Determinants of Life Expectancy in Eastern Mediterranean Region: A Health Production Function

Background: Determinants of health or health production function in health economics literature constitute noticeable issues in health promotion. This study aimed at estimating a health production function for East Mediterranean Region (EMR) based on the Grossman theoretical model. Methods: This ecological study was performed using the econometric methods. The panel data model was used in order to determine the relationship between life expectancy and socioeconomic factors. The data for 21 EMR countries between 1995 and 2007 were used. Fixed-effect-model was employed to estimate the parameters based on Hausman test. Results: In estimating the health production function, factors such as income per capita (β=0.05, P<0.001), education index (β=0.07, P<0.001), food availability (β=0.01, P<0.001), level of urbanisation (β=0.10, P<0.001), and employment ratio (β=0.11, P<0.001) were specified as determinants of health status, proxied by life expectancy at birth. A notable result was the elasticity of life expectancy with respect to the employment rate and its significance level was different between males (β=0.13, P0.001). Conclusion: In order to improve the health status in EMR countries, health policymakers should focus on the factors which lie outside the healthcare system. These factors are mainly associated with economic growth and development level. Thus, the economic stabilisation policies with the aim of increasing the productivity, economic growth, and reducing unemployment play significant roles in the health status of the people of the region

Managers' Perceptions of Diversity Dimensions in Crisis Management at Shiraz Teaching Hospitals

Background & Objectives: Today, the diversity is one of the basic principles in crisis management process in the hospitals. This process requires serious attention due to its complexity and diversity. This study aimed at investigating the managers' perception about diversity dimensions of crisis management in hospitals affiliated to Shiraz University of Medical Sciences. Methods: This cross-sectional descriptive study was conducted in 10 educational hospitals of Shiraz University of Medical Sciences in 2017. A total of 40 executive, administrative, financial and accounting, and nursing directors were selected through census method and participated in the study. Data were collected using the questionnaire of diversity dimensions in crisis management and analyzed using descriptive statistics, correlation coefficient, t-test and ANOVA tests and through SPSS23 software. Results: The mean score of managers' perceptions of crisis management dimensions was 3.44. The highest and lowest levels of perceptions of managers were respectively obtained for the "inclusion and learning" dimension (Mean=3.75) and "recognition and risk management" (Mean= 3.29). There was a significant relationship between the mean scores of "mutual trust between staff and managers" and "work experience" (P = 0.04). Conclusion: Managers' perception of the "recognition and risk management" dimension was lower compared to other dimensions. Therefore, hospital managers should be more sensitive to using risk assessment results and follow a systemic attitude in their risk management plannings. Key¬words: Perception, Crisis Management, Teaching Hospital, Hospital Managers Citation: Yusefi AR, Kavosi Z, Nikmanesh P. Managers' Perceptions of Diversity Dimensions in Crisis Management at Shiraz Teaching Hospitals. Journal of Health Based Research 2017; 3(3): 227-236

A Study of the Performance of Referral System in Urban Family Physician Program in Fars Province, Iran

Introduction: The family physician referral system has been determined as a major goal to economic, social, and cultural development in the field of health in Iran. The necessity of implementing this system has been explicitly stated in high-level documents. Hence, the aim of this study was to evaluate the overall performance of the referral system in Fars Province in 2015. Methods: In this cross-sectional study, 20% of family physicians (75 doctors) were randomly selected; then, all patients of these physicians (1289 patients) in one work shift were studied. The data were collected in three parts containing the questions related to the physician and patients using data collection forms. Finally, data analysis was performed through SPSS, version16, using descriptive statistics and Chi-square test. Results: The results showed that 70.3% of the patients (906 patients) had used the referral system to visit specialists. Most of the referral forms had been completed correctly (63.6%). Most of the referrals (820 cases) were recognized as necessary (59.4%) and from the first level of referral, i.e. by the family physician (96.3%: 1241 cases). The patients aged 70 and over had the minimum self-referrals, whereas young people aged lower than 20 had the maximum selfreferrals (P=0.03). Also, more self-referrals were observed among highly educated patients (P=0.001). Conclusion: Based on the findings, the most important problems of the referral system included self-referrals, incomplete referral forms, and unnecessary referrals. Self-referral could be solved through education, establishment of an electronic referral system, and legal measures. Also, educating doctors, making an electronic referral system, and using auxiliary staff and incentive measures can reduce the incompleteness of the referral forms. To reduce the patients’ unnecessary referrals, development of referral guidelines might be very effective

