Social disparities and inequalities in healthcare access and expenditures among Iranians exposed to sulfur mustard: a national study using spatio-temporal analysis.

BACKGROUND: Sulfur Mustard (SM) is a chemical warfare agent that has serious short-term and long-term effects on health. Thousands of Iranians were exposed to SM during the eight-year Iran-Iraq conflict and permanently injured while the socioeconomic imbalance in their healthcare utilization (HCU) and health expenditures remains. This study aims to describe the HCU of SM-exposed survivors in Iran from 2018 to 2021; identify high-risk areas; and apply an inequality analysis of utilization regarding the socioeconomic groups to reduce the gap by controlling crucial determinants. METHODS: From Oct 2018 to June 2021, the Veterans and Martyrs Affairs Foundation (VMAF) recorded 58,888 living war survivors with eye, lung, and skin ailments. After cleaning the dataset and removing junk codes, we defined 11 HCU-related variables and predicted the HCU for the upcoming years using Bayesian spatio-temporal models. We explored the association of individual-level HCU and determinants using a Zero-inflated Poisson (ZIP) model and also investigated the provincial hotspots using Local Moran's I. RESULTS: With ≥ 90% confidence, we discovered eleven HCU clusters in Iran. We discovered that the expected number of HCU 1) rises with increasing age, severity of complications in survivors' eyes and lungs, wealth index (WI), life expectancy (LE), and hospital beds ratio; and 2) decreases with growing skin complications, years of schooling (YOS), urbanization, number of hospital beds, length of stay (LOS) in bed, and bed occupancy rate (BOR). The concentration index (CInd) of HCU and associated costs in age and wealth groups were all positive, however, the signs of CInd values for HCU and total cost in YOS, urbanization, LOS, and Hospital beds ratio groups were not identical. CONCLUSIONS: We observed a tendency of pro-rich inequity and also higher HCU and expenditures for the elderly population. Finally, health policies should tackle potential socioeconomic inequities to reduce HCU gaps in the SM-exposed population. Also, policymakers should allocate the resources according to the hotspots of HCU.

Providing a model for financing the treatment costs during biological crises using the fiscal space development approach.

BACKGROUND: Expanding fiscal space for health can be defined as providing additional budgetary resources for health, which is highly important during biological crises. This study aimed to provide a model for financing the treatment costs during biological crises using the development of the fiscal space approach. METHODS: This study employed a descriptive mixed-method design, consisting of three stages. In the first stage, a systematic review of relevant literature was conducted using multiple databases, including Scopus, PubMed, and Google Scholar. A total of 45 studies that met the inclusion criteria were selected. In the second stage, a panel of 14 experts identified five primary and 32 secondary strategies using an open questionnaire. Any additional strategies not identified during the literature review were added if a consensus was reached by experts. In the final stage, the Best Worst Method (BWM) was used to prioritize the identified strategies and sub-strategies based on their feasibility, effectiveness, quick yield, and fairness. RESULTS: Five strategies and fifty sub-strategies were identified. The most important strategies were the increase in health sector-specific resources (0.3889), increase in efficiency of health expenditures (0.2778), structural reforms (0.1111), health sector-specific grants and foreign aid (0.1667), and conducive macroeconomic conditions (0.05556). The most important sub-strategies were establishing and increasing earmarked taxes for the health sector (0.0140), expanding Universal Health Coverage (UHC) plans (0.0103), attracting the participation of non-governmental organizations (NGOs) and charitable organizations in the health sector (0.0096), integrating basic social insurance funds (0.0934), and tax exemptions for economic activists in the health sector (0.009303) during the crisis. CONCLUSION: This study identified five main strategies and 50 sub-strategies for financing the treatment costs during biological crises. The most important strategies were increasing health sector-specific resources, improving efficiency of health expenditures, and implementing structural reforms. To finance health expenditures, harmful and luxury goods taxes can be increased and allocated to the health sector during crises. UHC plans should be improved and expanded, and the capacity of NGOs and charitable organizations should be better utilized during crises.

Forecasting Iran national health expenditures: General model and conceptual framework.

BACKGROUND: Forecasting the future trend of health expenditures is an important step toward sustainable financing of health-care systems. This study aims to develop a conceptual framework for forecasting Iran health spending growth. MATERIALS AND METHODS: At first, we concentrated on the general model and conceptual framework of health expenditure projection by reference to a broad literature review and smart classifications of the origins of health spending and indicators. At the second step, we developed a time series modeling for econometric estimation and forecasting national health expenditure without restrictive assumptions except for current laws and regulatory environment. In the third step, we tested the accuracy of model by forecasting Iran real per capita health expenditures (2017-2025). RESULTS: The results of the literature review represented a distinct classification of the origins of health spending and indicators, applicable to any health system and health spending projection model. Furthermore, the model of expenditure forecasting shows the power of certainty of no spurious estimation, assessment of the normal state of a health system, and test of the accuracy of forecasting results. The projection by the Iranian health system database showed that the real per capita health spending will grow 43 percent till 2025 in the absence of any unforeseen disturbance in the future. CONCLUSIONS: The presented model provides estimates that are compatible with actual trends of health spending and can be applied to forecast health expenditure in the near future. The forecasted image of Iran's health spending growth implies that health authorities need to concentrate more on the growth rate of the health budget and its fiscal space in the near future.

