million) to 2008 (747 researchers per million). The growth of scientific articles published in Iran has been increased six times from 2001 to 2009. In 2009, the country produced 6313 articles and has been ranked in the 21st place in the world. Overall, 61.6% of the research and development costs are funded by public sector.Conclusion: The majority of the research and development indices have remarkable progress after the Islamic Revolution; however, the bulk of research budgets are funded by public sector. Moreover, policies and decisions are not made based on research results.

Introduction: Given the importance of monitoring the status of maternal health provision in the country, this study aimed to evaluate the utilization of maternal health services by province using data from Multiple Indicators Demographic and Health Survey in I.R Iran.Methods: This study used data Multiple Indicators Demographic and Health Survey conducted in 2010 in I.R. Iran. Indicators of maternal health services including place of delivery, type of delivery (vaginal or Cesarean section), postnatal care (at least one visit), antenatal care coverage, and births attended by skilled health personnel were calculated using data on 3974 women aged 15-54 with a live birth in the two years preceding the survey. Findings of the study were compared with the results reported from Demographic and Health Survey conducted in 2000.Results: All indicators of maternal health services except Cesarean section have been improved in the past 10 years. The Cesarean section rate has been increased from 35% to 46% with a rising trend, becoming a countrywide phenomenon. The highest rates of delivery in en route belonged to Tehran province (5.33%).Highest rates of delivery in home were observed in Sistan and Baluchestan, and Kohgilouyeh and Boyer Ahmad provinces. The lowest rate of postnatal care belonged to Ilam (45.7%) and Kerman (55.9%) provinces.Conclusion: Regarding improvements in the surveyed indicators in women aged 15-54, inequalities in provinces of the country have clearly been decreased during the past decade. Appropriate intervention programs should be developed to address local needs and reduce Cesarean section rate effectively. Postnatal care needs to be at high priority among national programs.Appropriate intervention programs should be developed to address local needs and reduce Cesarean section rate effectively. Postnatal care needs to be at high priority among national programs.