The Effect of Fiscal Decentralization on Under-five Mortality in Iran: A Panel Data Analysis

Background: Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. Methods: We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. Results: According to the findings of this research, fiscal decentralization in the health sector had a negative impact on U5M. On the other hand, fiscal decentralization in provincial revenues had a positive impact on U5M. In addition, U5M had a negative association with the density of physicians, hospital beds, and provincial GDP per capita, but a positive relationship with Gini coefficient and unemployment. Conclusion: The findings of our study indicated that fiscal decentralization should be emphasized in the health sector. The results suggest the need for caution in the implementation of fiscal decentralization in provincial revenues

Prevalence and determinants of under-nutrition among children under six: a cross-sectional survey in Fars province, Iran

Background: Childhood malnutrition as a major public health problem among children in developing countries can affect physical and intellectual growth and is also considered as a main cause of child morbidity and mortality. The objective of this study was to estimate the prevalence of under-nutrition and identify determinants of malnutrition among children under 6 years of age in Fars province, Iran. Methods: This survey was conducted by house to house visit through multi-stage sampling in 30 cities of Fars province, during December 2012 to January 2013. A total of 15408 children, aged 0–6 years old, were studied for nutritional assessment in terms of underweight, stunting, and wasting. Also, socio-demographic measures were obtained from structured questionnaire. Backward stepwise logistic regression was used to relate underlying factors to the odds of under-nutrition indices. Results: The rates of stunting, underweight, and wasting were 9.53, 9.66, and 8.19%, respectively. Male children were more stunted compared to females (OR= 1.41, CI: 1.26–1.58). Also, stunting was significantly associated with lower family income (OR= 3.21, CI: 1.17–8.85) and lower maternal education (OR= 0.80, CI: 0.64–0.98). Living in urban areas, and poor water supply were identified as significant risk factors of all three types of childhood under-nutrition. Moreover, Khamse and Arab ethnic groups were more vulnerable to under-nutrition. There was a suggestion that non-access to health services were associated with wasting (OR= 1.87, CI: 1.39–2.52) and also large family size was related to underweight (OR= 1.35, CI: 1.10–1.65). Conclusion: The prevalence of under-nutrition in the study population was categorized in low levels. However, planning the public preventive strategies can help to control childhood under-nutrition according to underlying factors of malnutrition in the study population including gender, settlement area, family size, ethnicity, family income, maternal education, health services, and also safe water supply

Evaluation of Prescription Appropriateness of CT Scan for Low Back Pain in Shiraz’s Referral Trauma Hospital Using RAND Appropriateness Method

Introduction: This study aims to identify the appropriateness of CT Scan prescriptions for Lumbar Spine using the RAND Appropriateness Method in Shiraz University of Medical Sciences (SUMS). Methods: A total of 281 patients referred to the hospitals affiliated with Shiraz University of Medical Sciences were selected as sample of the study in 2016. The scenarios derived through the RAND Appropriateness Method were compared with medical records of these patients by educated physicians. Results: Out of 281 cases of lumbar spine MRI prescriptions, 57.7% were appropriate, 32.7 % were uncertain, and 9.6 % were considered to be appropriate. In addition, some related factors to appropriateness of prescriptions were identified. Conclusions: Clinical guidelines developed using RAND Appropriateness Method can be an appropriate instrument for policy makers, health care providers, and health insurance companies in order to reduce inappropriate cares and quality improvement, especially in developing countries. It is recommended that appropriateness of prescriptions will be considered as the criteria for payment and reimbursement to prescribers. In this way, inappropriate cares may be reduced

Study of patients absconding behavior in a general hospital at southern region of Iran

Background: Patients’ escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. Methods: This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011–3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. Results: The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (OR adj = 0.13), gender (OR adj = 2.15), self-employment/unemployed (OR adj = 0.47), emergency/admission (OR adj = 2.14), internal/admission (OR adj = 3.16), insurance status (OR adj = 4.49) and residence expenditure (OR adj = 1.15). Conclusion: Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital

Determinants of Life Expectancy in Eastern Mediterranean Region: A Health Production Function

