Identifying factors affecting destination choice of medical tourists: a systematic review of literature

Objective: Overseas travels in which improved health is the main component, “medical tourism”, has emerged as a new source of competitive advantage all over the world. The present study seeks to identify the factors that affect destination choice of medical tourists.Methods: We systematically searched relevant databases including Pub Med, Embase, Science Direct, Web of Science and Medline databases using terms “medical tourism” OR “health tourism”.Studies were identified and screened in accordance with the preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) published in English or Farsi, determining factors that develop  country’s ability to become a preferred destination for outbound patients seeking healthcare services in foreign countries.Results: The search retrieved (1374) citation of which 18 studies were eligible.Across the eligible articles, 13 overarching themes including 75 that encourage medical tourists to choose a specific destination sub-themesemerged.Conclusions: Results of this study offer evidence for a comprehensive approach to strategic outreach and market expansion for medical tourism decision makers for attracting more medical tourists to their countries.Keywords: Medical tourism, health tourism, attractive factors, destination choic

Cancer patients during and after natural and man-made disasters: A systematic review

Background: Disasters affect all social functions. In particular, hospitals must mobilize their resources for response to mass injuries. This process can affected treatment of cancer patients and may resulted in delayed care. Considering the importance of continuity of care for cancer patients, the aim of this systematic review was to identify challenges and preparedness measures for cancer patients during and after disasters. Materials and Methods: This systematic review that was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between January 2000 to December 2017. The keywords searched included: "disaster," "emergency," "crisis," "disruptive event," "technological disaster," "natural disaster," "cancer," "cancer patient," "chronic disease," "continuity of care," and "patient with chronic disease. "The Google Scholar, ISI Web of Science, Science Direct, PubMed and Scopus databases were searched. Results: After screening and review of article eligibility, seven were included in the study. The selected articles were compared from several aspects. The results showed that most publications concerned all of the chronic diseases or all types of cancers. In addition breast cancer appeared a field of interest in disaster studies. Cancer studies in disaster management usually concentrated less on technological disasters. Conclusion: In aftermath of disasters, the concentration on measures to provide services for injuries and food, water and shelter, results in many challenges for cancer patients. Thus the health system must prepare cancer patients and caregivers for better responses to disasters. In addition, surge capacity must be considered in hospitals and other medical facilities to guarantee continuity of care

Prevalence of hepatitis C virus infection among prisoners in Iran: A systematic review and meta-analysis

Background: Hepatitis C virus (HCV) is one of the major public health problems both in developed and developing countries. Prison represents a high-risk environment for prisoners, in that it is characterized by high-risk behaviors such as injecting drug use (IDU), tattooing, unprotected sexual intercourses, or sharing syringes. The aim of this study was to quantitatively evaluate the prevalence of HCV among Iranian prisoners conducting a systematic review and meta-analysis. Methods: We searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Sciences, the Cochrane library, Scopus, CINAHL, and PsycINFO as well as Iranian bibliographic thesauri (namely, Barakatns, MagIran, and SID) up to December 2017. The Newcastle Ottawa Scale (NOS) was used to assess the quality of the studies included. HCV prevalence rate with its 95 confidence interval (CI) was estimated using the DerSimonian-Laird random-effects model, with Freeman-Tukey double arcsine transformation. Egger's regression test was used to evaluate publication bias. Results: Finally, 17 articles were selected based on inclusion and exclusion criteria. Overall, 18,693 prisoners were tested. Based on the random-effects model, the prevalence of HCV among Iranian prisoners was 28 (CI 95 21-36) with heterogeneity of I 2 = 99.3 (p = 0.00). All studies used an ELISA test for the evaluation of HCV antibodies. The findings of this study showed that the highest prevalence rate (53) was among prisoners who inject drugs. Conclusion: The findings of our study showed that the prevalence of HCV among Iranian prisoners is dramatically high. Managing this issue in Iran's prisons requires careful attention to the availability of health facilities and instruments, such as screening, and harm reduction policies, such as giving sterile syringes and needles to prisoners. An integrated program of training for prisoners, prison personnel and medical staff is also needed to improve the level of health condition in prisons. © 2018 The Author(s)

The hepatitis C infection in Iran: A policy analysis of agenda-setting using Kingdon's multiple streams framework

Background: Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran. Methods: A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon's multiple streams framework was used to guide data analysis. Results: The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support. Conclusion: The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers. © 2019 The Author(s)

Proposing a model of �hospital value-based purchasing� in selected teaching hospitals in isfahan, Iran: 2015 - 2016

