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.

[Waiting time to visit an endocrinologist in Iran: shortage of workforce or inappropriate distribution of patients?]

Objective [s]: Shortage in human resources is an important challenge for health sector. It is the main cause of demand rationing and queues to receive services. Proper information about the present situation helps to manage queues and waiting time. This study aimed to estimate waiting time to visit an endocrinologist and provide practical solution for its management

Method: This was a cross - sectional study. Samples were selected from participants of the annual Iranian endocrinologist conference, 2008 in Tehran. Twenty four endocrinologist completed the questionnaires. The research tool was a self - administered questionnaire

Results: The study findings showed that the median and mean waiting time of endocrinologists was 15 and 30 days for first visit respectively [0 -135 days]. Number of endocrinologists' activity was the only variable that had positive correlation with waiting time [P= 0.027]. About % 41.7 of endocrinologists had the possibility of increasing their clinical working hours by 10.8 hours per week

Conclusion: Waiting time to visit an endocrinologist seems occurred due to inappropriate distribution of patients and not the shortage of workforce

[Social relationships and health: findings from the Iranian Health Perception Survey [IHPS]]

Objective [s]: To assess social relationships status oamong Iranians and find out its association with their health condition

Methods: It was a cross-sectional study of a sample of 27,883 general population of Iran aged 18 to 65 years. Social relationships were measured using a single item rated on a 5-point Lkert scale. Self-reported health also was measured by a similar question. Logistic regression analysis was performed to analyze the data

Results: Most participants indicated that they had good and very good social relationships. Gender, employment status, and income had significant association with social relationships. Negative assessment of health increased the risk of low social relationships up to 6.58 times and similarly negative assessment of very poor or poor social relationships increased the risk of lower health status up to 5.6 to 7.3 times respectively

Conclusion: The findings suggest that social relationships are associated with social factors such as income, gender and employment. Also social relationship has significant effect on public's health. Perhaps social relationships could be considered as a mediatory factor between social condition and health

[Depression among the general population in Iran: Iranian health perception survey]

Objective[s): To collect data on self-reported depression among the general population in Iran and indicate its contributing factors

Methods: This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate their anxiety on a 5-point scale. The record of demographic and socioeconomic data included age, gender, education, marital status, employment, income, self-reported health and chronic diseases. Logistic regression analysis was used to estimate odds ratios for contributing factors to self-reported depression

Results: In all 27,883 individuals took part in the study. The mean age of respondents was 32.7 [SD = 11.8) years. Overall 8.6% reported that they were very or very much depressed. The results obtained from logistic regression analysis showed that divorced [OR= 2.46] and wife dead [OR= 1.77], unemployed [OR= 1.45], lower income groups [OR =1.65], those with lower self-reported health [OR for lowest group=7.27], and having at least one chronic disease [OR=1.58], were more likely to suffer from depression

Conclusion: The findings indicated that there were inverse relationships between depression, marital status, income and self-reported health

[Happiness among Iranians: findings from the Iranian Health Perception Survey [IHPS]]

Objective[s]: As part of a study on health perception among Iranian people, the happiness with affected factors was assessed

Methods: This was a population-based study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate a 5-point happiness scale indicating their own present happiness status. The data were analyzed descriptively. In addition logistic regression analysis was performed to assess the association between independent variables and happiness

Results: In all 27,883 individuals took part in the study. The mean age of respondents was 32.7 [SD=11.8] years. Overall 39.3% rated their happiness as 'neither much/nor low', 35.4% as 'much" and 3% as "Not at all". The findings showed that in addition to some demographic variables such as employment and income, the self-rated health was the most significant contributing factor to happiness [OR=7.82, 95% CI=5.32-11.48, P<0.0001]

Conclusion: The findings suggest that improving daily living conditions might help to improve happiness among the Iranian population

[Iranian's percpectives about health importance]

Objective[s]: As part of a study on health perception among Iranian people, the importance of health was assessed

Methods: This was a population-based study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate a 5-point scale indicating how value health in their life. The data were analyzed descriptively. In addition logistic regression analysis was performed to assess the association between independent variables and the importance of health

