Legal and policy requirements of basic health insurance package to achieve universal health coverage in a developing country.

OBJECTIVES: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. RESULTS: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

Scoping literature review on the basic health benefit package and its determinant criteria.

BACKGROUND: There are various criteria and methods to develop Basic Health Benefit Package (BHBP) in world health systems. The present study aimed to extract criteria used in health systems in different countries around the world using scoping review method. METHODS: A systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, World Bank, World Health Organization, and Google databases between January and April 2016. Papers and reports were gathered according to selected keywords and were examined by two authors. Finally, the criteria were extracted from the selected papers. RESULTS: The primary search included 8876 papers. After studying the articles' titles, abstracts, and full texts, 9 articles and 14 reports were selected for final analysis. After the final analysis, 19 criteria were extracted. Due to diversity of criteria in terms of number and nature, they were divided into three categories. The categories included intervention-related criteria, disease-related criteria, and community-related criteria. The largest number of criteria belonged to the first category. Indeed, the most widely applied criteria included cost-effectiveness (20), effectiveness (19), budget impact (12), equity (12), and burden of disease (10). CONCLUSION: According to the results, different criteria were identified in terms of number and nature in developing BHBP in world health systems. It seems that certain criteria, such as cost-effectiveness, effectiveness, budget impact, burden of disease, equity, and necessity, that were most widely utilized in countries under study could be for designing BHBP with regard to social, cultural, and economic considerations.

The decision-making matrix of propensity to outsourcing hospital services in Bandar Abbas, Iran.

OBJECTIVE: To determine the level of managers' propensity for outsourcing the services in hospitals using decision-making matrix. METHODS: The applied, cross-sectional study was conducted at three hospitals affiliated to Bandar Abbas University of Medical Sciences, Iran, in 2013, and comprised managers and employees of four service units: radiology, laboratory, nursing, and nutrition services. Data was collected using two questionnaires and face-to-face interviews. Data was analysed using SPSS 16 and by using decision-making matrix. RESULTS: Of the 122 subjects in the study, 12(9.8%) were managers and 110(90.2%) were other employees. The highest and lowest propensities for outsourcing were related to nutrition (66.6%) and nursing services one (8.33%). The decision-making matrix showed low outsourcing of the nursing, radiology, and laboratory services based on the services' features. However, there were difference between the results obtained from laboratory service decision-making matrix and the propensity for laboratory service outsourcing. CONCLUSIONS: The difference between the results obtained from the matrix and managers' viewpoint can be due to the lack of managers' sufficient attention to the features of hospital services when making decisions on outsourcing them.

Investigation of the preparedness level of the hospitals against disasters in Bandar Abbas, Iran, in 2012.

OBJECTIVE: To determine the preparedness level of hospitals against natural disasters in Bandar Abbas, Iran. METHODS: The cross-sectional, descriptive study was conducted in all the 9 hospitals in Bandar Abbas, Iran, during 2012. The required data was collected using a standard checklist comprising 220 items in 10 areas. It was completed for each hospital using observations and interviews. SPSS 16.0 was used to analyse the data. RESULTS: The overall level of preparedness against disasters in Bandar Abbas hospitals was 38.6%. They were at a poor level in the areas of reception (31.4%), evacuation (28.1%), traffic (33.3%), security (34.6%), communication (30.6%), human resources (38.6%), and commanding and management (20.1%). Areas of emergency services (55.1%), training (53.5%), and logistics (53.5%) were moderate, while none of the areas could score enough to be in the good or very good category. CONCLUSION: Preparedness was poor and hospital administrators should establish necessary technical and communication infrastructures through sufficient budgets to improve weak areas.

Sharps injuries in the operating room.

OBJECTIVES: We aimed to identify who sustains needlestick and sharps injuries, under what circumstances and what actions are taken to minimize the risk and in response to intraoperative NSSIs. METHODS: The cross-sectional study was conducted in 2013 on 215 operation room personnel in 14 hospitals of the Hormozgan province, Iran. RESULTS: Two hundred and fifty appropriate responders completed the questionnaire (86 %). Anaesthesia 59 (27.4 %) and operation room technicians 55 (25.6 %) sustained the greatest numbers of NSSIs over the past year. Awareness of local protocols was significantly worse in the residents group. The commonest reasons for noncompliance with NSSIs local protocols were not sure of the local protocols 44 (20.4 %) and prolonged operation so unable to leave operation table 37 (17.3 %). CONCLUSIONS: A revision of the local protocol to reduce the time it takes to complete may improve compliance. Education is of paramount importance in making health care workers aware of this issue. The application of safety devices led to a reduction in NSSIs and reduces the risk of blood borne infection as well.