Asymmetric Information in Iranian's Health Insurance Market: Testing of Adverse Selection and Moral Hazard

BACKGROUND: Asymmetric information is one of the most important issues in insurance market which occurred due to inherent characteristics of one of the agents involved in insurance contracts; hence its management requires designing appropriate policies. This phenomenon can lead to the failure of insurance market via its two consequences, namely, adverse selection and moral hazard. OBJECTIVE: This study was aimed to evaluate the status of asymmetric information in Iran's health insurance market with respect to the demand for outpatient services. MATERIALS/PATIENTS AND METHODS: This research is a cross sectional study conducted on households living in Iran. The data of the research was extracted from the information on household's budget survey collected by the Statistical Center of Iran in 2012. In this study, the Generalized Method of Moment model was used and the status of adverse selection and moral hazard was evaluated through calculating the latent health status of individuals in each insurance category. To analyze the data, Excel, Eviews and stata11 software were used. RESULTS: The estimation of parameters of the utility function of the demand for outpatient services (visit, medicine, and Para-clinical services) showed that households were more risk averse in the use of outpatient care than other goods and services. After estimating the health status of households based on their health insurance categories, the results showed that rural-insured people had the best health status and people with supplementary insurance had the worst health status. In addition, the comparison of the conditional distribution of latent health status approved the phenomenon of adverse selection in all insurance groups, with the exception of rural insurance. Moreover, calculation of the elasticity of medical expenses to reimbursement rate confirmed the existence of moral hazard phenomenon. CONCLUSIONS: Due to the existence of the phenomena of adverse selection and moral hazard in most of health insurances categories, policymakers need to adjust contracts so that to reduce these phenomena. Given the importance of financing, the presence of such problems can lead to less coverage of health insurance provided by insurers, loss of contracts with health care institutions and service providers, and lower quality of health services

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

INTRODUCTION: In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance. METHOD: In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran. RESULTS: In 2012, an overall 8.04 of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance. CONCLUSION: Since demand for supplementary medical insurance is hugely influenced by households' economic status, policy-makers in the health sector should devise measures to improve households' economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their financial ability to pay. Moreover, insurance companies should adjust their insurance policy according to clients' needs, household characteristics, and their incomes

Core competencies for health headquarters: a systematic review and meta-synthesis

BACKGROUND: The availability of human resources for the health sector is not enough requirement for addressing health needs. Instead, it is necessary to take effective steps to meet the requirements of the health care system in case the system has the necessary competencies. This study was performed to identify the competencies of health headquarters in meeting the needs of the health system. METHODS: This thematic synthesis was performed to develop a set of central themes that summarize all the topics raised in the articles reviewed in this study. The quality of the articles was assessed by the Standards for Reporting Qualitative Research. RESULTS: We included 12 articles from seven countries. Seven central themes were inductively developed from the analysis: (1) Leadership and management, (2) Analyzing, interpreting, and reporting, (3) Public health knowledge, (4) Interpersonal relationship, (5) Personality competencies, (6) Cultural and community competencies, and (7) International/Global health competencies. CONCLUSION: The findings of this review may help to address how to recruit and retain health headquarters, optimize the headquarters ability and expertise, and develop some approaches to promote their scientific, practical, and professional levels. These issues can drive the organization toward their visions, strategies, and great objectives

A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

Context: In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives: The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services personnel”? Data Sources: A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians. Study Selection: Inclusion criteria comprised studies in the English or Persian language and researcher’s access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results. Data Extraction: A “Data extraction form” was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors. Results: The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes. Conclusions: Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and delays in response times. Therefore, afterthought and resolve are more crucial than ever. Workplace violence reduction strategies and suggestions for future studies are also discussed

Network governance theory as basic pattern for promoting financial support system of the poor in Iranian health system

