Management Strategies in Health System
Year:2023 | Volume:8 | Issue:2|Papers Count:8

Abstract Background: Individualized care is a concept that describes personal characteristics of patients in clinical conditions, their personal life situation, and their preferences in order to promote participation in decision-making. The purpose of this study was to validate the Persian version of the Suhanen et al. 's (2005) individualized care scale. Methods: This cross-sectional study was conducted in 2019. Initially, the individualized care scale of Suhanen et al (2005) was translated in forward-backward way with 19 items and on a 5-point Likert scale (1 = completely disagree, 2 = disagree, 3 = no opinion, 4 = agree, 5 = completely agree). Content and face validity were then assessed using the opinions of 10 health management professionals (majors of health care management, health policy and health economics) Internal reliability of the questionnaire was assessed using the opinions of 20 patients admitted to gynecology, internal medicine and surgery wards of Yazd 3 teaching hospitals, and Cronbach's alpha coefficient (0. 93) was calculated using SPSS 20 software. Results: The results of content validity calculation showed that all items of the current questionnaire had acceptable Content Validity Ratio, and the Content Validity Index was 0. 73 for this questionnaire. Face validity analysis also demonstrated that all experts approved the questionnaire items. Cronbach's alpha coefficient for the whole questionnaire was 0. 93, and for "clinical status", "personal life situation" and "decision-making control over care, " was 0. 90, 0. 87 and 0. 90 respectively,the values were acceptable, and the reliability of the questionnaire was confirmed,none of the items were removed. Conclusion: The questionnaire can be used as a credible and valuable tool for assessing individualized patient care.

Background: Evaluating the performance of hospitals will increase effectiveness, efficiency, and quality of services provided and improves responding to the customer. Performance indicators are the most widely used tools for measuring the performance of hospitals. The prevalence of Covid-19 pandemic has affected health care systems at various levels with significant implications for health, the economy, and social structures. Therefore, the present study evaluates the performance of inpatient wards of hospitals affiliated with South Khorasan University of Medical Sciences in the years before and during the COVID-19 pandemic. Methods: The current study was cross-sectional, which was conducted during the years before (2018-2019) and during the outbreak of COVID-19 (2020-2021). The research population included all inpatient departments of hospitals affiliated with Birjand University of Medical Sciences (28 departments). The performance of services was analyzed using data collection form, and through the Pabon Lasso model, the efficiency of the hospital was analyzed. Excel 2018 was used to draw Paben Lasso diagram, describe the data, and check the process of change. Service performance and change process before and during the COVID-19 pandemic were examined using SPSS22 software and Paired sample t-test statistical test (The significance level was determined at 0.05). Results: The results of this study showed that in the years before and during the COVID-19 pandemic, the functional ratios of bed occupancy percentage decreased by 29.20%, the average patient stay increased by 6.90%, and the annual bed turnover rate decreased by 32.80%. The results of paired sample t-test with a significance level of 0.05 showed that there was a significant relationship regarding the internal wards and CCU (Coronary Care Unit) between 3 functional indicators: bed occupancy percentage, bed turnover rate and average patient stay; there was no significant relationship in the burn ward. After examining the wards of kidney and urinary tract surgery, ear, nose and throat surgery, orthopedics, psychiatry, pediatrics, infectious diseases, general surgery, open heart ICU (Intensive Care Unit), neurosurgery, and cardiovascular surgery, 2 functional indicators of bed occupancy percentage and bed turnover rate, in the ICU ward, the functional index of the percentage of bed occupancy, and in the neonatal wards, the NICU (Neonetal Intensive Care Unit), the average length of patient stay showed a significant relationship. After examining the efficiency of the wards, the number of efficient districts changed from 32.14 to 28.57%, and the number of inefficient districts changed from 25 to 28.57%. Moreover, positive changes in the efficiency status of the open heart and neonatal ICU departments and negative changes in the efficiency status of the pediatric, internal, psychiatric, and infectious wards were observed in the target period. Conclusion: With the arrival of Covid-19 pandemic, service performance regarding the indicators of bed occupancy percentage, and annual bed turnover rate, and efficiency in hospitals affiliated with Birjand University of Medical Sciences decreased due to limitations in providing services to patients. During the studied years, on average, less than one third (30.36 %) of hospital wards in Kara district were functional, and therefore, had a favorable performance; therefore, periodic and continuous evaluation is suggested to help the policy makers to utilize the available resources using the Pabenlaso model or other models.

