Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey.

BACKGROUND: Households exposure to catastrophic health expenditure is a valuable measure to monitor financial protection in health sector payments. The present study had two aims: first, to estimate the prevalence and intensity of catastrophic health expenditures (CHE) in Iran. Second, to investigate main factors that influence the probability of CHE. METHODS: CHE is defined as an occasion in which a household's out-of-pocket (OOP) spending exceeds 40% of the total income that remains after subtraction of living expenses. This study used the data from eight national repeated cross-sectional surveys on households' income and expenditure. The proportion of households facing CHE, as a prevalence measure, was estimated for rural and urban areas. The intensity of CHE was also calculated using overshoot and mean positive overshoot (MPO) measures. The factors affecting the CHE were also analyzed using logistic random effects regression model. We also used ArcMap 10.1 to display visually disparities across the country. RESULTS: An increasing number of Iranians has been subject to catastrophic health care costs over the study period in both rural and urban areas (CHE = 2.57% in 2008 and 3.25% in 2015). In the same period, the overshoot of CHE and the mean positive overshoot ranged from 0.26% to 0.65% and from 12.26% to 20.86%, respectively. The average absolute monetary value of OOP spending per month has been low in rural areas over the years, but the prevalence of CHE has been higher than urban areas. Generally put, rural settlement, higher income, receiving inpatient and outpatient services, and existence of elderly people in the household led to increase in CHE prevalence (p < 0.05). Interestingly, provinces with more limited geographical and cultural accessibility had the lowest CHE. CONCLUSIONS: According to the findings, Iran's healthcare system has failed to realize the aim of five-year national development plan regarding CHE prevalence (1% CHE prevalence according to the plan). Therefore, revision of financial health care protection policies focusing on pre-payments seems mandatory. For instance, these policies should extend the interventions that target low-income populations particularly in rural areas, provide more coverage for catastrophic medical services in basic benefit packages, and develop supplementary health insurance

Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

Background: Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. Methods: This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. Results: The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. Conclusion: The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin’s change theory and the model presented in this paper underpins the change management in any organization

Evaluation of the Client Patients Waiting Time in Referral Restorative Dentistry Department of Dental Clinic Using Six Sigma Model

Introduction: Waiting time is one of the factors affecting patients' satisfaction with the quality of services, therefore, reducing the waiting time has an essential role in the improvement of services and clients' satisfaction. The present study was performed to study the client patients waiting time in referral restorative dentistry department of dental clinic using Six Sigma model. Method: In this descriptive study, 300 patients who referred to the restorative dentistry department of dental clinic, were included. Finally, 30 subjects were selected using random sampling method. Data were collected by waiting time measurement forms and researcher-made checklists. To determine the process quality, six sigma model was used. Finally, data were analyzed using SPSS version 16. Results: The highest mean waiting time belonged to the oral diseases department (mean=31 min) and the lowest one belonged to the examination unit of restorative dentistry department (mean=15 min). The most important factors extending the waiting time were simultaneous entrance of patients (mean=4.6 min), lack of medical students' skill and experience (mean=4.2 min), lack of employees and integration of reception unit with cash desk (mean=4 min), respectively. Conclusion: Therefore, by analyzing reception process, appropriate management, and using Six Sigma model, waiting time will reduce, clients' satisfaction will increase, and the quality of services will improve

Evaluating the Program of Bachelor Degree in Health Services Management at Kerman University of Medical Sciences, Iran, Using the CIPP Model (Context, Input, Process, Product)

Background & Objective: Evaluation is necessary to ensure the quality of education in any educational system. Any educational program needs to be evaluated critically before any modification and revision. This study was conducted to evaluate the program of Bachelor Degree in Health Services Management at Kerman University of Medical Sciences, Iran, by applying the CIPP model of evaluation (Context, Input, Process, Product). Methods: In this cross-sectional descriptive study, 10 faculty members, 64 students and 90 alumni participated. Three valid and reliable questionnaires were completed regarding four dimensions and nine domains of CIPP model. In order to analyze the data, Man-Whitney, Pearson correlation and descriptive statistic tests were applied. Results: The whole scores for the context, input, process and product were 2.34, 2.97, 3.68 and 2.55, respectively. Faculty members significantly gave a higher total score for context in comparison to alumni (P < 0.05); nevertheless, there was not any significant difference between these both groups regarding the product total score. In addition, there was not any significant difference between faculty members and students in input and process scores. A significant correlation was observed for different dimensions of the CIIP model (P < 0.05). Totally, health care management program was evaluated as a partially accepted program. Conclusion: CIPP evaluation model can show the advantages and disadvantages of an educational program; therefore, decision and policy makers can come to a point whether to stop, review or continue a program. Keywords Evaluation CIPP model (Context Input Process Product) Health services management Kerman Ira

