Equity of health care financing in Iran

This study presents the rst analyses of the equity of health care financing in Iran. Kakwani Progressivity Indices (KPIs) and concentration indices (CIs) are estimated using ten national household expenditure surveys, which were conducted in Iran from 1995/96 to 2004/05. The indices are used to analyze the progressivity of two sources of health care financing: health insurance premium payments and consumer co-payments (and the sum of these), for Iran as a whole, and for rural and urban areas of Iran, separately. The results suggest that health insurance premium payments became more progressive over the study period; however the KPIs for consumer co-payments suggest that these are still mildly regressive or slightly progressive, depending upon whether household income or expenditure data are used to generate the indices. Interestingly, the Urban Inpatient Insurance Scheme (UIIS), which was introduced by the Iranian government in 2000 to extend insurance to uninsured urban dwellers, appears to have had a regressive impact on health care nancing, which is contrary to expectations. This result sounds a cautionary note about the potential for public programs to crowd out private sector, charitable activity, which was prevalent in Iran prior to the introduction of the UIIS.Equity, Health care nancing, Kakwani progressivity index, Iran

MobileDenseNet: A new approach to object detection on mobile devices

Object detection problem solving has developed greatly within the past few years. There is a need for lighter models in instances where hardware limitations exist, as well as a demand for models to be tailored to mobile devices. In this article, we will assess the methods used when creating algorithms that address these issues. The main goal of this article is to increase accuracy in state-of-the-art algorithms while maintaining speed and real-time efficiency. The most significant issues in one-stage object detection pertains to small objects and inaccurate localization. As a solution, we created a new network by the name of MobileDenseNet suitable for embedded systems. We also developed a light neck FCPNLite for mobile devices that will aid with the detection of small objects. Our research revealed that very few papers cited necks in embedded systems. What differentiates our network from others is our use of concatenation features. A small yet significant change to the head of the network amplified accuracy without increasing speed or limiting parameters. In short, our focus on the challenging CoCo and Pascal VOC datasets were 24.8 and 76.8 in percentage terms respectively - a rate higher than that recorded by other state-of-the-art systems thus far. Our network is able to increase accuracy while maintaining real-time efficiency on mobile devices. We calculated operational speed on Pixel 3 (Snapdragon 845) to 22.8 fps. The source code of this research is available on https://github.com/hajizadeh/MobileDenseNet

User fee removal for the poor:a qualitative study to explore policies for social health assistance in Iran

INTRODUCTION: Removal of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran. METHODS: This is a qualitative study carried out in 2018. The purposive sampling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software. RESULTS: The most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms. CONCLUSION: Implementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization

Universal Pharmacare in Canada: A Prescription for Equity in Healthcare

Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada

Globalization and Middle East: A glance to the globalization process

Globalization is compressing the world and increasing this knowledge that the world is a whole. This process challenges the government to the different and modern ways especially the governments facing many problems with the population. Globalization increases the national, tribalism and citizenship awareness so people dispute with the government to attend their rights. This action especially in the Middle East where many of the government still are trying to keep country-government model is seen. This article studies the globalization process and the problems of the Middle East

Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017

Background Maternal mortality has remained a challenge in many low income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017. Methods The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services. Results The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. Conclusion We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups

The role of protein kinase C in ischemic tolerance induced by hyperoxia in rats with stroke

Recent studies suggest that normobaric hyperoxia (HO) protects the rat brain from ischemia reperfusion (IR) injury. Protein kinase C (PKC) is a key signaling molecule involved in protection against IR injury but its role in protective effect of HO in brain injury in unknown. In this study we attempted to see if PKC is involved in the effect of HO. Rats were divided into four main experimental groups. The first two were exposed to 95 % oxygen (HO) in a chamber 4 h/day for 6 consecutive days. Each of these groups had a control group exposed to 21 % oxygen. To investigate the role of PKC during HO, chelerythrin chloride (CHEL, 1 mg/kg/day), a PKC inhibitor, or its vehicle was given to animals for 6 days. After 24 h, the rats were subjected to 60 min of right middle cerebral artery occlusion (MCAO). After 24 h reperfusion neurological deficit scores, infarct volume, brain edema and blood–brain Barrier (BBB) permeability were assessed. HO decreased the infarct volume and brain edema in comparison with controls. PKC inhibition was associated with a significant increase in infarct size in both HO and control animals. PKC inhibition was unable to change brain edema in the experimental groups. Both HO and PKC inhibition reduced the BBB permeability within 24 h post occlusion of middle cerebral artery. Although both HO and PKC inhibition were associated with inhibition of BBB permeability during ischemic brain injury in rats, the neuroprotective effect of HO was independent of PKC in the MCAO model