Background: Determinants of health or health production function in health economics literature constitute noticeable issues in health promotion. This study aimed at estimating a health production function for East Mediterranean Region (EMR) based on the Grossman theoretical model. Methods : This ecological study was performed using the econometric methods. The panel data model was used in order to determine the relationship between life expectancy and socioeconomic factors. The data for 21 EMR countries between 1995 and 2007 were used. Fixed-effect-model was employed to estimate the parameters based on Hausman test. Results : In estimating the health production function, factors such as income per capita ( β =0.05, P <0.001), education index ( β = 0 . 0 7, P <0.001), food availability ( β =0.01, P <0.001), level of urbanisation ( β =0.10, P <0.001), and employment ratio ( β =0.11, P <0.001) were specified as determinants of health status, proxied by life expectancy at birth. A notable result was the elasticity of life expectancy with respect to the employment rate and its significance level was different between males ( β =0.13, P <0.001) and females ( β =0.08, P >0.001). Conclusion : In order to improve the health status in EMR countries, health policymakers should focus on the factors which lie outside the healthcare system. These factors are mainly associated with economic growth and development level. Thus, the economic stabilisation policies with the aim of increasing the productivity, economic growth, and reducing unemployment play significant roles in the health status of the people of the region

Service Quality in Iran’s Medical Tourism: Hospitals in Shiraz City

Introduction: Medical tourism is a main source of national income. Thus, evaluating the viewpoints of medical tourists about the quality of service provided by healthcare centers may be useful in planning to develop this industry. The present study aimed to measure the gap between medical tourists' expectations and perceptions of the quality of service offered by the hospitals in Shiraz using the SERVQUAL model. Methods: This cross-sectional study was performed on 200 medical tourists referred to hospitals in the city of Shiraz which is located in the south of Iran. The subjects were selected randomly over the first 6 months of 2013. Data collection tools were a descriptive questionnaire and an adaptation of the SERVQUAL questionnaire. Results: The results showed that the mean age of medical tourists was 49.67 and most of them were from Oman. Overall, the patients' expectations exceeded their perceptions of the provided quality of service, and all gap mean scores were negative. The largest negative gap score pertained to reliability with an overall average of -0.59, followed by responsibility, assurance, tangibility, empathy, and access to care. Conclusion: The research findings can effectively help managers identify problems with the current quality of service and improve performance so as to increase the medical tourists' satisfaction level. Also, highlighting the most important service attributes, which are highly attractive to patients, will help authorities improve their operation performance and develop innovative ideas on both strategic and tactical levels

Associated factors of birth weight outcomes in the south of Iran: A cross-sectional survey

Background: Adverse birth outcomes are serious health problems that increase morbidity and mortality in neonates. Socioeconomic inequities are linked with Low Birth Weight (LBW) and High Birth Weight (HBW); however, the associations of these factors differ in various groups. The present survey aimed to estimate the prevalence of LBW and HBW and also to determine the associated demographic and socioeconomic factors. Methods: A population-based, cross-sectional survey was conducted on 6495 children, aged 0-2 years, selected through cluster and multistage sampling methods in 30 cities of Fars province, Iran, from December 2012 to January 2013. Determinants were assessed using a questionnaires including demographic, health parameters, and socioeconomic variables. Also, birth weights were recorded from health report cards. We examined the association between probable factors related to LBW and HBW, and analyzed the data using multinomial regression model. Results: Among the study population, 636 (9.7%) were LBW and the rate of HBW was estimated to be 152 (2.3%). In multinomial regression, the odds ratio of LBW was significantly higher in girls (OR=1.38, 95%CI=1.17-1.63), and the first (OR=1.7, 95%CI=1.25-2.31) and the second born child (OR=1.4, 95%CI=1.06-2.02); this ratio was lower in families with the father as the head of the family (OR=0.31, 95%CI=0.13-0.68) or mother (OR=0.43, 95%CI=0.11-1.64), and children from low populated families (OR=0.54, 95%CI=0.42-0.68). Moreover, the lower maternal education (OR=2.52, 95%CI=1.36-4.70) was significantly associated with increased HBW; however, girls (OR=0.56, 95%CI=0.39-0.79), low populated families (OR=0.60, 95%CI=0.37-0.96), and fathers as family head (OR=0.19, 95%CI=0.05-0.71) lowered the odds of HBW. Conclusion: LBW was identified at a relatively high level. The prevention of adverse birth outcomes may be applicable by targeting demographic and social determinants like gender, birth order, family size, mother’s education, and family head as predictors of birth weight in public health interventions