Provincial health accounts in Kerman, Iran: an evidence of a “mixed” healthcare financing system

Background: Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province. Methods: The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General’s office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province. Results: During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services. Conclusion: The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By emphasizing on Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare s e c tor

Clinical Risk Factors of Need for Intensive Care Unit Admission of COVID-19 Patients; a Cross-sectional Study

Introduction: It could be beneficial to accelerate the hospitalization of patients with the identified clinical risk factors of intensive care unit (ICU) admission, in order to control and reduce COVID-19-related mortality. This study aimed to determine the clinical risk factors associated with ICU hospitalization of COVID-19 patients. Methods: The current research was a cross-sectional study. The study recruited 7182 patients who had positive PCR tests between February 23, 2020, and September 7, 2021 and were admitted to Afzalipour Hospital in Kerman, Iran, for at least 24 hours. Their demographic characteristics, underlying diseases, and clinical parameters were collected. In order to analyze the relationship between the studied variables and ICU admission, multiple logistic regression model, classification tree, and support vector machine were used.  Results: It was found that 14.7 percent (1056 patients) of the study participants were admitted to ICU. The patients’ average age was 51.25±21 years, and 52.8% of them were male. In the study, some factors such as decreasing oxygen saturation level (OR=0.954, 95%CI: 0.944-0.964), age (OR=1.007, 95%CI: 1.004-1.011), respiratory distress (OR=1.658, 95%CI: 1.410-1.951), reduced level of consciousness (OR=2.487, 95%CI: 1.721-3.596), hypertension (OR=1.249, 95%CI: 1.042-1.496), chronic pulmonary disease (OR=1.250, 95%CI: 1.006-1.554), heart diseases (OR=1.250, 95%CI: 1.009-1.548), chronic kidney disease (OR=1.515, 95%CI: 1.111-2.066), cancer (OR=1.682, 95%CI: 1.130-2.505), seizures (OR=3.428, 95%CI: 1.615-7.274), and gender (OR=1.179, 95%CI: 1.028-1.352) were found to significantly affect ICU admissions. Conclusions: As evidenced by the obtained results, blood oxygen saturation level, the patient's age, and their level of consciousness are crucial for ICU admission

Cost analysis of the education of students in School of Public Health, Kerman University of Medical Sciences, Iran, using activity-based costing model

Background & Objective: Quantifying real costs in total and per student is one of the key objectives of budgeting in long-term plans for higher education sector; without any doubt, this will improve the performance of universities. However, the evidences and experiences in this regard are very limited within Iran. The purpose of this study was to estimate and analyze all costs of a school (as a model) compatible with activity-based costing in the logics of operating budgeting. Methods: Having reviewed all available relevant documents of School of Public Health, Kerman University of Medical Sciences in one academic year (2010-11), real costs were extracted and categorized. In the same time, all available facilities (classes, laboratories, library, computer rooms, and common rooms), human resources, students, and infrastructures of the school were surveyed. The cost data were grouped into five sections: training costs, research costs, administrative costs, current supportive costs, and maintenance/development costs. Results: The total cost of School of Public Health was 24, 726 million Iranian Rial (IRR) consisted of 18,850 IRR for teaching costs, 1,894 IRR for research costs, 2,519 IRR for administrative costs and 1,463 IRR for maintenance and current costs. The total per student cost was 31.11 IRR. The total per postgraduate student cost was 2.5 times more than of undergraduate students. Conclusion: A main part of the costs, particularly salaries, is out of hand of direct managers of the school. These costs are usually hidden, and are not presented in costs at the school level. It seems that fixed salary of academic staff inflated human costs, while it is suggested that with a better educational management, the system could increase their responsibilities, and improve their productivities. Our computation, as a model, may help medical universities around the country to create a clear picture of their costs in line with the rules of operating budgeting. Keywords Cost per student educational costs operating budget economics of education educational plannin

