The Impact of Public and Private Health Expenditures on Poverty in developing countries

Background & Objectives: Changes in twenty-first century and incidence of development gap among countries has caused particular attention of all economic schools to the problem of poverty and the factors affecting it, as a consequence of underdevelopment. Health and health expenditures are considered as a tool for governments to get out from poverty. Methods: This study is one type of econometric studies with using panel data for Iran and 30 developing countries during 2005 to 2012. To determine the effect of health expenditures on poverty headcount ratio, Hassman and Chow tests were used in order to select the type of random or fixed effect regression model. Data analysis was done through Eviews 6 software. Results: Among factors affecting poverty, health expenditure had more significant impact on poverty. So that, one unit increase in public and private health expenditures caused respectively -2.93 decrease and 1.19 unit increase in headcount poverty ratio. In comparison to health expenditure, access to health facilities and primary school enrollment rate with respectively coefficients of -0.81 and 0.34 had less impact on poverty headcount ratio. Conclusion: Governments should pay more attention to policies of financing health sector and more expansion of governmental functions in financial support of health sector rather than private sector. Key¬words: Public Health Expenditure, Private Health Expenditure, Poverty Headcount Ratio ¬Citation: Harati J, Harati Khalilabad T, Rezapour A. The Impact of Public and Private Health Expenditures on Poverty in developing countries: 2005– 2012. Journal of Health Based Research 2016; 2(4): 345-354

Resource Utilization and Cost of Hospitalized Patients with COVID-19 in Iran: Rationale and Design of a Protocol

There is little data on direct medical costs and how to overcome the shock introduced by the novel Coronavirus (COVID-19) which emerged in Wuhan, China. The aim of this report is to present the methodology of an observational study for analyzing the resource utilization and direct medical costs of hospitalization. A multicenter retrospective observational study will be conducted on hospitalized patients with COVID-19 in selected hospitals of Tehran University Medical Sciences from February 2020 to June 2020. Cost calculations will be based on micro-costing approaches according to the health insurance perspective. Demographic, clinical, and cost data for the aforementioned patients will be collected through reviews of medical and financial records using a self-made questionnaire categorized in three parts (Form No. 1). The first part consists of demographic characteristics, the second part includes clinical information (e.g., symptoms, comorbidities, and complications), and the third part consists of resource utilization and cost data. Descriptive statistics (means, frequencies, percentages, and 95% confidence intervals) will be used to report data. With this report we sought to provide a valuable framework for estimating the direct medical costs of COVID-19 for hospitalized-patients basis on the severity of presentation. This will be the core for an assessment of the economic burden of COVID-19 in different presentations of the disease

Resource Utilization and Cost of Hospitalized Patients with COVID-19 in Iran: Rationale and Design of a Protocol

There is little data on direct medical costs and how to overcome the shock introduced by the novel Coronavirus (COVID-19) which emerged in Wuhan, China. The aim of this report is to present the methodology of an observational study for analyzing the resource utilization and direct medical costs of hospitalization. A multicenter retrospective observational study will be conducted on hospitalized patients with COVID-19 in selected hospitals of Tehran University Medical Sciences from February 2020 to June 2020. Cost calculations will be based on micro-costing approaches according to the health insurance perspective. Demographic, clinical, and cost data for the aforementioned patients will be collected through reviews of medical and financial records using a self-made questionnaire categorized in three parts (Form No. 1). The first part consists of demographic characteristics, the second part includes clinical information (e.g., symptoms, comorbidities, and complications), and the third part consists of resource utilization and cost data. Descriptive statistics (means, frequencies, percentages, and 95% confidence intervals) will be used to report data. With this report we sought to provide a valuable framework for estimating the direct medical costs of COVID-19 for hospitalized-patients basis on the severity of presentation. This will be the core for an assessment of the economic burden of COVID-19 in different presentations of the disease

Health technology assessment of Bevacizumab compare with combination of Bevacizumab with Erlotinib for treatment of patients with metastatic colorectal cancer

Introduction: Effective and efficient treatment for patients with metastatic colorectal cancer that can increase survival rate with limited side effects, is important. The purpose of this study was health technology assessment of Bevacizumab compare with combination of Bevacizumab with Erlotinib for treatment of patients with metastatic colorectal cancer. Methods and Results:In the present investigation first a systematic review on finding the studies was conducted. To reach this goal a comprehensive search in PubMed, Cochrane Library, Scopus, CRD, American Society of Clinical Oncology and European Society for Medical Oncology databases using the PICO based keywords was performed. Then, a retrieved study by means of two independent and expert reviewer during several steps (based on title, abstract and full-text, excluding of duplicated or unrelated cases) was chosen and non-qualified studies was exiled from the study. After that, 20 chosen randomized trial studies were evaluated by two experienced evaluators by Cochrane tool in terms of types of Bias. Eventually obtained data from the investigation was meta-analyzed by Revman5.3 software and safety, effectiveness and economical evaluation of the device were studied based on this data. To calculate the expenses of Bevacizumab and Erlotinib, Cost-effectiveness Analysis with the perspective of the service provider in the public sector was performed. In total, three randomized controlled trials with 682 patients met the inclusion criteria.  The combination of Bevacizumab with Erlotinib for maintenance therapy of patients with metastatic colorectal cancer improved progression free survival by 0.19 and overall survival by 0.22. Degree three and four side effects of developed during treatment were limited and manageable. The combination of the two drugs was cost effective from the perspective of the service provider. Conclusions:Based on current evidence, prescribing the combination of Bevacizumab and Erlotinib in the maintenance treatment of metastatic colorectal cancer patients is cost effective from the perspective of service provider in the public sector, and the use of this combination in the health system is economically viable

