Iranian health insurance system; past experiences, present challenges and future strategies

The Iranian healthcare system is primarily an insurance based system. This structure has an important influence on the efficiency and equity of the provision of healthcare in Iran. This paper reviews the history of the Iranian healthcare system and the impact of the Iranian health insurance system on healthcare performance based on the results of interviews with key opinion leaders and empirical evidence. This review uses mixed methods: a systematic literature review of electronic databases supplemented by hand searching of books and journals including Government publications and other grey literature. The issues identified were explored through a series of semi-structured interviews with key informants from within the Iranian healthcare system. The interviews were recorded transcribed, coded, classified, and analysed thematically. Empirical evidence was also sought to support or contradict the views expressed in the interviews. Sixteen interviews with key informants were conducted and presented anonymously. The interviewees raised many issues which were summarized into five main issues: increasing health expenditures, lack of systematic health technology assessment, very limited financial resources, challenging management and regulation, and uncovered population. A wide range of issues have affected the efficiency, quality and equity of the services provided by the Iranian healthcare system. The initial and most important step toward improving the efficiency, equity and quality of the health insurance system is to focus on evidence-based policy making to generate feasible, reasonable and comprehensive reforms

Health care financing in Iran; is privatization a good solution?

This paper considers a range of issues related to the financing of health care system and relevant government policies in Iran. This study used mixed methods. A systematic literature review was undertaken to identify relevant publications. This was supplemented by hand searching in books and journals, including government publications. The issues and uncertainties identified in the literature were explored in detail through semi-structured interviews with key informants. These were triangulated with empirical evidence in the form of the literature, government statistics and independent expert opinions to validate the views expressed in the interviews. The systematic review of published literature showed that no previous publication has addressed issues relating to the financing of healthcare services in Iran. However, a range of opinion pieces outlined issues to be explored further in the interviews. Such issues summarised into four main categories. The health care market in Iran has faced a period in which financial issues have enhanced managerial complexity. Privatization of health care services would appear to be a step too far in assisting the system to confront its challenges at the current time. The most important step toward solving such challenges is to focus on a feasible, relevant and comprehensive policy, which optimises the use of health care resources in Iran

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part1: variations in drug prescribing

Rational prescribing is associated with improved safety in drug use, better quality of life for patients and cost-effective care. Medication prescribing is a relatively unexplored area of research in Saudi Arabia and until now most studies have been in the secondary and tertiary health care system. This paper is the first of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews variations in prescribing patterns and influences on physicians' prescribing behaviour worldwide and in Saudi Arabia

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 2: rational prescribing

Unlike suB-optimal prescribing rational prescribing, coupled with certain indicators, is associated with improved safety in drug use in drug for prescribing, better quality of life for patients and cost-effective care. Medication prescribing is relatively unexplored area of research in Saudi Arabia and until now most studies have been health care system. This paper is the second of 3 review articles that form the interconnected studies of prescribing patterns and medication errors in the public care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer- reviewed journals over the previous 3 decades. The paper reviews rational prescribing with its indicators suboptimal prescribing, classification of medication errors, and how to achieve quality in health care prescribing worldwide and in Saudi Arabia

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 3: prescribing errors

Medication errors are globally huge in magnitude and associated with high morbidity and mortality together with high costs and legal problems. Medication errors are caused by multiple factors related to health providers, consumers and health system, but most prescribing errors are preventable. This paper is the third of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews the etiology, prevention strategies, reporting mechanisms and the myriad consequences of medication errors

Medication prescribing pattern in primary care in Riyadh city, Saudi Arabia

Physicians' prescribing behaviour is closely linked with patient safety and this area is poorly researched in Saudi Arabia. The objective of this stulf was to analyse physicians' prescribing patterns and the adequacy of noted information in the primary health care sector in Riyadh city. All medication prescriptions from 5 public [n = 1182] and 5 private [n - 1200] health centres were collected by simple random sampling during 1 working day. Antibiotics were the most commonly prescribed drugs in both sectors. The mean number of drugs per prescription was 2.08 and 2.36 in the public and private sectors respectively. Information and instructions noted on prescriptions varied considerably between private and public health centres. Similarly the medication prescribing pattern differed across the 2 health settings. Primary care physicians in Saudi Arabia need continuing training to improve their prescribing practices

Medication errors in primary care in Riyadh city, Saudi Arabia

Medication errors can cause a variety of adverse drug events but are potentially preventable. This cross-sectional study analysed all medication public and 5 private primary health care clinics in Riyadh city, collected by simple day. Prescriptions for 2463 and 2836 drugs from public and private clinics which were analysed using Neville et al.'s classification of prescription errors. Prescribing errors were found on 990/5299 [18.7%] prescriptions. Both type B and type C errors [major and minor nuisance] were more often associated with prescriptions from public than private clinics. Type D errors [trivial] were significantly more likely to occur with private health sector prescriptions. Type A errors [potentially serious] were rare [8/5299 drugs, 0.15%] and the rate did not differ significantly between the 2 health sectors. The development of preventive strategies for avoiding prescription errors is crucial

Determinants of physicians' medication prescribing behaviour in primary care in Riyadh city, Saudi Arabia

This study in Saudi Arabia explored the determinants of physicians' prescribing behaviour in primary care in Riyadh city. A self-administered questionnaire designed to explore factors influencing prescribing [sociodemographic factors; practice access to educational materials; pharmaceutical company representatives, and patients factors] was completed by 87 PHC physicians. A factor analysis of 56 variables extracted 7 factors that explained 46% of the variance. Of these, 4 components positively related to perceived good prescribing behaviour could be summarized as: clinical experience of physicians; use of educational materials for continuous updating of medical knowledge; enhanced levels of continuing medical education and willingness to involve patients in decision-making; and working as a team using pharmacists for consultation and emphasizing the role of medical education.The other 3 factors derived from the analysis were less easy to interpret and may have been statistical anomalies [or measurement errors]

Predictors of quality of medication prescribing in primary care in Riyadh city, Saudi Arabia

Identifying the indicators of good quality medication prescribing assists physicians in preventing medication errors. This study in Riyadh city aimed to examine the relationship between physicians' self-reported influences on prescribing and the quality of their prescribing, defined as the completeness and accuracy of their prescription documentation. A sample of 600 randomly selected prescriptions written by 87 physicians were rated as high or low quality. The same physicians completed a questionnaire to determine the indicators of quality prescribing. The 7 components identified with factor loadings +0.5 or -0.5 were subjected to binary logistic regression modelling. While a range of potential quality indicators of drug prescribing were identified, none of the variables underpinning the 7 components/factors survived the binary logistic regression mode. More studies are needed that take into account other quality indicators of medication prescribing in Saudi Arabia

Effectiveness of three interventions on primary care physicians' medication prescribing in Riyadh city, Saudi Arabia

A number of strategies have been shown to improve the quality of drug prescriptions. The objective of this study was to implement and assess the effectiveness of 3 interventions on physicians' prescribing and cost containment: training physicians about quality prescribing, regulatory and administrative measures to improve rational drug prescribing; and a multi-faceted approach using 2 these strategies plus additional elements. Three public health centres, 1 for each intervention, were randomly selected, 61 physicians were trained in drug prescribing and completed a pre- and post-training questionnaire, and 100 post-intervention prescriptions from each centre were compared. All 3 interventions effectively improved the quality of drug prescriptions and the notation of drug-related information and trainees returned positive evaluations of the training course. Whether or not physicians' improvement in prescribing will be sustained is unclear and therefore subsequent follow-up evaluations are needed