Background: Recently, HVBP has been a tool for improving the quality of healthcare services and managing costs. This study was conducted to identify and propose an appropriate model of HVBP in the general selected teaching hospitals in Isfahan, Iran. Objectives: The purpose of this study was to propose an Iranian model of HVBP in the selected teaching hospitals in Isfahan, Iran, 2015 - 16. Methods: This study was a theoretical and qualitative study. It was cross-sectional and prospective in terms of time, direction, and trend. The sample was determined purposefully in Delphi methods. Three types of Delphi methods were conducted including: theory, policy, and implementation Delphi. The sample size in Delphi methods respectively included 9, 13, and 21 that were selected in type of experts sampling and cascading in 2015 - 16. Inclusion and exclusion criteria were designated to select sample in all three types of Delphi methods. Results: According to the results of the study, the proposed Iranian model of HVBP had seven dimensions including structure, process, outcome, patient experience, quality of clinical care, sensitivity of care team, and efficiency with the weight percentages of 5, 5, 25, 20, 15, 15, and 15, respectively. Each of the dimensions had 5, 6, 5, 7, 5, 4, and 1 components/component, respectively. Conclusions: This study identified and proposed a model of HVBP in the Isfahan selected general teaching hospitals. The practical application of the findings was to determine the dimensions and components of HVBP in Isfahan general teaching hospitals. According to the findings of this study, it is suggested that a series of related research be conducted to complete the identification process of HVBP in Iran in other types of hospital settings. © 2017, Iranian Red Crescent Medical Journal

Proposing a model of �hospital value-based purchasing� in selected teaching hospitals in isfahan, Iran: 2015 - 2016

Background: Recently, HVBP has been a tool for improving the quality of healthcare services and managing costs. This study was conducted to identify and propose an appropriate model of HVBP in the general selected teaching hospitals in Isfahan, Iran. Objectives: The purpose of this study was to propose an Iranian model of HVBP in the selected teaching hospitals in Isfahan, Iran, 2015 - 16. Methods: This study was a theoretical and qualitative study. It was cross-sectional and prospective in terms of time, direction, and trend. The sample was determined purposefully in Delphi methods. Three types of Delphi methods were conducted including: theory, policy, and implementation Delphi. The sample size in Delphi methods respectively included 9, 13, and 21 that were selected in type of experts sampling and cascading in 2015 - 16. Inclusion and exclusion criteria were designated to select sample in all three types of Delphi methods. Results: According to the results of the study, the proposed Iranian model of HVBP had seven dimensions including structure, process, outcome, patient experience, quality of clinical care, sensitivity of care team, and efficiency with the weight percentages of 5, 5, 25, 20, 15, 15, and 15, respectively. Each of the dimensions had 5, 6, 5, 7, 5, 4, and 1 components/component, respectively. Conclusions: This study identified and proposed a model of HVBP in the Isfahan selected general teaching hospitals. The practical application of the findings was to determine the dimensions and components of HVBP in Isfahan general teaching hospitals. According to the findings of this study, it is suggested that a series of related research be conducted to complete the identification process of HVBP in Iran in other types of hospital settings. © 2017, Iranian Red Crescent Medical Journal

Prevalence of hepatitis C virus infection among prisoners in Iran: A systematic review and meta-analysis

Background: Hepatitis C virus (HCV) is one of the major public health problems both in developed and developing countries. Prison represents a high-risk environment for prisoners, in that it is characterized by high-risk behaviors such as injecting drug use (IDU), tattooing, unprotected sexual intercourses, or sharing syringes. The aim of this study was to quantitatively evaluate the prevalence of HCV among Iranian prisoners conducting a systematic review and meta-analysis. Methods: We searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Sciences, the Cochrane library, Scopus, CINAHL, and PsycINFO as well as Iranian bibliographic thesauri (namely, Barakatns, MagIran, and SID) up to December 2017. The Newcastle Ottawa Scale (NOS) was used to assess the quality of the studies included. HCV prevalence rate with its 95 confidence interval (CI) was estimated using the DerSimonian-Laird random-effects model, with Freeman-Tukey double arcsine transformation. Egger's regression test was used to evaluate publication bias. Results: Finally, 17 articles were selected based on inclusion and exclusion criteria. Overall, 18,693 prisoners were tested. Based on the random-effects model, the prevalence of HCV among Iranian prisoners was 28 (CI 95 21-36) with heterogeneity of I 2 = 99.3 (p = 0.00). All studies used an ELISA test for the evaluation of HCV antibodies. The findings of this study showed that the highest prevalence rate (53) was among prisoners who inject drugs. Conclusion: The findings of our study showed that the prevalence of HCV among Iranian prisoners is dramatically high. Managing this issue in Iran's prisons requires careful attention to the availability of health facilities and instruments, such as screening, and harm reduction policies, such as giving sterile syringes and needles to prisoners. An integrated program of training for prisoners, prison personnel and medical staff is also needed to improve the level of health condition in prisons. © 2018 The Author(s)

