Correction to: Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran.

An amendment to this paper has been published and can be accessed via the original article.

Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran.

BACKGROUND: In 2014, a revision of the national medical tariffs for inpatient health care services took place in Iran, and a new hotline was set up to report informal payments. It was expected that such measures would eliminate or decrease informal payments prevalence. This study estimates the prevalence of informal payments for inpatient health care services in the post-reform period, explores factors associated with informal payments and examines patients' and healthcare providers' views regarding the causes of informal payments and possible practical solutions for their reduction. METHODS: We surveyed by phone patients who used inpatient health care services in seven Iranian hospitals in 2016. Descriptive and regression analyses were used to estimate the prevalence and determine factors associated with informal payments. We conducted a qualitative analysis through thematic analyses based on focus group discussions and in-depth interviews. RESULTS: Of 2696 respondents, 14% reported paying informally for inpatient services. Informal payments were reported more frequently among private hospital users, given more frequently to physicians in public teaching hospitals and 'other staff' in private hospitals, in the form of cash and voluntary. Being an adult, hospital or treatment type, being insured, and household head's education influenced the probability of paying informally. The amount paid informally was associated with being insured, the educational status of the household's head, household size, service, and hospital types. Based on qualitative findings, the leading causes of informal payments reported by patients and healthcare providers can be categorized into four groups - financing challenges; governance challenges; service delivery challenges; and actors and stakeholders. Modifying, adjusting and applying policy interventions; supervision, monitoring and evaluation; and actors and stakeholders were identified as possible solutions for tackling informal payment in the inpatient health care services. CONCLUSION: The prevalence of informal patient payments for inpatient services in the post-reform period seems to have reduced; however, they remain to be common. Regular monitoring, reviewing of payment policies to the physicians, informing patients, changing the behaviour of healthcare providers and patients, and developing ethical guidelines to prevent informal payments were suggested for reduction and elimination of informal payments in the Iranian healthcare sector.

A leadership model for Iranian health-care organizations.

PURPOSE: Leadership is the ability to influence, guide and encourage employees to achieve organizational goals. Leadership has a significant role in organizations' success or failure. Thus, this paper aims to develop a model to elucidate leadership practices in the Iranian health-care organizations (HCOs). DESIGN/METHODOLOGY/APPROACH: Qualitative approach was used in this study due to its explorative nature. Semi-structured interviews were conducted with 32 key managers and 30 professionals working at different HCOs. Inductive analysis was carried out using the grounded theory approach to develop an initial leadership model for HCOs. The proposed model subsequently was verified by an experts' panel. FINDINGS: The proposed leadership model emerged from the Iranian HCOs encompasses six main categories: leader, followers, high-ups and peers, context, processes and outcomes. Leader, followers and contexts as main categories did also have further sub-categories. RESEARCH LIMITATIONS/IMPLICATIONS: Study findings are cautiously transferrable as it reflects the Iranian context. While the model was verified, it might still benefit from more and diverse views. PRACTICAL IMPLICATIONS: This model can be used by health-care policymakers and managers for improving managers' leadership competencies and practices and enhancing health outcomes through motivating and mobilizing health-care resources toward achieving organizational goals. ORIGINALITY/VALUE: This study aims to give an answer for "what is the current status of leadership in Iranian HCOs?" and "how can we reinforce the strengths and address the weaknesses?"

Leadership challenges in health care organizations: The case of Iranian hospitals.

Background: Effective leadership is a vital component of health care systems and has an extensive range of functions in improving organizational effectiveness and efficiency. This study aimed at exploring leadership challenges encountered by leaders in Iranian hospitals. Methods: This qualitative study was conducted on a purposeful sample of 27 members of hospital management team in Tehran using face-to-face semi-structured interviews and in-depth interviews. Thematic analysis was used to analyze and report the data. Results: In this study, 5 main themes emerged upon the challenges of leadership in health care organizations as follow: organizational structure (complexity, centralization, and bureaucracy); human resources (the number and distribution of human resources, staff empowerment, and education, motivational mechanisms, and staff diversity); work nature (sensitivity, stress and tension, customer diversity, and team- oriented); leaders (knowledge and skills, appointment, superiors and colleagues, and time); and context (regulations and programs, cultural issues, social issues, and economic issues). Conclusion: The results of this study shed some light on the leadership challenges in a culturally specific developing country. The results also proved the importance of using educated leaders who are capable of understanding, analyzing, and dealing with such complex challenges.

Factors affecting the informal payments in public and teaching hospitals.

BACKGROUND: Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences. METHODS: In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly; then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests. RESULTS: The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals' housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status. CONCLUSION: Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals' staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments.

Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer.

BACKGROUND: Evidence from randomized controlled trials (RCTs) has shown a significant survival advantage of trastuzumab. Although extant work in developed countries examined economic evaluation of trastuzumab in adjuvant treatment for early breast cancer based on the 1-year treatment, there is uncertainty about cost-effectiveness of trastuzumab in the Adjuvant Treatment of early breast cancer in developing countries. This study aimed to estimate cost-effectiveness of adjuvant trastuzumab therapy compared to AC-T regimen in early breast cancer in Iran. METHODS: A cost-effectiveness analysis was performed using a Markov model to estimate outcomes and costs over a 20-year time period using a cohort of women with HER2 positive early breast cancer, treated with or without 12 months trastuzumab adjuvant chemotherapy. Transition probabilities were derived mainly from the BCIRG006 trial. Costs were estimated from the perspective of the Iranian health care system. Both costs and outcomes were discounted by 3%. One-way sensitivity analysis was undertaken to assess the associated uncertainties in the expected output measures. RESULTS: On the basis of BCIRG006 trial, our model showed that adjuvant trastuzumab treatment in early breast cancer, yield 0.87 quality-adjusted life-years (QALY) compared with AC-T regimen. Adjuvant trastuzumab treatment yielded an incremental cost-effectiveness ratio (ICER) of US$ 51302 per QALY. CONCLUSION: By using threshold of 3 times GDP per capita, as per World Health Organization (WHO) recommendation, 12 months trastuzumab adjuvant chemotherapy is not a cost-effective therapy for patients with HER2-positive breast cancer in Iran.

Rate of Pressure Ulcers in Intensive Units and General Wards of Iranian Hospitals and Methods for Their Detection.

BACKGROUND: This study aimed to estimate the rate of pressure ulcers in intensive care units (ICUs) and medical and surgical wards of Iranian hospitals and compare the performance of methods of medical record review as well as direct observation for their detection. METHODS: The research team visited 308 patients in medical and surgical wards of hospitals affiliated with Tehran University of Medical Sciences and a further 90 patients in their ICUs between March 2009 and April 2010. In addition 310 patient records were randomly selected from patients discharged from the ICUs between March 2009 and April 2010. And a further 600 patient records were randomly selected from the patients that were discharged from medical and surgical wards between March 2010 and April 2011. These 910 selected records were retrospectively reviewed to identify pressure ulcers. Data were collected by a structured checklist. RESULTS: In ICUs 24 of 90 patients (26.7%, 95% CI: 17.56 to 35.84) that were directly observed and 59 of 310 patients (19.0%, 95% CI: 14.63 to 23.37) that were studied by retrospective review of medical records had pressure ulcers. In medical and surgical wards, 5 of 308 patients (1.6%, 95% CI: 0.20 to 3.00) that were directly observed had pressure ulcers, but no pressure ulcer was detected by review of 600 medical records. CONCLUSION: Pressure ulcers are significantly more frequent in ICUs than in medical and surgical wards and a significant proportion of pressure ulcers are not reported.