Results: In all 27,883 individuals took part in the study. The mean age of respondents was 32.7 [SD=11.8] years. The results indicated that 70 percent of the respondents valued the health very or very much important. For there analysis of the data showd that males and females valued the health similarly but age and education had significant contribution to people's perceptions

Conclusion: The findings of this study intoduce a noteworthy outlook of health importance among Iraninas and could be useful in characterizing public cognitions of health and provide essential basis for program development and health related interventions

Waiting time for specialist consultation in Tehran

Waiting time is an important indicator of patient satisfaction and the quality of care. The aim of this study is to determine the waiting time in physician offices in Tehran, Iran. This was a cross-sectional study. The target population of this study consisted of specialist and subspecialist offices in Tehran. We used a census sampling method to study the population. Data of 5475 physicians was extracted from data banks, of which 43.4% were not accessible. Thus 3098 cases were included and analyzed. We conducted telephone interviews to gather data, which was subsequently analyzed using SPSS software. Out of the 3098 physicians interviewed, 2585 were specialists [83.4%]; the remaining were subspecialists. The mean waiting time for a patient's first visit to a specialist was 4.30 days [SD = 8.10] and for subspecialists it was 7.61 days [SD = 13.98]. The average waiting time in our study was less than a week for specialists and almost a week for subspecialists. The health system in Iran has not established a complete referral system and with this situation, waiting time may have adverse effects on the health of patients. Thus studying and managing waiting time in some medical specialties or regions is a priority in our country

[People's knowledge on health and life style]

A study of relationship between self-reported knowledge on health and lifestyle. This is a cross-sectional study and the study population is all Iranian aged between 18-65. In this study 27883 cases have been sampled by the multistage sampling method. A questionnaire was used for data gathering that was made and standardized by researchers. The bivariate correlation between self-reported general knowledge on health and three variables for assessing life style consist of nutrition status, Smoking and exercise was meaningful for all variables. The relationship between knowledge and smoking way negative and the other were positive. Trying to promote people's knowledge may increase their health related behavior and life style. In this way strengthening health communication in the Medias and updating existing information can improve people's knowledge. By the way trying to improve health literacy in the community may affect use of existing information and improve people's knowledge on health

Iranian health perception survey [IHPS]: the study protocol

This paper aims to document our approach to data collection for a nationwide study on health perception among an Iranian general population using a simple and short questionnaire. This project was developed through group discussions in Iranian Institute for Health Sciences Research. An extensive literature search carried out to provide a simple and short questionnaire to cover topics related to health [physical, mental and social], health-related behaviors, self-reported health, health information, and satisfaction with health care as perceived and rated by the respondents. The intention was to collect data from a random sample of individuals aged between 18 and 65 years living in Iran. Primarily a sample of 24000 individuals from all 30 provinces in Iran was thought. However, the actual sample size obtained was 27883. The plan then was to analyze the data using a descriptive approach locally and nationally. It is hoped that this study would provide basic information for better understanding on how people thinking and how they are behaving about their health. Based on the results obtained we also might be able to establish areas for health interventions and contribute to health policy in Iran

Determinants of satisfaction with health care system: a population-based study from Iran

Satisfaction with health care system is an important indicator of health care delivery effectiveness. It could contribute to both policy and practice. This study aimed to examine Iranians' satisfaction with health care. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate their overall satisfaction with health care system on a 5-point-likert scale. The record of demographic and socioeconomic data included age, gender, education, marital status, employment, income, and chronic diseases. Logistic regression analysis used to estimate odds ratios to indicate factors contributing to satisfaction with health care system. In all, 27,833 individuals examined in this study. The mean age of respondents was 32.7 [SD=11.8] years old. Overall 20.7% of the respondents were satisfied or very satisfied with the health care delivery system while 36.2% of people indicated low or no satisfaction with health care system. The regression analysis results indicated that income [a proxy measure of access to health care], and information variable were the most significant factors contributing to people's dissatisfaction [OR for lower income=2.17, P<0.0001; OR for people with poor health information=2.01, P<0.001]. The study findings suggest that access to health care and information would lead to improved people's satisfaction with health care system

