ABSTRACT
OBJECTIVES: The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. METHODS: This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. RESULTS: The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. CONCLUSIONS: A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.
Subject(s)
Employment , Insurance Coverage , Methods , MotivationABSTRACT
OBJECTIVES@#The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions.@*METHODS@#This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework.@*RESULTS@#The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage.@*CONCLUSIONS@#A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.
ABSTRACT
Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice [DP], i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services.
Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons.
Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age.
Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 [standard deviation 0.33] hours full-time equivalent [FTE] on health care service delivery. Specialists with DP had long service delivery time [beta = 0.427]. Female specialists [beta = 0.049] and full-time specialists [beta = 0.082] spent less time on health care service delivery. Permanent specialists had higher FTE [P < 0.001] and as the population increases, FTE increases [P < 0.05].
Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Surgeons , Hospitals , Professional PracticeABSTRACT
Background: Dual practice [DP] is performing several different jobs at the same time and has effects on healthcare services delivery.
Aims: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran.
Methods: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA [version 10.0]. Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln.
Results: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations.
Conclusions: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.
Subject(s)
Humans , Male , Female , Middle Aged , Medicine , Professional Practice , Private Practice , Public SectorABSTRACT
Objectives: There is a widespread interest in exploring healthcare providers' attitudes and perceptions about patient safety culture. This study was done to determine the reliability and validity of the Arabic version of Safety Attitude Questionnaire [SAQ] in Palestinian hospitals
Methods: This was a methodological study and the SAQ was translated into Arabic using the forward-backward translation technique. Four Ministry of Health hospitals in the Gaza Strip were randomly selected, and proportionate systematic sampling was followed to select the participants. Questionnaires were distributed to 370 physicians and nurses. Face and content validity were tested, and the content validity index was determined using the average approach. Internal consistency was assessed with Cronbach's alpha, split-half reliability, and intercorrelation between the questionnaire scales. Construct validity was assessed through exploratory and confirmatory factor analysis
Results: A total of 339 questionnaires were received, giving a response rate of 91.6%. Questionnaire acceptability was good and relevant to the study purpose. Cronbach's alpha value was 77.7 [74.7-82.2]. Goodness of fit indices from the confirmatory factor analysis showed a satisfactory model fit: comparative fit of indices [CFI = 0.797], root mean square error of approximation [RMSEA = 0.085], and standardized root square residual [SRMR = 0.074]. Factor analysis with varimax rotation revealed that six factors explained 62.3% of the variance
Conclusions: The Arabic version of SAQ [short form 2006] is valid and reliable, and shows a satisfactory model of fit. This instrument shows promise to be a sound tool to assess the safety culture in Palestinian hospitals
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OBJECTIVES: Increasing interest has emerged in the use of subjective well-being as a development indicator and for the evaluation of public policies. The aim of this study was to assess life and health satisfaction and their determinants in the adult population of Iran. METHODS: We conducted a survey of a sample of 3,150 adults at least 18 years of age in Tehran, the capital of Iran. The subjects were selected using a stratified random sampling method, and they were interviewed face-to-face at their usual residence by trained interviewers. Life satisfaction was used as a measure of subjective well-being. We used ordinary least square regression models to assess the associations of life and health satisfaction with socio-demographic variables. RESULTS: On a 0-10 scale, the mean (standard deviation) scores for life and health satisfaction were 6.93 (2.54) and 7.18 (1.97), respectively. The average score for life satisfaction in females was 0.52 points higher than in males. A U-shaped relationship was found between age and life satisfaction, with respondents 35 to 44 years of age having the lowest average level of life satisfaction. Satisfaction with life and health among divorced respondents was significantly lower than among never-married and married participants. The scores for life satisfaction in respondents who rated their health status as poor were 3.83 points lower than in those who rated their health status as excellent. CONCLUSIONS: The majority of the population of Tehran was satisfied with their life and health. Self-rated health status had the greatest impact on life satisfaction.
Subject(s)
Adult , Female , Humans , Male , Divorce , Iran , Methods , Personal Satisfaction , Public Policy , Surveys and QuestionnairesABSTRACT
Background: Accidents are the second cause of death in Iran and one of the significant challenges in public health. They can affect people in all ages. In this study, we try to calculate years of life lost due to intentional and unintentional injuries, which is considered as one of the main indicators for prioritizing public health problems
Methods: This study is a practical cross sectional survey research HSR [health system research] that uses secondary analysis on the death data of Ghazvin province. The calculations also take into account the WHO standards in age group, sex and years of life lost [YLL] due to death
Results: This study showed that the unintentional accidents were the leading cause of death based on YLL from 2004 until 2008 in Ghazvin province. The number of deaths due to intentional and unintentional accidents was 3796 deaths as of which 2954 [77.8%] was male and 842 [22.2%] female. In general three quarter of the YLL due to early death relates to accidents for males and less than a quarter relates to accidents for females. Between 2004 until 2008, the maximum number of years of life lost [YLL] in both sexes is for the age group of 15 to 49
Conclusion: Considering the high level of years of life lost [YLL] due to accident in this province, especially in men, more appropriate interventions for the more risk prone age groups and male in general need to be taken into account
ABSTRACT
Survival analysis is a set of methods used for analysis of the data which exist until the occurrence of an event. This study aimed to compare the results of the use of the semi-parametric Cox model with parametric models to determine the factors influencing the length of stay of patients in the inpatient units of Women Hospital in Tehran, Iran. In this historical cohort study all 3421 charts of the patients admitted to Obstetrics, Surgery and Oncology units in 2008 were reviewed and the required patient data such as medical insurance coverage types, admission months, days and times, inpatient units, final diagnoses, the number of diagnostic tests, admission types were collected. The patient length of stay in hospital 'leading to recovery' was considered as a survival variable. To compare the semi-parametric Cox model and parametric [including exponential, Weibull, Gompertz, log-normal, log-logistic and gamma] models and find the best model fitted to studied data, Akaike's Information Criterion [AIC] and Cox-Snell residual were used. P<0.05 was considered as statistically significant. AIC and Cox-Snell residual graph showed that the gamma model had the lowest AIC [4288.598] and the closest graph to the bisector. The results of the gamma model showed that factors affecting the patient length of stay were admission day, inpatient unit, related physician specialty, emergent admission, final diagnosis and the number of laboratory tests, radiographies and sonographies [P<0.05]. The results showed that the gamma model provided a better fit to the studied data than the Cox proportional hazards model. Therefore, it is better for researchers of healthcare field to consider this model in their researches about the patient length of stay [LOS] if the assumption of proportional hazards is not fulfilled