Background: The share of out-of-pocket payments in Iranian families has the greatest burden on the poor and lead to an impoverishment caused by catastrophic health expenditures. In order to improve access of the poor to public resources, it is necessary to create a better governance system and effective policy-making. The purpose of this study is to improve network effectiveness of the Iranian health system and to design a financial protection network for the poor, based on the network governance theory. Methods: We are using a quantitative method framework in conjunction with a Social network analysis (SNA) strategy. To draw an optimal network, we conducted interviews with experts by focusing on the arrangement and relationship among different institutions. The research sample was purposefully selected. We used UCINET software for data analysis and NetDraw software to draw networks. Results: In this article, an optimal network was proposed with the following characteristics: First, the problem of the density of relationships among several central institutions and the isolation of the other institutions have been solved. Second, in our model, the relationships have been distributed in a balanced manner among all institutions in the network. Third, the number of participants has been reduced and consensus on poor people support policies has been achieved in this optimal network. Forth, executive organizations keep their central positions and upper institutions are not at the central position, so that the power is distributed in favor of more balanced governance. However, in order to increase efficiency and to have coherent decision-making, it is necessary to establish a �core� for this optimal network. The �core� has to include the organizations with the most relationship with others. Conclusion: The result revealed that the usefulness of network analysis as a tool for proposing the effectiveness of governance. By strengthening the relationship among the main actors, an organized system of network management can be achieved. The network has to include all actors from different levels, from policy-making to implementation. The network also has to clarify the tasks from identifying the poor to covering costs. From an academic perspective, this study showed the adequacy of network analysis as a tool for policy sciences. Governance in our optimal health financial protection model follows the shared-governance pattern due to its high density, low centralization and low distance. The model of network governance can be the source of changes in the health governance system. It is a necessary structural condition to provide access to universal health coverage. © 2021, The Author(s)

Catastrophic health expenditure among Iranian rural and urban households, 2013-2014

Background: During the last two decades, the trend of out-of-pocket payments (OOP) for health services by Iranian households has been a matter of concern and it has exposed a significant proportion of them to catastrophic and impoverishing health expenditures. Objectives: The current study aimed to investigate three objectives: First, the mean of out-of-pocket payments among Iranian households for health services; second, the headcount and overshoot measures of catastrophic health expenditure; and finally the level of inequality in its distribution. Materials and Methods: This descriptive study on Iranian rural and urban households was conducted from April to June 2015. The sample sizes were 19437 rural and 18888 urban households that Iranian Statistical Centre (ISC) selected them through a three -step randomized clustered sampling. The headcount and overshoot measures for catastrophic health expenditure were calculated. Also, the concentration index was calculated in order to investigate the inequality in distribution of the mentioned measures. Results: The catastrophic health expenditure headcount ratio varied from 0.5 to 14.3 and from 0.48 to 13.27 for rural and urban households, respectively. Also, the overshoot of catastrophic health expenditure varied from 9.62 to 18.72 and from 8.8 to 17.74 for rural and urban households, respectively. Conclusions: Considering Iran�s economic condition during the last five years, the catastrophic health expenditure headcount ratio was more than 2 in Iran. © 2015, Iranian Red Crescent Medical Journal

Emergency health evaluation of affected population during disasters: Are there new approaches

Disasters are inescapable phenomena. Once they occur, reliable and objective information becomes vital in sound decision-making to respond. Emergency health evaluation of affected population can be used to gather information about the patterns of access to medical care, basic household needs, and other health needs. The objective of this review was to summarize evidence from scientific studies on the various methods of emergency health evaluation following disasters. MATERIALS AND METHODS: A comprehensive list of studies was provided in May 2017 by an extensive search using PubMed, Web of Sciences, Ovid Medline, ProQuest Research Library, and World Health Organization Library. RESULTS: Of the 1592 retrieved articles, 21 articles were included in this review. In a majority of the studies (n = 18), a questionnaire was used and an interview was conducted to collect information, but in three studies, smartphone-based methods were used. Sampling method in most of the studies was cluster sampling in Community Assessment for Public Health Emergency Response method. But in eight studies, random sampling method was used. In a majority of the studies, the demographic status of samples and in 18 studies, the condition of diseases, water, shelters, health, food, mortality rate, and existing medical services were investigated. CONCLUSIONS: Although new methods such as social media and smartphones were already investigated in some articles, but these approaches require further investigation since there is a growing need fo r new methods. © 2019 Journal of Education and Health Promotion Published by Wolters Kluwer - Medknow

A bibliometric overview of 30 years of medical sciences productivity in Iran

Objectives: The number of medical universities and their faculty members has significantly increased in Iran during the last 30 years. This development has led to the training of a large number of healthcare professionals. But, its effect on medical sciences productivity has not yet been fully analyzed. Here, we use a bibliometric analysis to assess the current status of Iranian medical sciences production in different subject areas. Methods: The bibliographic data of Iranian medical subjects during the years 1978 - 2008 were collected from the Science Citation Index Expanded database and analyzed according to publication number, different medical subject areas, citations and the annual Iranian mid-year population. Results: It was shown that Iranian scientists have established good collaboration with developed countries. The numbers of medical publications, even after normalization to the population size, and citations of these publications have significantly increased in recent years. It has also been shown that pharmacologic research constitutes the major theme in the Iranian medical research system and thus enjoys the highest rate of growth. Conclusion: Strengthening of the non-pharmacologic research infra-structure is advised for both basic and clinical departments, keeping in mind the existing successful research model of pharmacology in Iran