People's perspectives about the role of physicians and health specialists: Iranian health perception Survey [IHPS]

To identify community views on the role of physicians and health specialists on people's health. This was a nationwide cross sectional study. A random sample of 27883 individuals aged between 18 and 65 years were entered into the study. Each respondent was asked to indicate the role that health professionals play in the public community health. In all, 45.2% of the respondents indicated that health professionals had very influence in shaping public community health while only 1.8% of people believed [they have no role]. However, about 30% of people indicated a limited role for health professionals. The findings suggest that about one-third of people believe health professional do not have influential role in public health. This might be an indicator of people's access to health care and merits future investigation

Percieved health knowledge among Iranians: a nationwide study

People's knowledge about health is one of the essential requirements for improving health. This study aimed to investigate how people rate their own knowledge about health at population level. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate their knowledge about health on a 5 point scale. Demografic and socioeconomic data including age, gender, education, marital status, employment, income, chronic diseases and self-reported health were recorded. Logistic regression analysis was used to estimate odds ratios for contributing factors to self-reported knowledge on health. In all 27,883 individuals looks part in the study. The mean age of the respondents was 32.7 years. Most people [48.3%] reported that their knowledge about health was at intermediate level. The result obtained from logistic regression analysis showed that all demographic variables [age, gender, education, marital status, employment and income] and people's health status [having chronic disease and self-reported health] were significant predicting factors of people's perceived knowledge about health. Radio and television were identified as the main information sources. The findings indicated that the perceived health knowledge among Iranians was fair. However it seems that mass media should take more responsibility to improve health knowledge of the general population

Who is responsible for health: Iranian health perception survey [IHPS]

To examine how people thinking and behaving about their health. This was a nationwide cross sectional study. A random sample of individuals age 18 to 65 years were entered into the study. Respondents were asked to rate their views on a 5-point scale indicating who is responsible for their own health. The record of demographic and socioeconomic data included age, gender, education, marital status, employment, income and chronic diseases. Logistic regression analysis used to estimate odds ratios for contributing factors to responsibility for health. In all, 27,883 individuals taken part in the study. The means age of the respondents was 33.67 [SD=11.8] years. Overall, 52% of people reported that individuals themselves are responsible for their own health and 14% reported that the state is responsible for public community health. The results of logistic regression analysis showed that males [OR=1.40], low level income groups [OR=1.43], having at least one chronic disease [OR=1.52] were more likely to assign responsibility for health to governance sectors. The findings suggest that most people believe that health is a personal issue that everybody should take care of him or herself

How people rate their own health: a nationwide study from Iran

Little is known about self-reported health in developing countries such as Iran. As part of a large study on health perception in Iran this was investigated. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate their own present health status on a 5-point scale. The record of demographic and socioeconomic data included age, gender, education, marital status, employment, income, place of residence, and chronic diseases. Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for indicating of the contributing factors to self-reported health. In all 27,883 individuals were studied. The mean age of respondents was 32.7 [SD = 11.8] years. 71.5% rated their health as good or better than good while the remaining 28.5% indicated their health less than good and poor. The findings showed that in addition to some demographic variables, the most contributing factors to poor self-rated health were: income [OR=2.81 for lower income], and presence of chronic diseases [OR=7.6, 85%CI=6.8-7.5]. Living in smaller towns was found to contribute to a better self-reported health [OR=0.89, P=0.01]. The findings indicated that there were inverse relationships between self-reported health and socioeconomic and ecological factors. The results suggest that social determinants of health play an important role in people's evaluation of their own health status. Policies need to address these concerns

Prevalence of tobacco consumption: Iranian health perception survey

To determine prevalence of tobacco consumption among Iranians. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Prevalence of tobacco consumption was measured asking each respondent to indicate whether they consume tobacco products [cigarette, hookak and pipe] or not, and if yes how much? In all 27,883 individuals looks part in the study. The mean age of the respondents was 32.7 years [SD=11.8]. 74.6% of the respondents indicated that they were not smokers and among the smokers, 10.4% smoke 1-5 cigarettes daily, 8.5% smoke 6-10, 4.6% smoke 11-20 and 1.5% smoke more than 20 cigarettes per day. Logistic regression analysis showed that age, education, gender, occupation and marital status had significant relationship with smoking. The findings suggest that one out of four individuals consume tobacco to some extent. The need for interventions to reduce smoking among Iranian adult population seems necessary

