Eliciting Preferences for Health Insurance in Iran Using Discrete Choice Experiment Analysis

Background: The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016.Methods: A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models.Results: The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P < .001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P = .485) disutility (OR = 0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P < .001) the highest for the private hospitals’ benefits (OR = 2.82) followed by public hospitals’ benefits (OR = 2.02) and outpatient benefits (OR = 1.75), and the premium revealed statistically significant (P < .001) disutility (OR = 0.96). Conclusion: Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals’ utility from the insurance benefits packages

Dental health-care service utilisation and its determinants in West Iran: a cross-sectional study

Dental health care is not only an effective strategy for the prevention, early diagnosis and treatment of oral diseases but also contributes to the general health of communities. This study aimed to investigate the situation of dental health-care service utilisation and its determinants in Kermanshah city, western Iran, in 2015. Methods and materials A cross-sectional study on a total of 894 household heads was conducted. The participants were selected using a multistage sampling technique. A self-administered questionnaire was used to collect the data. Multiple logistic regression was performed to assess factors associated with utilisation of dental-care services and a negative binomial regression was carried out to identify the main factor associated with the frequency of visiting a dentist for dental health care. A statistically significant association was considered at a value of P < 0.05. All the analyses were performed using STATA version 12. Finding Of the total household heads who participated in the study, 60.3% and 9.9% reported visiting a dentist for dental treatment in the past year and for 6-monthly dental check-ups, respectively. The average ± standard deviation number of visits by a respondent was 2.08 ± 2.97. Of the total number of respondents, 281 (31.4%) reported visiting a dentist once or twice in the last 12 months for dental health-care services, while 28.9% reported visiting a dentist more than twice in the same time period. Ageing, having dental insurance, higher income, being a university graduate, self-rated poor oral health and not regularly brushing own teeth were the main factors associated with utilisation of dental health-care services. Conclusion Our study indicates that dental health-care utilisation among households in the study area was influenced by a number of factors, including being socio-economically disadvantaged, self-rated poor oral health and not regularly brushing own teeth. Therefore, in this setting, dental-intervention programmes, including dental health insurance, should focus on mechanisms that can strengthen utilisation of preventive dental health-care services among disadvantaged households

Availability and inequality in accessibility of health centre-based primary healthcare in Ethiopia.

BACKGROUND:Achieving fair access to healthcare and improving population health are crucial in all settings. Properly staffed and fairly distributed primary health care (PHC) facilities are prerequisites to ensure accessible healthcare services. Nevertheless, availability and accessibility issues are common public health concerns, especially in under-resourced countries including Ethiopia. Measuring inequalities in accessibility of healthcare resources guide policy decisions to improve PHC services and ultimately achieving universal health coverage (UHC). PURPOSE:To assess availability and measure magnitude and trend of inequalities in accessibility of health centre-based PHC resources in Ethiopia during 2015 to 2017. METHODS:We conducted a cross-sectional population-based analysis of district-level data collected from 16th December 2017 until 24th May 2018. Afar, Dire-Dawa, and Tigray regions were purposefully included in the study to represent the four pastoralist/semi-pastoralist, three urban and four agrarian regions in Ethiopia, respectively. We used ratios, different inequality indices and Gini decomposition techniques to characterise the inequalities. RESULTS:In 2017, median of health centres (HCs) per 15,000 inhabitants and their Gini indices (GIs) for Afar, Dire-Dawa, and Tigray were 0.781, 0.566, 0.591 vs. 0.237, 0.280, 0.216 respectively. Median overall skilled health workers (SHWs) per 10,000 inhabitants were 5.250, 7.539, and 6.246, respectively. These accounted for 11.80%, 16.94% and 14.04% of the WHO target of 44.5 to achieve SDGs. The corresponding GIs for the regions were 0.347, 0.186 and 0.175. Despite a higher overall SHWs inequality in the urban districts of Tigray (GI = 0.301), only Tigray showed significant inequality reductions in GHE (p < 0.001) and in all categories of SHWs (p < 0.05). CONCLUSIONS:Our analysis provided a clear picture of availability and inequalities in PHC resources across three regions in Ethiopia. Identifying contributing factors to low densities and high inequalities of SHWs may help improve PHC services nationwide, along with pathway towards UHC

Assessment of postgraduate international students learning preferences at Tehran University of Medical Sciences, Tehran, Iran