Evaluation of Education Development Centers for Medical Sciences: Challenges and Strategies

Background & Objective: The main objective of medical education is the training of competent and qualified personnel to maintain and improve public health. In this regard, education development centers (EDC) for medical sciences have been established to provide and assess the quality of education. Therefore, due to the need for these centers, this study aimed to examine their challenges and provide strategies to improve their performance. Methods: An applied and qualitative study was carried out in 2013. The study population was 288 members of the managers and personnel of study centers and development offices of faculties, educational deputies, heads of universities, and faculty members. Data was collected during a 2-day scheduled conference in the form of 5 key lectures, 3 panels, and 6 Focus Group Discussions. Data analysis was performed using framework analysis. Results: In the correct establishment of the centers, 7 key challenges and 18 sub-challenges were identified. Within the framework of the educational governance and leadership, components such as policy making, monitoring, evaluation, and predisposing components of implementation like structure, manpower, and processes were identified. The relationship between policy making, evaluation, and sub-components is defined by two key factors of knowledge management and communications. Conclusion: EDC centers have been challenged because of moving away from the original position of knowledge management and communications in the field of governance to ensure and improve the quality of education. The 3 trends of integration of education and service delivery, privatization of services, and lack of clarity of interactions between public and private sector have exacerbated these challenges. Keywords Governance and educational leadership Quality of education Education development centers for medical science

Identifying the Challenges of Kerman University of Medical Sciences, Iran, in Achieving the Goals of Iran’s Health Scientific Road Map and Providing Strategies

Background & Objective: After preparing the health scientific road map, universities of medical sciences should play their role in this regard. This study aimed to identify the main challenges of Kerman University of Medical Sciences, Iran, in achieving the goals of the health scientific road map. Methods: This study was conducted as a qualitative study. The study population consisted of KMU`s top managers and experts. Purposeful and snowball sampling methods were used. 25 interviews were conducted in 2012. Using a semi-structured interview, the challenges of Kerman University of Medical Sciences in achieving the goals of health scientific road map were investigated. A framework method was applied for the data analysis. Results: At the end of this qualitative study, 10 basic concepts consisting of policy making and management, financing and facilitating processes, development and promotion of human resources, development and promotion of education, research, dissemination of knowledge, entrepreneurship, services provision, culture and norms, and facilitating communication, and 46 subgroups of challenges were identified. Conclusion: Given the importance of achieving the goals of health scientific road map and the importance of medical sciences universities in this regard, Kerman University of Medical sciences must develop a comprehensive plan to reduce the challenges. Keywords Health scientific road map Kerman University of Medical Sciences Iran Innovation syste

The Projection of Burden of Disease in Islamic Republic of Iran to 2025

Objective: Iran as a developing country is in the transition phase, which might have a big impact on the Burden of Disease and Injury (BOD). This study aims to estimate Burden of Disease and Injury (BOD) in Iran up to 2025 due to four broad cause groups using Disability-Adjusted Life Year (DALY). Methods: The impacts of demographic and epidemiological changes on BOD (DemBOD and EpiBOD) were assessed separately. We estimated DemBOD in nine scenarios, using different projections for life expectancy and total fertility rate. EpiBOD was modeled in two scenarios as a proportion of DemBOD, based on the extracted parameters from an international study. Findings: The BOD is projected to increase from 14.3 million in 2003 to 19.4 million in 2025 (95% uncertainty interval: 16.8, 21.9), which shows an overall increase of 35.3%. Non-communicable diseases (12.7 million DALY, 66.0%), injuries (4.6 million DALY, 24.0%), and communicable diseases, except HIV/AIDS (1.8 million DALY, 9%) will be the leading causes of losing healthy life. Under the most likely scenario, the maximum increase in disease burden due to DemBOD is projected to be observed in HIV/AIDS and Non-communicable diseases (63.9 and 62.4%, respectively) and due to EpiBOD in HIV/AIDS (319.5%). Conclusion: It seems that in the following decades, BOD will have a sharp increase in Iran, mainly due to DemBOD. It seems that communicable diseases (except HIV/AIDS) will have less contribution, and especially non-communicable diseases will play a more significant role