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BACKGROUND: The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran. METHODS: In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran. RESULTS: In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2) strengthening and improving rehabilitation, relevant appropriate technologies, Supportive Services, and Community Based Rehabilitation, and 3) Collecting international data on social support and improving the quality of research and services related to rehabilitation. CONCLUSION: To achieve a successful national rehabilitation framework in any country, it is required to strengthen information and research database, implement annual monitoring of policymaking, assess the next year rehabilitation needs of society, finding causes of disabilities for effective planning.
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Background: Disability can involve many by diseases, injuries, or aging, and thus access to rehabilitation services has a key role in improving these patients' social life. Since 2008, Iran has improved the access to rehabilitation facilities along with the global convention. Yet, nationwide studies are required to evaluate the fair distribution of centres in each province. Thus, the present study aimed to evaluate the distribution of outpatient rehabilitation services in 32 provinces of Iran to help policymakers make more appropriate decisions. Methods: In this cross sectional study, which was conducted between April and October 2017, a master facilities list (MFL) of rehabilitation services that was developed in Iran was used to identify health facilities. Data were collected from the statistics of the Deputy for Rehabilitation of Social Welfare Organization offices and Red Crescent Organization in 32 provinces of Iran. Descriptive data were analysed by SPSS version 22 and reported by percentage and number in 1 000 000 population; distribution was drawn on Iran's map by the GIS software. Results: According to the MFL, outpatient rehabilitation services include physical medicine & rehabilitation, physiotherapy, occupational therapy, speech therapy, audiometry, and orthotics & prosthetics (90%); other rehabilitation centres include general rehabilitation centres, day care centres, and vocational centres (10%). The largest number of occupational therapy, physiotherapy, and audiology offices were found in Tehran, where general rehabilitation centres, day care centres, and vocational centres were less than 3 per 1 000 000 population. There were no rehabilitation centers in 14 provinces, and there were very few physical medicine and rehabilitation centres in most of the provinces. Conclusion: There was significant difference in the distribution of outpatient rehabilitation facilities in different provinces of Iran and some provinces required urgent attention of policymakers, as they had the least number or no rehabilitation facilities.
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Background: Tremendous difficulties are imposed on families with preterm and premature babies, both at birth and during their lifetime. The present study aimed at evaluating the potential economic impact of preterm and premature birth in Iran. Methods: In this descriptive cross-sectional study (2014-2015), we studied preterm and premature newborns, who have been subjected to hospitalization in Ali-Asghar hospital. We followed social perspective to estimate the economic consequences of preterm and premature birth in 3 categories of direct medical, direct non-medical, and indirect costs. Required data were collected from documents in the NICU, and studying medical records, and interviewing their parents. Data were analyzed by Microsoft Excel. Results: Direct medical, direct non-medical and indirect affairs were 84%, 6%, and 10% of the total cost, respectively. The estimated social costs were 373, 529, 189; 508, 774, 181; and 529, 481, 996 US dollars (according to their corresponding incidence of 5.8%, 7.9%, and 9.9%). We also found that 75% of the direct medical costs of initial hospitalization were due to intensive care beds. Conclusion: The economic burden of preterm and premature birth in Iran is considerable and to decrease the costs, it is necessary to implement preventive programs for preterm and premature newborns and to provide management care and support for families dealing with this problem.
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BACKGROUND: There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences. METHODS: This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used. RESULTS: No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05). CONCLUSION: Based on the students' perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered.
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BACKGROUND: Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study. METHODS: In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, inputoriented and variable return to scale assumptions were applied and Deap2.1 software was used. RESULTS: The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked. CONCLUSION: Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful.
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BACKGROUND: Health inequality monitoring especially in Health care financing field is very important. Hence, this study tends to assess the inequality in household's capacity to pay and out-of-pocket health carepaymentsin Tehran metropolis. METHODS: This cross-sectional study was performed in 2013.Thestudy population was selected by stratified cluster sampling, and they constitute the typical households living in Tehran (2200 households). The required data were collected through questionnaires and analyzed using Excel and Stata v.11. Concentration Index on inequality was used for measuring inequality status in capacity to pay and household payments for health care expenses; and also the concentration index for out-of-pocket payments and capacity to pay was used to determine the extent of inequality. The recall period for inpatient care was one year and 1 month for outpatient. RESULTS: The average of out-of-pocket payments for receiving the outpatient services was determined to be 44.33US$ and for each inpatient1861.11 US$. Concentration index for household's outof- pocket payments for inpatient health care, out-of-pocket payments for outpatient health care and health prepayments were calculated 0.13, -0.10 and -0.11, respectively. Also, concentration index in household's capacity to pay was estimated to be 0.11whichindicatedinequality to the benefit of the rich. The households used financing strategies like savings, borrowing or lending to pay their health care expenditures. CONCLUSION: According to this study, the poor spend a greater portion of their capacity to pay for outpatient and inpatient health care costs and prepayment, in comparison to the rich. Thus, supporting the vulnerable groups of the society to decrease out-of-pocket payments and increasing the household's capacity to pay through government support in order to improve the household economic potential, must be considered very important.
