Physicians' retention rate and its effective factors in the Islamic Republic of Iran

Background: Migration of physicians from less developed countries to affluent ones has become as one of the major concerns of human resource policy-makers. This leads to problems such as inequity in the distribution of physicians, lack of physicians in less developed areas, as well as an excess of the health workforce in developed environs. Thus, policy-makers aim to increase retention of physicians in their places of origin.

Aims: This study aimed to find those effective factors for the retention of physicians in the Islamic Republic of Iran.

Methods: 30 569 records of public sector physicians in 2016 were gathered from the Ministry of Health and Medical Education database, and the retention rate of each province was calculated. Geographic information system [GIS] was used to show retention in each province, and linear and logistic regression analysis were used to determine the effective factors for physicians' retention in the country.

Results: There was a significant relationship between per capita gross domestic product of each province and its retention rate of physicians [OR = 1.56], retention rate of family physicians [OR = 7.38], and retention rate of specialists [OR = 1.59]. In addition, relationships were significant for the human development index [all physicians [OR = 1.22], family physicians [OR = 2.36], and specialists [OR = 1.23]]. Married physicians, higher paid physicians, and those who worked in headquarters and clinics showed greater willingness to stay in their area of origin.

Conclusions: Physicians' retention rate is dependent on both macro and microlevel factors.

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

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.

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran / 예방의학회지

OBJECTIVES: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS: Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS: Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

Assessing the accessibility and degree of development in health care resources: evidence from the West of Iran

Introduction: health care is one of the most important sectors in the development of each country and disparities in their distribution will reduce the level of development. The aim of this study was to examine the access to healthcare and degree of development in health care resources in the west of Iran in 2011

Method: this was a cross-sectional and retrospective study. The study setting was 51 cities of five western provinces of Iran, including Kermanshah, Kurdistan, Ilam, Lorestan and Hamadan. For assessing these towns in terms of the degree of development in healthcare resources by the numerical taxonomy technique, 23 indicators of health resources were selected and obtained from the statistics yearbook. The data was analyzed by EXCEL software

Results: our study showed that the highest and lowest access to health care based on numerical taxonomy belonged to cities of Kermanshah [0.61] and Salas Babajani [1.07]. Also, most towns of Ilam, Lorestan and Kurdistan provinces are underdeveloped and developing, while the most towns of Kermanshah and Hamadan provinces were placed in the developed region

Conclusion: this study showed that there was a large gap between the cities of one province and also among the provinces in terms of the access to and degree of development in health care resources. Therefore, it is suggested that a higher priority in terms of health resource allocation should be placed on the developing and underdeveloped areas in order to reduce these disparities

Technical efficiency of Shiraz school of medicine in research and education domains: a data envelopment analysis

Introduction: Efficiency evaluation of universities and faculties is one of the tools that help managers to identify the departments' strengths and weakness. The main objective of the present research was to measure and compare the technical efficiency of Shiraz school of medicine departments using Data Envelopment Analysis [DEA] technique

Methods: This cross-sectional and retrospective study was performed on clinical and non-clinical departments in research and education domains over the period of 2006 to 2011. Different inputs and outputs were considered for research and educational domain separately. Efficiency was measured based on the observed optimal performance

Results: Findings showed that pathology and anatomy departments achieved the score of 100 in technical efficiency in education during 2006 to 2011. During this period, parasitology, psychiatric and pediatrics department's achieved the score of 100 for technical efficiency in research domain. The lowest mean of relative educational efficiency belonged to orthopedic department; as to relative research efficiency, the lowest mean was shown in orthopedics and genetics departments. The mean technical efficiency of non-medical departments in education and research domain was 91.93 and 76.08, respectively, while the mean technical efficiency of the clinical department in educational and research fields was 91.02 and 82.23, respectively

Conclusion: Using multiple input and output in DEA technique provided a comprehensive evaluation of efficiency in Shiraz school of medicine departments. The DEA could successfully estimate the technical efficiency of the departments in research and educational fields. Moreover, the deficiency in each department was found; this could help them to plan for improvement