Building a House on Sand: How Tobacco Use Is Devouring Resources.

Background: Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and international databases so as to generate useful information about the costs of tobacco use globally. Methods: A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to identify relevant studies from 1990 to June 2021 using keywords like burden, productivity, indirect cost, direct cost, economic, monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into 2020 international dollars per adult. Findings: A total of 1,781 articles were identified, of which 361 were deemed to be eligible for inclusion. Eventually, 23 articles were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as a percentage of gross domestic product (GDP), was reported for South Korea (1.19%). Noteworthy, in all studies, indirect costs accounted for the highest proportion of all costs. The mean total cost amounted to 5,866 million dollars. The direct costs ranged from 179 million dollars in South Korea to 8,156 million dollars in Israel. Meanwhile, the indirect costs ranged from 289 million dollars in Hong Kong to 9,808 million dollars in India. Conclusion: The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from 0.33 to 1.19% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are needed to address the economic burden of smoking.

The Variations in Catastrophic and Impoverishing Health Expenditures, and Its Determinants in Iran: A Scoping Review.

Background: The high reliance on out-of-pocket (OOP) payments for health financing in Iran have been led to different inequity problems such as catastrophic health expenditure (CHE) and impoverishment. This scoping review has been conducted to understand the variations in CHE and impoverishment, the underlying determinants of CHE, and its inequality in the past 20 years. Methods: This scoping review is guided by Arksey and O'Malley's scoping review framework. systematically PubMed, Scopus, Web of Science, ProQuest, Scientific Information Database, IranMedex, IranDoc, Magiran Science, Google Scholar, and grey literature were searched systematically from 1 January 2000 to August 2021. We included studies that reported the rate of CHE, impoverishment, inequality, and its influencing factors. Simple descriptive statistics and narrative synthesis were used to present the review findings. Results: From 112 included articles, the average incidence of CHE was 3.19% at the 40% threshold, and about 3.21% of the households had impoverished. We found an unfavorable status of health inequality indices, including the average of fair financial contribution (0.833), concentration (-0.01), Gini coefficient (0.42), and Kakwani (-0.149). The most widely applied key drivers influencing the rate of CHE in these studies were household economic status, place of residence, health insurance status, household size, head of the household's gender, education level and employment status, having a household member under 5/ above 60 years old, with chronic diseases (in particular cancer and dialysis), disability, using inpatient and outpatient and dentistry services, medicines and equipment, and low insurance coverage. Conclusion: The result of this review calls for intensifying health policies and financing structures in Iran to provide more equitable access to all populations, especially the poorest and vulnerable. Moreover, the government is expected to adopt effective measures in inpatient and outpatient care, dental services, medicines, and equipment.

Policy analysis of the protection of Iranian households against catastrophic health expenditures: a qualitative analysis.

BACKGROUND: Despite the adoption of various policies and strategies in recent decades, the Iranian health system has not succeeded in protecting households against catastrophic health expenditures (CHE) and impoverishment. Accordingly, this qualitative study aimed to critically analyze current policies for reducing CHE. METHODS: This qualitative study was conducted as a retrospective policy analysis based on a document review and semi-structured interviews with key informants between July to October 2022. Two theoretical frameworks were used, including the Analysis of Determinants of Policy Impact (ADEPT) model and Walt and Gilson's "Policy Triangle framework." The country's related documents were searched through databases. In total, 35 participants were interviewed. Interviews and documents were analyzed using directed content analysis in MAXQDA v12 software. Interobserver reliability, peer check, and member check were done to confirm the trustworthiness of the data. RESULTS: Twelve main themes and 42 sub-themes emerged from the data. The findings revealed that policy accessibility, policy background, and a clear statement of goals influenced the policy process. However, resources, monitoring and evaluation, opportunities, and obligations negatively affected the implementation process. In addition, a policy analysis based on the policy triangle framework demonstrated that the main factors affecting the policy on reducing CHE in Iran were "conflicts of interest," "contextual factors," "monitoring and evaluation," and "intersectoral relationship" factors. CONCLUSION: The present study reflected the multifaceted nature of the barriers to reducing CHE in Iran. The implementation of the policy on reducing CHE requires the political will to improve intersectoral collaboration, strengthen the stewardship role of the Ministry of Health, design monitoring and evaluation mechanisms, and prevent personal and organizational conflicts of interest.

Best Practices of Hospitals in Management of Epidemic Conditions: A Scoping Review.

BACKGROUND: Many hospitals globally have valuable experiences in preparing for management and responding to infectious epidemics. Identifying and analyzing these experiences can provide comprehensive and practical data for decision-making and effective performance. This study aimed to conduct a scoping review and content analysis of the best practices of hospital (private or public) management in epidemic conditions. MATERIALS AND METHODS: This research is a scoping review and content analysis, conducted in 2021. Data was collected by searching different databases, including Pubmed, Scopus, Web of Sciences, ProQuest, websites, search engines, and public reports without time limits. Content analysis was performed for data analysis. RESULTS: We retrieved 8842 records from databases and other sources. Finally, 24 studies from 12 countries were selected for analysis. Most studies belonged to the United States (9 cases), and most subjects were on Coronavirus disease 2019 (Covid-19) (19 studies). We classified the results into two major categories of in-hospital executive readiness and logistic readiness. Executive readiness included 11 main categories (physical structure, resource management, exposure reduction, patients and caregivers' management, corpse management, disinfection, staff support, patient admission, instructions and guidelines, tele- communication, and education) and 26 sub-categories. Logistic readiness consisted of three major categories (leadership/team making, communication, and using capabilities) and five sub-categories. CONCLUSION: Healthcare managers can use the identified categories and dimensions of managerial readiness and responsiveness as an action plan during an infectious disease epidemic.