Background: Medical tourism in Yazd city has been greatly developed as one of the treatment poles of the country and can be said that this industry has become one of the development axes of Yazd city. The purpose of this research is to identify the most important factors influencing the attraction of non-native medical tourists to the historical city of Yazd. Methods: The current research was of a qualitative type conducted in the fall of 1401. Desk research and Delphi method were used to collect data. The statistical sample of this study included 41 experts in the fields of treatment, tourism, and urban planning, and these experts were selected based on their related specialties using a snowball method. After studying the theoretical foundations of the research, 41 effective factors in attracting medical tourists were specified from related research texts, and during studying, categorization and editing, 23 indicators were provided to the experts in the form of a questionnaire on a 5-point Likert scale, and at the end of the questionnaire, an open question was provided. After analyzing the answers, the results were recorded and a new questionnaire was created for the next stage, which was repeated 3 times. According to the results of the Kolmogorov-Smirnov test at a significance level of 0.05, the correlation between the factors was analyzed using the W. Kendall non-parametric correlation test and the SPSS 18 software, and the Delphi technique was used to achieve the research objectives. Results: In the course of data analysis, indicators with an average difference of less than 0.1 were confirmed, indicators with an average of less than 4 were removed, and other indicators were moved to the next stage. After completing 3 stages of the test, 12 factors were identified as the most important factors affecting medical tourism in Yazd city, and these factors were placed in 5 categories: characteristics of the treatment staff, characteristics of the hospital, economic factors, giving information and communication, and other related factors. According to W. Kendall's correlation coefficients obtained during the 3 Delphi steps, the convergence and agreement of experts' opinions were confirmed. Conclusion: Considering that infrastructure indicators, personnel skills and economic factors are among the most important indicators of attracting medical tourists to the historical city of Yazd, it is suggested that to develop medical tourism in Yazd city, these items should be taken into consideration in managing the current situation of medical centers; Furthermore, investment should focus on the development of medical infrastructure.

Background: Oil revenues, as an important part of the government's revenues in Iran's oil-dependent economy, play an important role in providing public sector expenditures, including the health sector and consequently have an impact on health outputs. On the other hand, the way of using and managing oil revenues is an important factor in the way of this effect. Therefore, the main purpose of this study was to investigate the interactive effect of good governance and oil rent on life expectancy in Iran. Methods: The present descriptive-analytical study investigated the short-term and long-term equilibrium relationship between health output index, per capita income, oil rent, good governance index, and the cross (interactive) effect of good governance and oil rent from 1985 to 2020 using the time series data of Iran. The data used were collected from World Bank global development indicators database and international country risk guide. Also, model estimation was conducted using and autoregressive distributed lag and data analysis was performed using Eviews 10 software. Results: The results show that in the short and long term, the increase in oil rent improves the health output index in the country. One percent increase in the share of oil rent from gross domestic product (GDP), in the long and short term, increases the life expectancy in the country by about 0.101 and 0.668 percent, respectively. However, the interactive effect of oil rent and good governance index in the short and long term is negative and significant with coefficients of - 0.084 and - 0.515; which shows that oil rent leads to a decrease in life expectancy by weakening good governance indicators. Conclusions: Based on the findings of this study, it can be said that oil rent is inherently useful in promoting health in the country; but its improper use and management causes the health sector to not benefit from it and even become a loss.

Background: Biosimilars can be considered generic versions of branded biologic medicines. Substituting branded biologic medicines with biosimilars is important to reduce medication costs. In addition to reducing drug costs, the domestic production of biosimilars can provide many other economic benefits. Therefore, this study aimed to investigate the economic benefits of producing biosimilar medicines in Iran. Methods: This study was done in 2021 through 2 qualitative and quantitative steps. In the first step, after literature review, the interview guide was designed and semi-structured interviews with experts continued until reaching the saturation point, after interviewing 9 experts from different fields (imports, production, and policy making). The data were coded and analyzed by thematic analysis using MaxQDA software and the economic benefits of producing the biosimilars in Iran were extracted. In the quantitative step, the price advantage of producing domestic biosimilars was analyzed as one of their most important economic advantages compared to its equivalent in reference countries. In addition, the same comparison was done for the main imported branded medicines. Results: From the experts’ viewpoints, the most important economic effect of the domestic production of biosimilars was the reduction of medication costs through access to lower-priced medicines. The employment of professionals, development of new technologies, expansion of the pharmaceutical market, the reduction of foreign currency outflows, increased affordability and access to drugs, and ultimately the improvement of the health level of the society were the other economic aspects of these medicines. In the quantitative step, after comparing the prices of 23 domestic biosimilars with the prices of the equivalent medicines in reference countries, the prices of 21 medicines were lower than the average prices of equivalent biosimilars and the prices of 18 medicines were even lower than the minimum price of the equivalent biosimilars in the reference countries. In addition, the production of these drugs in the country is indirectly effective in reducing the price of the main branded drugs in the country, so that in the case of imported branded biologic medicines, out of 28 medicines, the prices of 26 medicines were lower than the average prices in the reference countries and the prices of 23 medicines were even lower than the minimum of prices in the reference countries. Conclusion: Based on the results of the study, it was concluded that the domestic production of biosimilar medicines in Iran, in addition to increasing access to biological drugs and promoting public health, provides many economic benefits, including saving drug costs.

