The Effect of Exchange Rate Uncertainty on Import of Medical and Pharmaceutical Products in Iran

Background: The field of medicine and medical equipment are partially dependent on the exchange rate. The aim of this study was to investigate the effect of real exchange rate uncertainty on the import of medical and pharmaceutical products during 1971-2012. Methods: In this longitudinal study, the related data were collected from the World Bank, the Central Bank of the Islamic Republic of Iran and Iran customs office during 1971-2012. Generalized Autoregressive Conditional Heteroskedastic (GARCH) model was used for modelling the real exchange rate. In order to evaluate the impact of real exchange rate uncertainty on import of medical and pharmaceutical products, the exchange rate uncertainty index and other variables such as gross domestic product (GDP), oil revenues (OILR) and private sector health expenditure (PRI) were applied in the import model. Finally, VAR model was estimated using Eviews software version 6. Results: Estimation of medical and pharmaceutical products import model using Johansson test showed a significant negative coefficient for the exchange rate uncertainty variable. Error correction factor in this study was -0.039. Results show that in each period, 3.9 percent of the shocks in the short term can be adjusted to long-run equilibrium values. Conclusion: The exchange rate uncertainty had a significant negative impact on imports of medical and pharmaceutical products. This issue is very important for policy makers of the health field and health economists

The Effect of Health Care Financing on Income Distribution in Iran: 2008- 2010

Background: Inequality in income distribution leads to the incidence of poverty and increase of the gap between social classes. Evidences suggest that policymakers in many developed and developing countries are concerned about the effects of health care financing on income distribution. The aim of this study was to investigate the effects of paying for health care on the distribution of income in rural and urban households in Iran. Methods: This descriptive- analytical, retrospective study was composed of a 3-year time series. Data were collected from the household income and expenditure survey of the Statistical Centre of Iran. To measure the inequality in the distribution of resources, Lorenze Curve and Gini index estimations were used. Data were analyzed using Stata11 software. Results: Gini coefficient for prepayment income, for the years 2008 to 2011, was respectively 0.367, 0.348 and 0.369 for urban households and 0.404, 0.362, 0.396, for rural households. The values of this index for post payment income in urban households were 0.300, 0.286 and 0.302 and 0.324, 0.300, 0.320 for rural households respectively. According to the results, paying for health care services has led to a significant reduction in the Gini coefficient and increase of equity. Conclusion: The results showed that paying for health care had a significant relationship with income distribution; it means that paying for health care and households’ contribution in health care financing reduced the Gini coefficient and improved income distribution. Keywords: Health care payment, Income distribution, Gini coefficient, Ira

Do Hospitals Affiliated With the Kurdistan University of Medical Sciences Perform Efficiently? Non-parametric Data Envelopment Analysis

Background: One way to improve the performance of hospitals, the largest resource-consuming units in the healthcare sector, is to continuously evaluate their performance.Objective: The current study assessed the performance of hospitals affiliated with the Kurdistan University of Medical Sciences using data envelopment analysis (DEA).Methods: This retrospective descriptive-analytic study used DEA to assess efficiency types (technical, managerial, and scale) in hospitals of the Kurdistan University of Medical Sciences (n = 12) in the years 2007 to 2011. The number of active beds, nurses, physicians (general and specialist), and other staff were inputs; inpatient admission and occupied bed days were outputs. Stata version 12 was used for data analysis.Results: The mean technical, scale, and managerial efficiency values were 0.85, 0.89, and 0.95, respectively. The highest and lowest slack inputs were nurses and active beds, respectively.Conclusion: The findings indicate that Kurdistan hospitals were less than appropriately efficient during the studied period. They also suggest that there is a capacity of about 15% for enhancing output in hospitals (compared with the most efficient studied hospitals) without increasing costs or inputs

