Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis / 예방의학회지

OBJECTIVES: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. METHODS: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. RESULTS: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p < 0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p < 0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. CONCLUSIONS: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Time series analysis of determinants of health care expenditure in Iran

Background: specifying the determinants of healthcare expenditure is one of the most important challenges in the health sector. The current study was aimed to assess factors affecting government health care expenditure in Iran

Methods: to identify short-term and long-term determinants of healthcare expenditure in Iran during 1971-2007, Auto Regressive Distributive Lag [ARDL] bound testing approach to co integration was used. The explanatory variables were

defined into economic, demographic and supply side categories. The data were collected from the official websites of the Iranian Statistics Centre, Central Bank of Iran, and the Ministry of Health

Results: we found health care expenditures as necessary goods in both short-term and long-term. In long-term, per capita income [Beta = 0.815, P-value = 0.033], elderly population [Beta = - 1.790, P-value < 0.001], and physician density [Beta = 3.204, P-value = 0.004] had effect on health care expenditure. In short-term per capita income [Beta = 0.577, P-value = 0.026] was the only factor that significantly affected health care expenditure

Conclusion: Government health expenditure is necessary goods in both short and long run. Thus governmental health care expenditure does should grow proportional to increase in national income. This could result to decrease in out of pocket payment

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

Optimization the number of nurses in the emergency department using linear programming technique

Introduction: Aim of current study is determination of optimal number of nurses in the emergency department of Shiraz Ali Asghar Hospital

Method: Current study is an applied study and belongs to operational research [OR] studies. The population has been studied in this research, includes records of referred patients to the emergency department of hospital in 2008. Sampling was performed in the forms of stratified [monthly] and simple for all of the records and each of months respectively. Required data collection was performed from statistics notebook and also patient's records using data collection forms. After average determination of entering patients in a day at eight period in three hours, determining the type of provided services and also the period of offering nursing services [with using time information]determine optimum number of required nurses in different periods of hospital with using of linear programming technique by lingo 8 software

Results: The minimum number of nurses needed in emergency department of Ali Asghar hospital regarding to desired services to the patients were obtained 1 and 3 nurses for each shift and a day respectively

Conclusion: According to the results the used number of nurses in the emergency department was more than optimum number. It seems that, obtained number of nurses from quantitative methods such as linear programming technique is much less than the calculated number experimentally by the directors of nursing

[Cost of diabetes in type II diabetic patients]

Objective [s]: To determine economics cost of diabetes in type II diabetic patients under the cover of Naderkazemi clinic in Shiraz in the first half of 2008

Methods: this study is an applicable one and the way of study is descriptive-analytic.the study society includes type II diabetic patients that referred to Naderkazemi clinic and made file. in this study among the 4900 files related to type II diabetic patient, at first, in the pilot study,30 files chosen by the way of systematic sampling and examined. standard deviation these files was +/-/38.that in respect to received standard deviation,220 files were chosen as samples that eventually with the help of statistics advisor,288 file were chosen as samples and were studied in a systematic way. the needed information in this study were gathered from observing the existing information in patient´s files, interviewing with personnel and manager and also from existing information and ducuments in provision, accounting and personnel departments. results were classified as charts and graphs and were expressed descriptively

Results: in this study, total economic costs of type II diabetes calculated 37942315040 Rials [4079818.8 dollar], that medical direct costs and indirect costs share was 3994348680[429499.9 dollar] and 33947966360[3650319 dollar] Rials, respectively. Medical direct and indirect costs of diabetes in a type II diabetic patient in first half of 1387 was 815173/2[87.65 dollar] and 6928156/4[744.96 dollar] Rials respectively, and altogether was 7743329/6 Rials [832.61 dollar]

Conclusion: Economic cost of type II diabetes is very high and complications of this disease can important influence on patient and their family. Because of restricting resources of medical-health in society, diabetes is one of medical-health priority in our country and should have large actions to reducing costs and complications of this disease