Background: Self-medication is one of the main socioeconomic and health problems in different societies and irrational drug consumption can sometimes lead to unfavorable outcomes and even death. The present study has been performed to investigate self-medication and its relevant factors in students of Shahid Sadoughi University of Medical Sciences in Yazd. Methods: This analytical study investigate 300 students of Shahid Sadoughi University of Medical Sciences Using Cochran's formula in Yazd (2020). The samples were selected by stratified sampling proportional to the strata size and the data were collected by a researcher-made questionnaire from Gholipoor etal's article (2012) and analyzed by descriptive statistics such as frequency, percentage, mean ± SD and multiple response analysis (MRA), chi-square and binary logistic regression. All statistical analyses were done by SPSS 20 (α=0.05). Results: The total self-medication rate was estimated 39%. The most common causes of self-medication among the students were the experience of the disease (50.4%) and considering the disease non-risky (47.0%).The most common self-medication case was cold (53.0%) and the most common way of supplying the drug for self-medication was purchasing from drugstores (52.1%).The results of multiple logistic regression showed that the only variable having a significant effect on the probability of self-medication was income (p = 0.02); odds of self-medication in students with an average income of 20-30 million Rials was about twice as high as students with an income of more than 30 million Rials (p = 0.02, OR = 1.8). Conclusion: Self-medication is not a safe habit and it can cause complications such as drug interaction, addiction, drug poisoning, concealment of the disease and in general, health risks. Meanwhile, the students’ attitude towards self-medication can affect the behavior of their future patients. So, it is suggested to inform students in this area.

Background: The proper selection of financial indicators can assist in making optimal decisions in financial resource management and enhancing the efficiency of universities. Therefore, the aim of this research was to identify the required financial indicators for designing and developing a comprehensive financial management system of the selected medical university. Methods: The present cross-sectional study was conducted in 2022 in 2 stages. In the first stage, the required financial indicators for designing and developing a comprehensive financial management system were identified through a literature review and financial theoretical foundations. In the second stage, the content validity of the indicators for application in the financial system was assessed through a survey of experts using the Waltz and Bausell and Lawshe questionnaires. The research population consisted of a group of university experts from Tehran medical sciences universities with a minimum of 10 years of work experience and at least a bachelor's degree, and a proper recognition of relevant affairs in the field of financial management, auditing, and accounting. Among them, 21 individuals were purposefully selected. Data analysis was performed using MaxQDA 12 and Excel software. Results: A total of 17 financial indicators were identified and classified into 6 main areas, including "liquidity," "profitability," "revenue generation," "capital structure," "investment," and "financial risk." The highest level of Content Validity Ratio pertained to the "profit" and "human capital value added" indicators (CVR= 90 %), and the highest level of Content Validity Index was also related to the "labor cost” and “human capital value added" (CVI = 100 %). Conclusion: University managers and policymakers can have a desired evaluation of the university financial performance using the proposed indicators in this research. Therefore, it is suggested to design software for recording indicators based on this model (17 indicators in 6 main areas) and establish a database for the assessment of the university financial performance and the mechanism for collecting and analyzing information based on it.

Background: In addition to being responsible for the death and infection of millions of people around the world, COVID-19 also created a range of social, economic, environmental, and mental health challenges. This study was conducted with the aim of investigating various dimensions, challenges, and effects of the pandemic in the aforementioned areas. Methods: The present scoping review was conducted in 2022. All published articles in the field of aforementioned dimensions were searched from the beginning of 2020 to the end of April 2022. Searches were made in English language databases including Medline through PubMed, Scopus, Web of Sciences and also manual search in Persian language databases including SID and Magiran. After reviewing gray and manual texts, finally 84 final articles were selected. The data were analyzed and classified using the content analysis method using the "framework of structural and intermediate determinants of health" of the World Health Organization. Results: Cases such as the reduction of the gross national product, the imbalance of supply and demand, the urgent need to strengthen social protection systems, the increase in inequality, the reduction of the social rights of women and children, and the reduction of access to health services are among structural factors and cases such as tourism damages, decrease in mental well-being, increase in irritability, anger and tension, fear of COVID-19 in the elderly and exposure to the spectrum of mental problems were among the intermediate determinant factors that have led to direct and indirect effects on the justice, health, and well-being of societies. Conclusion: The COVID-19 pandemic and the subsequent actions of the governments, such as nationwide quarantines and the creation of numerous restrictions, have led to a wide range of social, economic and environmental effects on societies. Countries need effective and extensive measures in determinant factors to get rid of the negative effects of the spread of this disease on the health and well-being of people in the long run.