Cost-savings of community water fluoridation program; Kerman, Iran, 2016

BACKGROUND AND AIM: Oral diseases are very important because they impose economic and social burden on societies. Given the resource scarcity, it is necessary to devise cost-effective and scientific strategies to prevent and control oral diseases. This study aimed to estimate the potential cost-savings for dental caries treatment associated with Community Water Fluoridation Program (CWFP) in Kerman, Iran. METHODS: An economic model to compare the costs of CWFP with treatment savings achieved through averted tooth decay was developed. Direct cost of prevented caries was taken equal to treatment savings. Implementation cost and the associated savings was estimated for Kerman in 2016. We obtained required data and parameters for costs and savings estimation through published documents and other sources. RESULTS: Annual cost-savings associated with implementing the water fluoridation in Kerman was estimated about $11160415.5 to$44350544.11. About $34.9 to$136 could be achieved per each dollar spent. Annual cost and benefit per capita was $0.66 and$23.4-$91.09 respectively. Net benefit per capita was$22.7 to $90.4. CONCLUSION: This study indicates significant annual savings from CWFP; additional savings could be achieved if this program is implemented in other regions. We could also receive even more if this program is integrated with other public oral health programs such as screening school children, community dentistry and oral health education. KEYWORDS: Water Fluoridation; Dental Caries; Cost Savings; Cost-Benefit; Oral Healt

Estimation of the Cost of Smoking-Attributable Diseases (Five Selected Diseases): A Case in Kerman City, Iran, 2014

Background: Cigarette seems to be the least valuable of addictive drugs. It is easily accessible to the public, and its harmful personal and social effects have attracted less attention. Therefore, the present research was carried out with the aim of presenting cost estimations of smoking-related diseases in smokers who aged 35 or higher in Kerman City, Iran, in 2014.Methods: Using the prevalence approach, the direct and indirect costs of smoking-attributable diseases including lung cancer, gastric cancer, myocardial infarction, stroke, and chronic obstructive pulmonary disease (COPD) were estimated. The initial data were obtained from the information in documents of medical document units as well as the 2014 income statements of teaching hospitals of Kerman University of Medical Sciences, Kerman City.Findings: In this research, total economic costs of diseases attributed to smoking were estimated to be 50 million dollars in 2014 in Kerman City, and calculations suggest that this figure accounts for 0.02% of Iran’s gross domestic product (GDP). Total direct cost of diseases caused by smoking in Kerman City adds up to 17 million dollars, whereas the estimated indirect cost of diseases caused by smoking is 33 million dollars. The yearly per capita cost of any of the selected five diseases is 270 dollars.Conclusion: Smoking places a high economic burden on health system and society as a whole. Therefore, stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking

Mapping catquest scores onto EQ-5D utility values in patients with cataract disease

Background: Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations. Objectives: This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the disease-specific Catquest measure. Patients and Methods: One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, the mean absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected. Results: The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R2of 0.697, an MAE of 0.1176 for the OLS and an R2of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) = 0.988 - 0.0281 × Catquest (PD) + 0.102 × gender (male = 1). Conclusions: Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available. Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples. © 2016, Iranian Red Crescent Medical Journal

Dynamic Analysis of the effect of Corruption on Health Indices in Selected Countries using Panel VAR Model

Introduction: Corruption is one of the economic, political and social tuberous phenomena that can be a threat for accessing health, equity and objectives. The aim of this study was to determine the dynamic impact of corruption on health. Methods: This longitudinal study was performed using the Panel VAR model. Moreover, the Johansen test was used to estimate the long-run relationship. Data of 43 countries during 1996-2011 were analyzed through EViews 6. Results: Results showed that, corruption control, in long-term, has a significant positive effect on the health of the society and one unit improvement in corruption leads to 7.47 years increase of life expectancy. Also, corruption control affects the mortality of children under one year with the coefficient of -35.3. Economic inequity and increasing government intervention in the economy have negative impacts on health indicators. Conclusion: Considering the negative impact of corruption on health, fundamental measures for moving towards good governance are required. Moreover, with regard to the impact of economic inequity and the size of government, improving governments efficiency to achieve health goals is necessary. Keywords: Corruption, Life expectancy, Children mortality, Auto regressiv