Knowledge of learning preference can help to improve learning and teaching process and understand its implications. The aim of this study was to assess the preference for taking in and putting out information in learning among postgraduate international students at Tehran University of Medical Sciences, Tehran, Iran. Using Institutional based cross-sectional descriptive study and self administrated structured version 7.2, visual, auditory, read/write, and kinesthetic and multimodal learners (VARK) questionnaire was used. The questionnaire was divided into two sections including (a) demographic profile and (b) sixteen multiple choice questions. Data was collected from 40 participants who were selected by purposive method. After coding and cleaning, data was entered and analyzed by SPSS version 21 and Microsoft excel using the VARK guidelines. Descriptive statistics was used to see the frequency and percentage of each variable. The p-value<0.05 was significance measurement for the result in this study. A total of 40 postgraduate international medical science students; the majority 8 (20%) were females and 32 (80%) of respondents were male. The most frequent unimodal learning preferences was read/write (32.5%). In addition, aural (27.5%), visual (20%) and kinesthetic (17.5%) were in the next order in learning preference of students. The mean scores of male students who preferred both bimodal learning and trimodal learning was 63.75 whereas in female participants it was 58.69. In conclusion, the mean scores of both bimodal and trimodal learning preferences were equal. However, the mean scores and standard deviation of quadrimodal learning preferences were lower than both bimodal and trimodal. Therefore, further study is necessary to fill this gap. [J Med Allied Sci 2016; 6(1): 14-22

Immediate health and economic impact of the Tigray war on internally displaced persons and hosting households

Abstract Globally, war is the major cause of displacement from the usual place of the biological environment. The war of Tigray exposed thousands of people to internal displacement and migration. Evidence has shown that displaced people and migrants shoulder the health and economic burden to ensure survival. However, evidence of the impact of the war on health and the economy related to the displaced people and their hosting communities is not documented. Thus, this study aimed to investigate the health and economic impact of the war on displaced people and the hosting community. A community-based survey was conducted among randomly selected 3572 households of 48 woredas/districts from August 06 to 30/2021 in Tigray. Each district had 4 enumeration sites and there were 20 households (HHs) to be sampled per each enumeration site. Data were collected using a pretested structured questionnaire using face-to-face interviews of displaced and hosting household heads. The entered data is exported to SPSS version 26 statistical packages for data analysis. Summary statistics and geo-spatial analysis was computed. The war had a significant impact on the health and economy of the community of Internally Displaced People (cIDPs) and hosting households. There were 12,691 cIDPs and 3572 hosting HHs. About 12.3% had chronic illness12.3% of (cIDP) who had chronic diseases and follow-up medication was forced to stop their medication. 536 (15%) civilian family members of cIDPs were killed at their homes. During the war, 244 (6.83%) of civilian family members faced physical disability. Consequentially, 43.8% and 58.8% of respondents of cIDPs suffered from severe depression and post-traumatic stress disorder. The war had a significant amount of personal resources such as domestic animals, cereals, cars, machinery, and HH furniture was looted and vandalized by the perpetrator forces from the cIDPs and hosting HHs. The range of family size in the hosting households was 3 to 22. The war had a significant health and economic impact on both cIDPs and hosting HHs. cIDPs suffered from various illnesses and disabilities related to the war with no medical access and follow-up care leading them to stressful situations such as depression and PTSD. There was also a huge economic damage and distraction which threatens the survival of the survivors

War-related sexual and gender-based violence in Tigray, Northern Ethiopia: a community-based study

Introduction Sexual and gender-based violence (SGBV) during armed conflicts has serious ramifications with women and girls disproportionally affected. The impact of the conflict that erupted in November 2020 in Tigray on SGBV is not well documented. This study is aimed at assessing war-related SGBV in war-affected Tigray, Ethiopia.Methods A community-based survey was conducted in 52 (out of 84) districts of Tigray, excluding its western zone and some districts bordering Eritrea due to security reasons. Using a two-stage multistage cluster sampling technique, a total of 5171 women of reproductive age (15–49 years) were randomly selected and included in the study. Analysis used weighted descriptive statistics, regression modelling and tests of associations.Results Overall, 43.3% (2241/5171) of women experienced at least one type of gender-based violence. The incidents of sexual, physical and psychological violence, and rape among women of reproductive age were found to be 9.7% (500/5171), 28.6% (1480/5171), 40.4% (2090/5171) and 7.9% (411/5171), respectively. Of the sexual violence survivors, rape accounted for 82.2% (411/500) cases, of which 68.4% (247) reported being gang raped. Young women (aged 15–24 years) were the most affected by sexual violence, 29.2% (146/500). Commonly reported SGBV-related issues were physical trauma, 23.8% (533/2241), sexually transmitted infections, 16.5% (68/411), HIV infection, 2.7% (11/411), unwanted pregnancy, 9.5% (39/411) and depression 19.2% (431/2241). Most survivors (89.7%) did not receive any postviolence medical or psychological support.Conclusions Systemic war-related SGBV was prevalent in Tigray, with gang-rape as the most common form of sexual violence. Immediate medical and psychological care, and long-term rehabilitation and community support for survivors are urgently needed and recommended