Trait anxiety among Iranians: a nationwide study

To collect data on self-reported anxiety among the general population in Iran and indicate its contributing factors. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate their anxiety on a 5-point scale. The record of demographic and socioeconomic data included age, gender, education, marital status, employment, income, and chronic diseases. Logistic regression analysis was used to estimate odds ratios for contributing factors to self-reported anxiety. In all 27,883 individuals took part in the study. The mean age of respondents was 32.7 [SD = 11.8] years. Overall 20.1% reported that they were very or very much anxious. The results obtained from logistic regression analysis showed that females [OR=1.52], lower income groups [OR for lowest income group=1.53], having at least one chronic disease [OR=1.27], and those with lower self-reported health [OR for lowest group=5.12], were more likely to suffer from poor mental health. The findings indicated that there were inverse relationships between anxiety, income and self-reported health. The contributing of income to psychological distress might be explained in the context of social determinants of health

Lifestyle and nutrition behaviors among Iranian population

There is a strong belief that poor nutrition is a major risk factor for developing ill health including chronic diseases. As part of a study on health perception among Iranian people, the relationship of nutrition with other lifestyle factors was assessed. This was a population-based study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to indicate how much they look after of own nutrition status. They rated their behavior on a 5-point scale. In addition to socio-demographic, the record of lifestyle data included smoking, and physical activity. Descriptive statistic and correlation were used to analyze the data. In all 27,883 individuals taken part in this study. The mean age of respondents was 32.7 [SD = 11.8] years old. 39.3% and 13.4% respondents indicated that they were very or very much concerned about their nutrition issues respectively. Further analysis showed that there were a positive correlation between nutrition behaviors and other lifestyle habits. Non-smokers, those with higher level of physical activities and those who were more health-oriented were more likely to take care of themselves regarding nutrition issues. The findings suggest that health-related behaviors are very connected to each other. Indeed cognitive interventions might be necessary to improve the health-related behaviors among Iranian nation

Chronic diseases in a population-based study: Iranian health perception survey [IHPS]

To describe self-reported chronic diseases in Iran. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Demografic and socioeconomic data including age, gender, education, marital status, employment, income, and chronic diseases were recorded. Logistic regression analysis was used to estimate odds ratios for contributing factors to self-reported chronic diseases. In all, 5518 individuals [20.7%] reported that they were suffering from chronic diseases. The frequency for major chronic diseases were: cardiovascular 1814 [6.5%], diabetes 933 [3.3%], musculoskeletal 2050 [7.4%], Cancer 205 [0.7] and the other diseases 953 [3.4%] Smoking, lack of adequate physical activity, low educational levels, lack of attention to nutritional status and overall health status were significantly associated with reported chronic diseases. This study confirmed that following epidemiologic transition, chronic diseases can impose the most important part of the burden of disease to many communities even to the most developing countries

[General practitioner supply: family physician program and medical workforce]

Iranian Ministry of Health and Medical Education [MOHME] decided to implement Family Physician Program [FPP] all across the country in 2005. Workforce supply is among essential factors in most implementation projects. The aims of this study were to estimate General Practitioner Supply in Iran, and workforce adequacy analysis of FPP. This study estimates [General Practitioner Supply] based on stocks and flow model and [Required General Practitioner] based on the policies, health care delivery programs and population. Implementation of FPP for whole population of Iran requires 32769 practitioners while according to the results of this study supply of general practitioners while according to the results of this study supply of general practitioners are about 28200. General practitioner supply is especially important in implementation of FPP. Currently, the program is implemented at rural level and in the cities with less than 20000 populations and the following step is expanding it throughout the country. The results of this study show that there is an obvious shortage around 4600 in general practitioners. Moreover the current experiences demonstrate that the recruiting and maintaining of general practitioners have not been successful in recent years. However, FPP expansion needs reassessment of population patterns receiving the service, and requires innovations to recruit and maintain practitioners