Systematic review of productivity loss among healthcare workers due to Covid-19.

OBJECTIVE: To assess existing evidence on the effects of COVID-19 on healthcare workers (HCWs) using the health-related productivity loss approach. METHODS: A systematic search of online databases including PubMed, Scopus, Ovid, Web of Science, and EMBASE was conducted up to 25 August 2020. Following two screening stages, studies related to the effects of COVID-19 on healthcare workers were included in the study. RESULTS: 82 studies were included in the analysis. The COVID-19 related death rate among HCWs ranged from 0.00-0.7%, while the positive test incidence varied between 0.00 and 24.4%. 39 evidences assessed psychological disorders. A wide range of psychological disorders observed among HCWs: 5.2 to 71.2% in anxiety, 1.00 to 88.3% in stress, 8.27 to 61.67% in insomnia, and 4.5 to 50.4% in depression. CONCLUSIONS: The early evidence suggests that healthcare workers are one of the most vulnerable groups when it comes to positive COVID-19 infection, mortality, and mental illness.

Designing a model for patient relationship management in the general hospitals using the combination of analytic hierarchy process and interpretive structural modeling.

BACKGROUND: Patient relationship management (PRM), in addition to saving costs, increases patient loyalty and creates a satisfactory environment for the patient and the service provider. This study aimed to design a model of PRM in general hospitals using the combination of the analytic hierarchy process and interpretive structural modeling (ISM). METHODS: This was an applied and cross-sectional study conducted in 2020 at three stages. At the first stage, using a systematic review, factors affecting PRM were identified. In the second stage, these factors were prioritized based on the pair-wise comparisons. In the third stage, the interaction levels of the factors were modeled for the general hospitals using ISM through the use of the MICMAC technique and Excel 2007 software. RESULTS: The results showed that "integrated information system," "registration of the patient's essential information," and "right data at the correct time" were the first to third priority in implementing PRM in the general hospitals. In the final model of ISM, three levels of effective factors were extracted, and 10, 4, and 6 factors were identified in the first, second, and third levels, respectively. CONCLUSION: Establishing the PRM strategy in the hospital, in addition to executive and managerial requirements, depends on the existence of an electronic customer relationship management system, and the choice of new technology, as well as the integration of information systems and technology culture, should be given special attention by managers.

Factors Affecting the Failure to Report Medical Errors by Nurses Using the Analytical Hierarchy Process (AHP).

This cross-sectional study aimed to determine factors affecting the failure to report medical errors in teaching hospitals affiliated to Iran. The required data were collected during stages of systematic review and develop of researcher-made questionnaire. A total of 131 nurses were selected using Cochran's sample size formula. The collected data were analyzed by Analytic Hierarchy Process (AHP) using Expert Choice software. Results showed that the most important factors affecting the failure to report medical errors by nurses were, respectively, management-related factors (W = 0.595), nurse-related factors (W = 0.276), and factors related to the error reporting process (W = 0.128).

Catastrophic and impoverishing health expenditures and it's affecting factors among health staffs in Iran: A case study in Tehran.

Background: Despite a lot of studies carried out on catastrophic and impoverishing health expenditures, exposure to these expenditures have not been studied among health staffs and their families yet. So that our study has analyzed exposure to CHE (Catastrophic Health Expenditures) and factors affecting them among the health staffs affiliated to army medical universities in Tehran. Methods: This study was a descriptive-analytical and cross-sectional study implemented in 2016. Among all health staffs of a university of medical sciences, the full details of 240 households (838 individuals) were collected by using a stratified random sampling method. The data gathering and analyzing process have been done based on WHO standard guideline. Finally, the odds ratio of CHE determinants is reported using logistic regression by backward elimination method and chi-square test. Results: The results of this study showed that 7.5% (CI: 7.3-7.7) of health staff households (54 individuals) are faced with CHE. The odds of exposure to CHE for households with 3 members and less, households with lower education level and households with two or more outpatient visits were significantly more than others (p<0.05). Households who have used dental services during the past year were 8.77 times (p<0.001) more at risk of CHE. Also, households with 3 members and less, households with lower education level and households with two or more outpatient visits were 8.59, 7.96, and 3.39 times more at risk of such payments, respectively. Conclusion: CHE is a common financing dilemma even among health staffs. Families who have more referring to health centers and less education level and also dental service users are more at risk of exposure. Health policy-makers should pay more attention to such vulnerable and high-risk groups. Finally, our study results recommended the increase of dental insurance coverage as an effective strategy to reduce exposure to CHE.