Public hospital facilities development using build-operate-transfer approach: Policy consideration for developing countries

Background: Advantages and limitations of build-operate-transfer (BOT) contracts in various forms of public-private partnership (PPP) arrangements have not been studied. Objectives: This study is the first of its kind to determine the framework, advantages, and limitations of BOT contracts for health care projects in selected countries. Methods: A comparative design was employed to identify factors affecting the development of medical facilities through the adoption of PPPs and the implementation of BOT contracts. England, Spain, Australia, Turkey, and Canada were selected, and data were gathered through well-known databases for the relevant studies. Electronic databases were searched using the keyword terms, �build-operate-transfer,� �public-private partnerships,� �health sector/health system,� �health care facilities,� �Spain,� �Canada,� �England or United Kingdom,� �Turkey,� and �Australia.� Results: The findings revealed that while there was insufficient information transparency for adoption of the BOT contract model in developing medical facilities and building new hospitals, some similarities were observed in its adoption in public fields. Adoption of the BOT contract model has been proven feasible in the selected countries for the health sector, in particular, for the development of new hospitals. These contracts are usually long-term in nature to provide the private sector with the chance to appropriately exploit the field. Different countries utilize this model to meet public regional and long-term health care needs, where the goal is not just a matter of seeking the private sector�s contribution. Conclusions: This study suggests that more information transparency is required for these types of contracts. Factors such as the term of the contract, the maintenance of the facilities built and their post-completion ownership status, facilities and credits offered to the private sector during the construction and operation phases, and the provision of financial and non-financial incentives to the private sector require deeper examination and should also be adjusted to the local contexts of the developing country. © 2016, Iranian Red Crescent Medical Journal

The role of insurance providers in supporting treatment and management of hepatitis C patients

Today, one of the most important global public health challenges is represented by hepatitis C virus (HCV), which imposes relevant costs. Globally speaking, the median cost of HCV-related complications ranges from 280 for an uncomplicated hepatitis to 139,070 for a liver transplantation. There are effective therapies for HCV patients worldwide, which has increased the hope of improving the process of managing and curing these patients. The adherence of patients to the pharmacological treatment and the use of effective drugs in the management of HCV disease are of crucial importance for health policy- and decision-makers. Studies show that, globally, insurance coverage for patients with HCV is not adequate in that still many patients are not covered by insurance programs. This issue as well as the economic conditions of countries are very serious challenges for ensuring an effective treatment. The most important and greatest help currently available to ensure HCV treatment is to implement plans to reduce costs and support patients. Some studies have shown that the expansion of coverage by private payers seems able to generate positive spillover benefits to public insures. Insurers, in addition to maintaining and increasing their own interests, are trying to increase their social status as a sponsor of patients. In conclusion, HCV disease requires serious policies and affordable insurance coverage. © 2019 The Author(s)

The hepatitis C virus in Iran: Health policy, historical, ethical issues and future challenges

Background. Hepatitis C infection (HCV) can have a harmful effect on the health of people and can impose relevant healthcare costs. The World Health Organization has identified the elimination of Hepatitis C by 2030 as an important goal for all countries. This study aimed to identify the HCV-related policies in Iran. Methods. A qualitative approach was used for this study. Data was collected through a comprehensive search of documents and interviews with different stakeholders related to the HCV program. Data was analyzed and validated using content analysis based on the policy triangle framework. Results. Our findings highlighted that certain social and cultural issues related to stigma can impact on awareness-raising processes. It is also necessary to consider HCV directly in the context of government policies. All relevant stakeholders should be included. Continued talks and interactions need to be made between them for the active participation of all actors. Conclusion. The findings of this study can provide useful information for improving, supporting and developing policy processes. Healthcare providers should address all aspects of the disease by 2030 in order to achieve the goal of HCV elimination. Evidencebased planning, support for up-to-date policies and resource mobilization are needed to achieve this ambitious goal. © 2019 Copyright by Pacini Editore Srl, Pisa, Italy