Household Overcrowding in Iran, a Low-middle-income Country: How Major of a Public Health Concern Is It? / 예방의학회지

Objectives@#Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran. @*Methods@#Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI. @*Results@#The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC. @*Conclusions@#The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level / 한국역학회지

OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

Risk factors of road traffic accidents associated mortality in northern Iran; a single center experience utilizing oaxaca blinder decomposition

Objectives: To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran

Methods: This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period from 2013 to 2014. The hospital data of traffic crashes were used. Data contained those patients who survived at the scene of accident. Injury severity score, time to admission, age, gender, season of crash and type of collision were variables used in this study. Oaxaca decomposition technique was used to show the amount of inequity. In addition, three regression models were used to show the reason of inequity

Results: Overall 1520 patients with road traffic accidents were admitted to our center during the study period. The mean age of the patients was 35.45 +/- 17.9 years, and there were 1158 [76.1 %] men among the victims. Motorbike accidents accounted for 869 [57.1%] injuries and 833 [54.8 %] accidents occurred in rural regions. The in-hospital mortality rate was 60 [3.9%]. The results of this study showed that 95% of inequity came from factors used in this study and 2.04% disadvantages were for rural crashes. Severity of crash and time to admission had relationship with death, while the effects of time to admission was higher in rural region and severity of the accident had more effect on mortality in urban regions in comparison with rural ones

Conclusion: The high rate of fatal accidents could be decreased by deleting the gap of access to health care services between urban and rural regions. This study suggested that more efforts of health system are needed to reduce the gap

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level / 한국역학회지

OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis.METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated.RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%).CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran / 가정의학회지

BACKGROUND: The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program. METHODS: We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined. RESULTS: No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform. CONCLUSION: The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.

Health sector inflation rate and its determinants in Iran: a longitudinal study [1995-2008]

Health price inflation rate is different from increasing in health expenditures. Health expenditures contain both quantity and prices but inflation rate contains prices. This study aimed to determine the factors that affect the Inflation Rate for Health Care Services [IRCPIHC] in Iran. We used Central Bank of Iran data. We estimated the relationship between the inflation rate and its determinants using dynamic factor variable approach. For this purpose, we used STATA software. The study results revealed a positive relationship between the overall inflation as well as the number of dentists and health inflation. However, number of beds and physicians per 1000 people had a negative relationship with health inflation. When the number of hospital beds and doctors increased, the competition between them increased, as well, thereby decreasing the inflation rate. Moreover, dentists and drug stores had the conditions of monopoly markets; therefore, they could change the prices easier compared to other health sectors. Health inflation is the subset of growth in health expenditures and the determinants of health expenditures are not similar to health inflation