Evaluating the Economic Efficiency of Radiology Units in General Hospital’s of Shiraz University of Medical Sciences in 2012, using Data Envelopment Analysis

Background: One of the appropriate tools in performance measurement of Radiology units is measuring the technical, allocative and economic efficiency. This factor has been analyzed in the current study for Shiraz hospitals. Methods: In this study, output data which includes radiographs (either outpatient or inpatient) and number of admitted patients in radiology departments of related hospitals; and input data which includes information regarding expert personnel, technicians and number of medical radiology equipment and finally, the variable of price that is related to radiology staff salaries and medical equipment prices; was collected. The research population and sample in this study were the general hospitals of Shiraz University of Medical Sciences and all radiology units of these hospitals, respectively. After data collection, the data was analyzed using Deap software and the different types of efficiency were calculated. Results: The findings show that the average scores of the economic efficiency were around 0.749.This value is lower than the scores of technical efficiency and allocative efficiency. About 15 percent of the radiology units have been efficient in terms of economic efficiency. Also, 21 Radiology units have had increasing returns to scale and 6 units had constant returns to scale. Conclusion: Considering that 75% of radiologoy departments have been economically inefficicent, it is necessary for authorities to consider allocating optimum resources according to the price of radiology equipment and input costs. Keywords: Radiology Unit, Economic Efficiency, Data Envelopment Analysis (DEA

Cost- effectiveness Analysis of Type 2 Diabetes Screening: A case study in Shiraz, Iran

Background: Economic evaluation includes evaluation of costs and benefits of screening. One of the economic evaluation methods is cost-effectiveness analysis. The aim of this study was cost-effectiveness analysis of type 2 diabetes screening in Shiraz, Iran. Methods: The target population of this cross-sectional study consisted of all Shiraz population over 30 years old. A total of 171067 persons old who had been referred for diabetes screening to 69 government health centers, 30 health stations of Shiraz and 10 clinics affiliated to Shiraz University of Medical Sciences were included. In this study, costs included screening, surveillance and effectiveness costs of averted disability-adjusted life years due to diabetes (DALYs). Results: The lost disability-adjusted life years due to diabetes, in the absence of screening diabetic patients was equal to 871.9327 years in research popoulation. This rate was equal to 10.3886 for diabetic retinopathy, 29.5624 for diabetic neuropathy, 0.0343 for diabetic foot and 83.8728 for diabetic nephropathy. The obtained ICER was 49111444 Rials per each DALY averted. Conclusion: The plan saved 871.9327 years of the individual lives covered by the program and according to the World Health Organization threshold this screening is costeffective. Keywords: type 2 diabetes, cost–effectiveness analysis, screening, Shira

The Survey of Quantitative Effect in Human Capital on the Economic Growth and Household Welfare in Rural and Urban Areas: A Structural Path Analysis Approach

Background: Because of the close relationship between economic growth and welfare of the societies many economists have been seeking to identify the sources of economic growth. Human capital through enhancing workforce skills and quality, increases the amount of workforce income which consequently leads to economic growth. Methods: This study is based on data from the Social Accounting Matrix of Iran in 2006 and is performed using structural path analysis. The study population is comprised of all Iran’s economic sectors and households. SIMSIP_SAM software was used to analyze the data. Results: A billion Rial increases in human capital would lead to income increases which are: 0.087 in energy, 0.083 in services, 0.082 in agriculture, 0.064 in industry sector, and 0.052 billion Rial in mining sectors. Among households' quintiles, the urban fifth quintile, with 0.15 billion Rial increase, is the most affected by human capital growth. In whole, household income showed 1.23 billion Rial increase. Conclusion: The development of human capital increases households’ quintile income almost equally. Thus these increases would prevent the increases of class differences and makes adjustments to it. Hence, increasing free provision of health and education services increase household welfare, economic growth and economic development. Keywords: human capital, economic growth, household welfare, structural path analysis, health, educatio