The Dilemma of Irrational Antibiotic and Corticosteroid Prescription in Iran: How Much It Can Affect the Medicine Expenditures?

In recent years the high cost of medicines and the lack of it were one of the major problems in developing countries that despite numerous efforts to solve the root causes of this problem, the issue remains, unfortunately. Therefore, this study aimed to assess the impact of antibiotics and corticosteroids prescription on the medicines expenditures. This was descriptive-analytical study that conducted to assess the function of medical expenditures through prescription letters and analysis the factors affecting medicine expenditures. We used the data of 91,994,667 selected prescription letters that were collected by the Ministry of the Health and Medical Education (MOHME) throughout the country in the year 2011 which was analyzed through a logarithmic regression model and OLS estimator. The average number of prescription items in each prescription letter were varied from 2.7 to 3.6, and the average price of each letter was varied from 30223 to 69986 Rials. Between 39 to 61 percent of prescription letters containing antibiotic items and between 15 and 35% of them contain corticosteroids. Also, the impact of antibiotic and corticosteroid prescriptions on the average expenditure of prescription letters were -1.4 and 0.032 respectively. Excessive and irrational prescribing had the greatest impact on medicine expenditures. On the other hand, the expenditure of prescription letters had the negative elasticity to antibiotics prescription and relatively inelastic for corticosteroids. So, raising the price of medications to reduce the use of them could not play a successful role in a control policy.

Assessment inequality in access to public cardiovascular health services in Iran.

Background: Timely access to cardiovascular health services is necessary to prevent heart damages. The present study examined inequality in geographical distribution of cardiovascular health services in Iran. Methods: Present study is a cross-sectional study conducted using demographic data from all Iranian provinces (31 provinces) from 2012 census by the Statistics Center of Iran (SCI). The Gini coefficients of CCU beds and cardiologists were used to assess equality in access to cardiovascular health services in Iran. MS Excel software was used to calculate Gini coefficients. Results: The proportions of CCU bed and cardiologist per 100,000 population were 4.88 and 1.27, respectively; also the Gini coefficients were 0.129 and 0.045, respectively. Conclusion: Descriptive statistics showed a skewness in distribution of pubic cardiovascular health services in Iran, though Gini coefficient revealed no significant inequality. However, equal distribution of CCU beds and cardiovascular specialists does not mean they are sufficiently available in Iran.

A study on the factors affecting the prescription of injection medicines in Iran: a policy making approach.

BACKGROUND & AIM: Inappropriate prescribing injection medicines can reduce the quality of medical care, patient safety, and leads to a waste of resources. Sufficient evidence is not available in developing countries to persuade policy-makers to promote rational drug prescription. The objective of this study is to assess some factors affecting the prescription of the injection medicines in Iran. METHODS: In this descriptive-analytic study, the data of 91,994,667 selected prescription letters were collected by the Ministry of the Health and Medical Education (MOHME) throughout the country at the year 2011 which were analyzed through a logarithmic regression model. RESULTS: Results of the study show that the percentage of the prescription letters containing injection items varied from 27 percent (in Yazd) to 57 percent (in Ilam). Also the impact of price on the prescription of the injection medicines was not significant (P=0.55). But the impact of the prescription of antibiotics and corticosteroid on injections were significant (P>0.05) and equal 0.44 and 0.65 respectively. CONCLUSION: Increasing price of injection medicines as a policy towards reducing consumptions cannot be a successful policy. But reducing the use of antibiotics and corticosteroids can be a more effective policy to reduce the use of injection medicines.

Assessment the trend of inequality in the distribution of intensive care beds in Iran: using GINI index.

BACKGROUND & AIM: While most of the published researches have reported the amount of inequity in geographical distribution of important health resources, only a small number of studies have focused on the trend of inequality in the distribution of these resources. The purpose of this study was to determine the trend of inequality in the distribution of intensive care beds in Iran during 2010 to 2012 by using the Gini coefficient. METHODS: This is a cross-sectional research conducted in 2013. The changes over three years (2010 to 2012) were calculated by Gini coefficient to investigate the trend of inequality in geographical distribution of intensive care beds (CCU, ICU and NICU). RESULTS: The Gini coefficient for CCU beds was calculated as 0.02, 0.04 and 0.06 in 2010, 2011 and 2012, respectively. The Gini coefficient for ICU beds was calculated as 0.03, 0.05 and 0.05 in 2010, 2011 and 2012, respectively. Also, the Gini coefficient for NICU bed was calculated as 0.02, 0.03 and 0.04 in 2010, 2011 and 2012, respectively. CONCLUSION: Regarding to Gini coefficient, the trend of inequality was increased in the distribution of intensive care beds in Iran. Particularly, the inequalities in distribution of CCU beds were significantly increased during past years. In fact, if this trend of inequality continues, the distribution of intensive care beds will be extremely unequal in the next five years in Iran.