Investigation of the Effect of Aging on Health Costs: A Systematic Review

Background & Objectives: Aging and the need for more health care in the elderly population have incurred large expenditures. Based on the importance of the aging population phenomenon and the increase in lifetime in recent decades, this study aimed to systematically review the studies on costs of elderly health care. Methods: In this systematic review, the articles published in PubMed Google Scholar, Science Direct, Scopus, and Ovid Medline databases from 2000 to 2017 were derived using a systematic search strategy. Results: The results of the reviewed studies showed that by increasing the consumption of long-term care and home care, the costs would increase and by reducing the consumption of acute hospital care, such costs would decrease. Based on the results, the average cost of elderly health care in the reviewed studies was 48101 US dollars in 2015. Moreover, the highest average costs were for inpatient services (19003US dollars) and long-term care and home care (12583US dollars). Conclusion: Considering the high costs of hospitalization of the elderly, measures like establishment of day care centers and home care instead of hospitalization should be taken into consideration in the elderly health care programs to reduce the number of hospitalizations. Key¬words: Aging, the Elderly, Health Costs, Hospital Costs, Systematic Review Citation: Rezapour A, Arabloo J, Alipour V, Alipour S. Investigation of the Effect of Aging on Health Costs: A Systematic Review. Journal of Health Based Research 2020; 5(4): 411-22. [In Persian

History of primary health care in Iran

Background: The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. Introduction: The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all. Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Discussion: Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. Conclusion: The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all

Cost analysis of educational courses of medical students in Iran

Estimating the cost of graduate courses can play an important role in deciding on the allocation of required resources. This study aimed to determine the cost of educational activities of graduate students in hospitals of medical universities in Iran. This study was performed in eight independent educational medical centers of Iran University of Medical Sciences, Tehran, Iran. After identifying the cost topics, the required information was collected through a semi-structured interview with the officials and students. Then, the amount of use of the graduate students from the cost headings was determined. The results identified that Doctor of Philosophy (PhD) students of microbiology with more than 950 United States dollar (USD) and PhD students of medical education with about 7 USD have created the highest and lowest costs, respectively. This study, for the first time, examined the educational costs of Iranian postgraduate students in the hospital. In conclusion, the results of this study indicated that the amount of the costs of different fields of graduate education in medical sciences is very different and it should be considered in the allocation of the resources

Catastrophic Health Expenditure among Iranian Households:Evidence from the COVID-19 Era

Background: Monitoring households’ exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period. Methods: The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household’s capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software. Results: The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level. Conclusion: A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients

Economic Evaluation of the Drugs Used In Treating Patients with Myocardial Infarction: A Systematic Review

Introduction: Myocardial infarctions (MI), as one of the outcomes of cardiovascular diseases, are responsible for 20% of deaths, so that every 30 seconds, one person suffers from MI. Various drugs are used to treat myocardial infarction, and we need to have precise information of the cost-effectiveness of these drugs. The aim of this study was to examine economic evaluation of the drugs used for treatment of patients with MI. Methods: In the present systematic review study, published articles related to economic evaluation of the drugs used for treatment of patients with MI within the time interval between 2000 and 2017 were searched, using electronic databases such as Tufts Medical Center Cost-Effectiveness Analysis Registry ,Cochrane library, NHS Economic Evaluations Database Medline, PubMed, Google scholar, web of science using the following keywords: Cost- effectiveness* OR cost- utility* OR economic evaluation * AND (myocardial infarction*) AND (angiotensin- converting enzyme inhibitor (lisinopril) OR thrombolytic agents (streptokinase, anistreplase or anisoylated plasminogen streptokinase activator complex OR beta blockers (metoprolol, propranolol, atenolol, acebutolol, bisoprolol). Due to heterogeneity in the outcome, we were not able to use meta-analysis. Methodological quality of the structure e of tarticles was examined by Drummond’s standard checklist. Results: Based on the inclusion criteria, the search of databases resulted in 12 articles that fully covered economic evaluation of the drugs used in treating patients with MI. The results of the present study indicated that a streptokinase and t-PA drug for treatment of patients with myocardial infarction was cost-effective. The results showed that most of the studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, the majority of the studies were used the Markov model. The quality-adjusted life years (QALYs) were the main outcome used for measuring the effectiveness. Conclusion: The results of the present study showed that a thrombolytic agent for treatment of patients with myocardial infarction was cost-effective. The results were relatively varied due to the differences in time horizon and variables used in the models such as efficacy and drug prices. Furthermore, these studies were designed and conducted in high-income countries; thus, the application of these results in low- and middle-income countries will be limited