Comparing selected countries using sin tax policy in sustainable health financing: Implications for developing countries.

BACKGROUND: Sustainable health financing is one of the main challenges of policy makers and planners. This study aimed at comparing the experiences of countries in using the sin tax policies for sustainable health financing resources. METHODS: This qualitative study was conducted in two phases. First, a comparative study was carried out by searching databases from 1990 to 2017, and six countries (Thailand, England, Australia, the Philippines, South Africa, and Vietnam) were selected. Second, the existing Iranian high policy documents from 2005 to 2017 were reviewed deeply by using the content analysis method. RESULTS: The sin tax, such as taxes on tobacco and alcohol, was one of the main policies to provide sustainable health financing in all selected countries. The Iranian health system had no significant-related legal and political gap, but there were limitations in enforcing and implementing them. Finally, it is necessary to evaluate the policy and follow its effects up. CONCLUSIONS: The main financial resources in the selected countries included health promotion funds with different names and goals which took taxes on harmful goods, tobacco, and alcohol. Weaknesses in implementing laws and monitoring them were the main reasons for the lack of sustainable financing.

Sustainable financing of health promotion services in selected countries: Best experience for developing countries.

Background: Sustainable health financing is one of the main challenges of policymakers in the health system. Thus, this study aimed to investigate the sustainable financing of health promotion services in 7 selected countries and to analyze the related documents in Iran in 2018. Methods: This was a comparative and qualitative study (document analysis). In the comparative phase, the studies related to the selected countries- Australia, England, Germany, Japan, Turkey, Sweden, and Denmark- were investigated. In the second phase of the study, through a qualitative method of content analysis, 60 related documents were examined from 2005 to 2018. The initial evaluation of the documents was done using the Scott method and data were analyzed using Nvivo 8 software. Results: Based on the main findings of the study, there were a variety of approaches to the sustainable financing of health promotion services: excise taxes on goods; health-related behaviors regarding tobacco and alcohol consumption and gambling; using the capacities of social insurance funds in Germany and Turkey; and relying on the government budget in all the studied countries. According to the results of documents analysis related to the sustainable financing of health promotion in Iran, 3 main issues and 11 sub issues were identified. Conclusion: Using any of these methods or a combination of them depends on the political, social, and cultural structure of each country. The provisions of the law seem to be almost comprehensive; however, implementation, operationalization and monitoring of these elements are of significant importance.

Designing a Comprehensive Pattern of Structural-Psychological Empowerment for Employees of Medical Sciences Universities.

BACKGROUND: The concept of empowerment requires the abandonment of traditional models. The need to design and develop employee empowerment patterns has been emphasized in several studies. The present study aims to design a comprehensive structural-psychological empowerment pattern for employees of medical sciences universities. MATERIALS AND METHODS: Our exploratory research was conducted on 410 employees of medical universities of Tehran, Iran, and Islamic Azad University. Firstly, a primary pattern was designed according to a review of available literature, texts, patterns, and tools. Then, the psychometric analysis was done using validation (face validity, content validity, construct validity, factor validity) and reliability (internal consistency and stability). Lastly, the final pattern was introduced after having been approved by experts. Data were analyzed using SPSS version 24 and AMOS made by USA IBM software. P<0.05 was considered as the significance level. RESULTS: Based on our study, 83.9% of participants were holders of bachelor's degrees or higher degrees. The results of validation (face, content, structure, and confirmation validity) and reliability (internal consistency [α=0.90] and stability [0.91]) showed that the structural-psychological empowerment pattern was appropriate, which was validated with 31 items and 8 domains. The scope of this pattern included resources, self-sufficiency, competence, support, effectiveness, and opportunity, significance, and information domains. The highest impact on the model was related to the support domain (impact factor=0.87). CONCLUSION: The present pattern is an appropriate and verified Iranian model in the field of structural-psychological empowerment, which is suggested in the cultural context of Iran, especially in medical universities.

Interaction between stewardship and social health insurances: A comparative and document analysis.

Background: Social health insurances provide protection to access affordable coverage of services and stewardships of health system need to intervene to fulfill these objectives. This study conducted to assess interaction between stewardship and social health insurances. Methods: This qualitative study conducted in two phases as comparative study and document analysis in 2018. Comparative study employed to identify the dimensions and requirements of interaction between stewardship of health systems and social health insurances in countries around the world. In document analysis, all evidence about Iran health financing reviewed. Data extraction forms were used to gather data. Results: There were less interaction between stewardship and social health insurances in revenue collection and risk pooling. Advisory role of stewardship and proposals to coverage of uninsured people and performing risk analysis were some examples of such interaction. In Iran's health system, where stewardship plays a magnificent role in service provision, the basis of interactions are contracts, payment systems and timeline of payments. Conclusion: Mechanisms of interaction in Iran is not clear or does not work properly. Thus, nonstructural merging of social health insurances needs to redefine these mechanisms.