Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households / 예방의학회지

Objectives@#Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. @*Methods@#This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. @*Results@#Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. @*Conclusions@#In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

effect of social and economic factors on maternal mortality in provinces of Iran within 2009-2013

Background: The mothers' role in health of family members is very important, and her death has uncompensable losses for the family and society. With regard to the importance of maternal mortal ratio in development indicators of the United Nations [UN] this study is conducted to investigate the impact of socioeconomic factors on maternal mortality ratio

Methods: In the current study the role of socioeconomic factors on maternal mortal ratio was investigated by panel regression. Data include number of maternal mortality, total fertility, number of hospital beds, number of midwifes, number of physicians and urbanization in the period between 2008 and 2012. Since the dependent variable was in count form, Poisson estimator, Hausman test, and Breusch-pagan test were used

Results: Based on the findings, household's income and fertility rate had direct and inverse association with maternal mortality, respectively. Investigating the association between midwifes and maternal mortality showed that increasing the number of midwifes decrease it, but no significant association was found between the number of physicians and maternal mortality. Number of hospital beds also showed a direct association [significant at 10%]

Conclusion: All of the variables to somehow are related with the level of development. In developed regions, per capita income, access to health resource and urbanization is higher and there is more equity in distribution of health resources. It could be concluded from the findings that by increasing the level of development, maternal mortality would decrease

Health production and determinants of health systems performance in WHO Eastern Mediterranean Region

This descriptive-analytical study used data envelopment analysis to evaluated the technical efficiency [TE] of health systems in Member States of the World Health Organization Eastern Mediterranean Region during 2004-2011. Life expectancy and infant mortality were used as outputs. Per capita total expenditure on health, and number of physicians, nurses and midwives and hospital beds per 1000 people were used as inputs. The determinants of TE of the health systems were examined using a regression model. United Arab Emirates and Somalia had the most efficient health systems with a TE score of 1. Djibouti and Libya had the most inefficient health systems, with TE scores of 0.346 and 0.435, respectively. The most important determinants of TE were the level of education and gross domestic product per capita. The relationship between unemployment and out-of-pocket health expenditure was not significantly associated with TE of the health systems. To improve TE of the health systems, countries should focus on individuals' empowerment in education and income level, rather than only on providing healthcare services

[ study of consumption pattern and hospitalization costs of elderly covered by Iran health insurance organization]

Introduction: Health policymakers faced with new challenges such as increasing elderly population. This study aimed to investigate the consumption pattern and hospitalization costs of the elderly covered by Iran Health Insurance Organization in teaching hospitals of Sanandaj, Iran

Method: In this descriptive-analytical as a cross sectional one, the samples included 5753 elderly covered by Iran Health Insurance Organization who used hospitalization services in three teaching hospitals of Sanandaj in 2013. Using Chi square and t-test, data analysis was performed

Results: The frequency of elderly hospitalizations was 6703 cases. Mean of hospitalization rate was 1.04 times in men and 1.36 times in women. The elderly hospitalization costs were about 27.8% of the total hospitalization costs. The costs of hospitalization services were statistically different between elderly and non-elderly patients except the rehabilitation services. Although there was statistically significant relationship between the age of elders and their length of stay but no statistically significant relationship between elderly's age and their hospitalization costs was reported. In addition, no significant difference between the mean costs of each hospitalization in men and women was reported

Conclusion: It was concluded that the hospitalization costs are higher in elderly patients compared to the non-elderly patients, so managers and policymakers are required to have a program for funding the elderly's health services costs. Considering the evidences in aged economic area including consumption patterns and services costs seems to be necessary

Stated time preferences for health: a systematic review and meta analysis of private and social discount rates

The present study aimed to provide better insight on methodological issues related to time preference studies, and to estimate private and social discount rates, using a rigorous systematic review and meta-analysis. We searched PubMed, EMBASE and Proquest databases in June 2013. All studies had estimated private and social time preference rates for health outcomes through stated preference approach, recognized eligible for inclusion. We conducted both fixed and random effect meta-analyses using mean discount rate and standard deviation of the included studies. I-square statistics was used for testing heterogeneity of the studies. Private and social discount rates were estimated separately via Stata11 software. Out of 44 screened full texts, 8 population-based empirical studies were included in qualitative synthesis. Reported time preference rates for own health were from 0.036 to 0.07 and for social health from 0.04 to 0.2. Private and social discount rates were estimated at 0.056 [95% CI: 0.038, 0.074] and 0.066 [95% CI: 0.064, 0.068], respectively. Considering the impact of time preference on healthy behaviors and because of timing issues, individual's time preference as a key determinant of policy making should be taken into account. Direct translation of elicited discount rates to the official discount rates has been remained questionable. Decisions about the proper discount rate for health context, may need a cross-party consensus among health economists and policy makers

[Assessing the effect of educational program based on small group on promoting knowledge and health literacy among women with type2 diabetes referring to selected hospitals affiliated to Tehran University of Medical Sciences]

