Technical efficiency and resources allocation in university hospitals in Tehran, 2009-2012

Background: Assessment of hospitals' performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran. Methods: This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier 4,1 software. Results: According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389. Conclusion: This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved

Patient safety culture in hospitals of Iran: A systematic review and meta-analysis

Background: Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method. Methods: Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed. Results: The overall PSC score based on the random model was 50.1. "Teamwork within hospital units" dimension received the highest score of PSC (67.4) and "Non-punitive response to error" the lowest score (32.4). About 41 of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately 52.7 of participants did not report any adverse event in the past 12 months. Conclusion: The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action

Inequity in household's capacity to pay and health payments in Tehran-Iran-2013

Background: Health inequality monitoring especially in Health care financing field is very important. Hence, this study tends to assess the inequality in household's capacity to pay and out-ofpocket health carepaymentsin Tehran metropolis. Methods: This cross-sectional study was performed in 2013.Thestudy population was selected by stratified cluster sampling, and they constitute the typical households living in Tehran (2200 households). The required data were collected through questionnaires and analyzed using Excel and Stata v.11. Concentration Index on inequality was used for measuring inequality status in capacity to pay and household payments for health care expenses; and also the concentration index for out-of-pocket payments and capacity to pay was used to determine the extent of inequality. The recall period for inpatient care was one year and 1 month for outpatient. Results: The average of out-of-pocket payments for receiving the outpatient services was determined to be 44.33US and for each inpatient1861.11 US. Concentration index for household's outof- pocket payments for inpatient health care, out-of-pocket payments for outpatient health care and health prepayments were calculated 0.13, -0.10 and -0.11, respectively. Also, concentration index in household's capacity to pay was estimated to be 0.11whichindicatedinequality to the benefit of the rich. The households used financing strategies like savings, borrowing or lending to pay their health care expenditures. Conclusion: According to this study, the poor spend a greater portion of their capacity to pay for outpatient and inpatient health care costs and prepayment, in comparison to the rich. Thus, supporting the vulnerable groups of the society to decrease out-of-pocket payments and increasing the household's capacity to pay through government support in order to improve the household economic potential, must be considered very important

A Cost-Minimization Analysis of Day-Care Versus in-Patient Surgery for Five Most Common General Surgical Procedures

Objective: This study aimed to compare costs of Day-care versus in-patient surgery for five most common general surgical proce-dures in a general hospital in Iran. Methods: In this retrospective study the records of all patients who underwent five most common general surgical operations (in-cluding Hernia, Hemorrhoid, Fistula, Pilonidal Sinus and Varicocele) between March 2011 and March 2013 were reviewed. The data about costs of these procedures was collected by a checklist, designed by the authors, one year before and one year after establishing the Day-Care ward in the hospital. The checklist was designed on the basis of 14 financial items related to surgical patients. All costs were measured from the provider's perspective. Results: The results of this study showed that after implementing day-care surgery ward, inpatient care costs, such as medi-cine/drugs, physician visits, medical consumable, personnel and hotel, reduced significantly per each procedure. However, the costs directly associated with each surgery, such as drugs and consumable, surgeon's wage and anesthesia costs, between these two periods was not significantly different. The highest amount of savings was related to the personnel costs, with 997,000 IRR reductions. On average, total cost of each procedure was reduced by 2,031,358 IRR after implementation of day-care ward. Conclusion: The findings from this study demonstrate that day-care surgery is a cost saving method compared to in-patient surgery for five most common general surgical procedures. It is recommended that hospital managers consider establishing day-care ward and conducting surgical procedures, in particular elective general surgical procedures, in this regimen, to decrease hospital costs and to make hospital beds free, for other patients who are more in need of specialized medical and nursing skills

Measuring equity in household's health care payments (Tehran-Iran 2013): Technical points for health policy decision makers

Background: Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013. Methods: This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month. Results: The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system. Conclusion: According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health

Prevalence, etiology, and types of dental trauma in children and adolescents: Systematic review and meta-analysis

Background: Dental traumas are common among children and adolescents in many societies posing health and social problems. The aim of this study was to conduct a systematic review and metaanalysis on prevalence, etiology, types, and other epidemiologic aspects of dental trauma in children and adolescents (0-18 years old). Methods: In this systematic meta-analytical review, data were collected searching for key words including traumatic dental injuries, dental trauma, dental injury, dental trauma, tooth injuries, tooth trauma, traumatized teeth, dentoalveolar trauma, oral trauma, epidemiology, etiology, prevalence, incidence, occurrence, child*, and adolescence in the following databases: Scopus, CINAHL, Science Direct, PubMed and Google scholar. Results: From the total of 3197 articles, 44 completely relevant papers were included in the study. The prevalence of dental trauma was variable based on geographical area and was estimated 17.5 in the population, with higher prevalence in boys. Falling was the major cause for dental trauma, and the most frequent location was home. The most frequent type of trauma was enamel fracture. Conclusion: A relatively high prevalence was detected for dental trauma, which calls for effective planning and intervention to prevent the occurrence in children and adolescents. These may include special care for children, eliminating fall-prone areas, installing safety measures at homes, using protective appliances in sports, education, and raising the knowledge and availability of services to address enamel fracture. Region-specific criteria should be taken into account in programs and interventions

Estimating the odd-ratio of factors affecting households' exposure to catastrophic and impoverishing health expenditures

Aims: The main object of this study was to estimate the odd-ratio of factors affecting families' exposure to catastrophic and impoverishing health expenditures. Methods: This research was a cross-section study with a clustered sampling method. The sampling units were Tehran's households who had lived in Tehran for at least one year before the data collection. The data gathering tool was the WHO questioner. The Logistic model and the stata13 software were used for estimating the odd-ratio of the factors determining households' exposure to catastrophic and impoverishing health expenditures. Results: According to the results of this study, the presence of a family member older than 60, using inpatient services and informal payments increase the probability of catastrophic expenditures. This is while insurance coverages reduces this issue. Conclusion: According to the obtained results, extending the insurance coverage and the prepayment mechanism, preparing low cost inpatient services by the extension of prepayments, codifying health care packages under the commitment of insurance agencies, reforming the payment systems and monitoring tariffs can prevent households from falling under the poverty line. This means that it can help families to overcome their poverty in order to have better lives