Health Literacy is the capacity in which individuals have to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Limited health literacy can reduce adults' ability to comprehend and adhere treatment plans. This study was designed and implemented to assess effect of health education on promoting knowledge and health literacy in women with type 2 diabetes. This randomized clinical trial study, was conducted among 160 women with type 2 diabetes, in two experimental and control groups. Tools of current study were a brief form of standard questionnaire [Short Test of Functional Health Literacy in Adults, TOFHLA] and knowledge was measured by self-administrated questionnaire. Intervention in a form of small groups, was performed in 6 educational sessions [45-60minuts] in experimental group. In order to analyzing data, SPSS16 software was used and independent t- test, Kruskal-Wallis, Whitney U, Wilcoxon, Co-Variation, Chi-square were conducted. Demographic variables of studied population in two groups was similar before intervention [p>0.05]. Differences between the scores of Knowledge and Health Literacy in two groups, after and before intervention, was totally different [after, p<0.001] and [before, p>0/05]. Study findings indicated that education with small group's strategy in experimental group, in comparison with current education is effective

Suicide and associated risk factors in Hamadan province, west of Iran, in 2008 and 2009

Hamadan is a province with high incidence rate of suicide. The present study was conducted to assess suicide and its associated risk factors in this province. In this cross-sectional study, all cases of suicide occurred in the province, were investigated from April 2008 to March 2010. The data were collected from Provincial Health Center and Forensic Medicine's databases using a checklist developed according to the available records. A number of 5414 suicide attempts had occurred [with 8.4% deaths] including 2753 women [with 3.4% death] and 2660 men [with 13.7% death]. Majority of the suicide attempts and com-pleted suicides occurred among adults aged 20-29 years. About 6.7% of the cases who attempted for suicide and 14.2% of the cases who died from suicide had a previous history of suicide attempt [P<0.001]. Familial problems [49.7%] and psychiatric disorders [31.6%] were among the most common reasons of suicide attempt. Using drugs [74.0%] were the most common method of attempting suicide while hanging [83.6%], burning [74.2%], and gunshot [52.4%] were the most common leading causes of completed suicide [P<0.001]. Adjusted odds ratio estimate of completed suicide in males against females was 2.27 [95% CI: 1.63, 3.14]. The odds of completed suicide increased 1.43 [95% CI: 1.30, 1.57] fold per 10 years of age. This survey identified and highlighted the most common and important potential risk factors for suicide. In addition, the effects of various demographic risk factors on suicide attempt and completed suicide were examined. These evidences may be useful for future research, policy, and treatment efforts aimed at understanding and preventing suicide.

Appropriateness of cesarean sections using the RAND appropriateness method criteria

The aim of this study was to identify the appropriateness of cesarean sections, performed in Tehran hospitals using standardized Rand Appropriateness Method [RAM] criteria. In this study we used the RAM criteria. In order to prepare the list of cesarean scenarios, clinical guidelines were selected, and the Appraisal of Guidelines for Research and Evaluation was used to choose the most appropriate. Two panels were held with the participation of related specialists. The scenarios derived through this method were compared with data existing in the medical records of 250 women who underwent cesarean sections in selected hospitals affiliated with Tehran University of Medical Sciences. The appropriateness rate of the cesarean sections was calculated. Out of 250 cases of cesarean sections performed, 91 [36.4%] were inappropriate, 41 [16.4%] were equivocal and 118 [47.2%] were considered to be appropriate. Appropriateness differed between public and private hospitals, which were statistically significant. This study shows that as with many other health services, cesarean section has many scenarios that there are different opinions about them and no decision about presenting these scenarios as yet. Moreover the result of study showed the rate of inappropriate cesarean sections in this study is one of the highest reported rates from different communities

Psychological consequences of abortion among the post abortion care seeking women in Tehran

Abortion either medical or criminal has distinctive physical, social, and psychological side effects. Detecting types and frequent psychological side effects of abortion among post abortion care seeking women in Tehran was the main objective of the present study. 278 women of reproductive age [15-49] interviewed as study population. Response rate was 93/8. Data collected through a questionnaire with 2 parts meeting broad socio-economic characteristics of the respondents and health- related abortion consequences. Tehran hospitals were the site of study. The results revealed that at least one-third of the respondents have experienced psychological side effects. Depression, worrying about not being able to conceive again and abnormal eating behaviors were reported as dominant psychological consequences of abortion among the respondents. Decreased self-esteem, nightmare, guilt, and regret with 43.7%, 39.5%, 37.5%, and 33.3% prevalence rates have been placed in the lower status, respectively. Psychological consequences of abortion have considerably been neglected. Several barriers made findings limited. Different types of psychological side effects, however, experienced by the study population require more intensive attention because of chronic characteristic of psychological disorders, and women's health impact on family and population health

Maintenance and safety management at diagnistic units of Gilan university of medical sciences' hospitals

Almost all hospitals have diagnostics units. These units are of great importance since they have complex and expensive equipment and experienced staff. The goal of this study was to assess diagnostic units approach to safety at GUMS hospitals in 2004. This was a descriptive cross-sectional study. Data collected with a two part checklist. The first part included demographic characteristics of the studied population and the second part was related to diagnostic unit's safety and status. Following a pilot study, reliability and validity of the checklist were determined, and final questionnaire was released. The safety level of hospitals in this study was classified according to a 3-level scale: Good/Acceptable, Intermediate, and Weak. 1]Overall Radiology unit's safety was at [Intermediate] level. In other words, five hospitals has [Intermediate] safety conditions and only one hospital could be classified as [Good]. 2] Laboratories' safety was rated [Intermediate] in general with four hospitals being at [intermediate] level and two at [good] level. 3] In general, diagnostic units' safety received [intermediate] score [i.e. five [intermediate] and one [good] level.] According to this study, overall diagnostic units' safety of GUMS hospitals seems to be [intermediate]. Thus there is a need to pay more attention to the importance of safety for patients, visitors and personnel and to develop safety standards and principles in hospitals