Investigating the effect of health transformation plan on the public hospitals performance indicators; a case study from Iran.

BACKGROUND: Health systems need constant changes and reforms in their structure to adapt to changing conditions and meet the needs of society. One of the fundamental changes in the health system of Iran is the health transformation plan (HTP), the effects of which must be examined from different aspects. Therefore, the purpose of this study is to investigate the effect of HTP on the performance indicators of public hospitals in Yazd city, Iran. METHODS: This cross-sectional study was carried out in all public hospitals in city of Yazd. Six performance indicators were examined monthly and in two time periods of 12 months before and 12 months after the implementation of Health Transformation Plan (HTP). The data was analyzed by SPSS software program version 22, using the paired T-test, and the Interrupted Time Series (ITS) model. FINDINGS: Findings showed that the performance indicators of the studied hospitals have improved after the implementation of the HTP. According to the ITS model, the implementation of HTP did not have a significant effect on the level and trend of the bed rotation distance, average length of stay and the ratio of surgical operations to bed indicators. However, it had a statistically significant effect on the level and trend of mortality and hospitalization rates. Moreover, the implementation of HTP had a significant effect on the level of the bed occupancy rate, but did not have a significant effect on the trend of this indicator. CONCLUSION: Based on the research findings, all the selected indicators changed to some extent after the implementation of HTP, which showed the effect of this plan on the performance of hospitals. However, not all indicators were statistically significant as the findings sub-section revealed.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran.

PURPOSE: For years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017. DESIGN/METHODOLOGY/APPROACH: In this descriptive-analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective. FINDINGS: QALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin. ORIGINALITY/VALUE: This study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

The effect of macroeconomic indicators on health-care expenditure in Iran.

INTRODUCTION: A sharp increase in expenditure is one of the challenges of the health system in Iran. Every macroeconomic variable affects health, and if it is disregarded, it will lead to higher macrobudgets. Physical and mental health as well as the use of health services change according to the macroeconomic conditions and business cycles (boom and recession). The present study aimed to determine the effect of macroeconomic indicators on health expenditure. METHODS: This study was descriptive analytical. The required data related to macroeconomic indicators and health expenditure in public and private sectors were collected during 1995-2014. The data were analyzed using the time series models in econometrics, Vector Auto Regression, and Granger causality technique. RESULTS: The results of this study indicated that health expenditure has a positive bilateral relationship with gross domestic production (GDP), gross national production, national income, and national consumption. On the contrary, expenditure has a negative bilateral relationship with liquidity rate and inflation rate. In addition, budget deficit has a negative unilateral relationship with health expenditure while population rate has a positive unilateral relationship with health expenditure. CONCLUSION: The results of this study indicated the increase of health expenditure in Iran that GDP is the most critical determining factor of health expenditure. In general, the total expenditure in the health sector in the world increases when the countries become richer. In line with the increase of resources, innovative financing methods and efficiency improvement are required for providing basic health services in low-income countries.

Optimization and economic evaluation of modified coagulation-flocculation process for enhanced treatment of ceramic-tile industry wastewater.

Enhanced treatment of ceramic-tile industry wastewater was investigated by modified coagulation-flocculation process using combination of poly-aluminum chloride (PAC) with anionic (A300), cationic polymer (C270) and nonionic polymers. The effects of pH, PAC coagulant dose alone and with polymers dose in various combinations was studied by jar tests. To compare the removal efficiencies of turbidity, total suspended solids (TSS), chemical oxygen demand (COD), and color at different levels, we run multivariate analysis of variance. Regarding the economic evaluation, we applied the incremental cost-effectiveness ratio. PAC had the best performance in pH 7 and in optimal dose of 400 mg/L; so that removal efficiency of wastewater turbidity, TSS, COD and color were 99.63%, 99.7%, 47.5% and 50.38%, respectively. The best removal efficiency for wastewater turbidity, TSS, COD and color were 99.87%, 99.89%, 87.5% and 93.02%, respectively which were obtained by combination of anionic polymer (1.5 mg/L) with PAC (300 mg/L). Furthermore, with combination of PAC + anionic + non-ionic polymers, the removal efficiency for wastewater turbidity, TSS, COD and color were 99.93%, 99.94%, 88% and 94.57%, respectively. The imposed cost for treating one cubic meter of ceramic-tile wastewater treatment by PAC + anionic and PAC + anionic and non-ionic polymers in comparison with PAC alone was reduced to 22.96% and therefore economically more affordable for the tile industry wastewater treatment.

The Assessment of Inequality in the Geographical Distribution of Burn Beds in Iran.

INTRODUCTION: In recent years, the World Health Organization (WHO) has emphasized the importance of determining the equality of the distribution of healthcare resources. Inequalities in the healthcare system are one of the world's most important developmental challenges, and the inefficiencies that exist in healthcare systems are the most important reason for these challenges. Thermal burns are one of the common injuries worldwide, and their effects are a significant reason for the mortality and morbidity rates throughout the world. Considering the importance of burns as one of the 30 leading causes of death in Iran, this study was aimed to compare the distribution of burn beds with its disability-adjusted life years (DALY) in Iran. METHODS: This applied analytic-descriptive study was conducted in order to determine the distribution of burn beds in Iran using the Lorenz curve. In this way, the distribution of burn beds was analyzed in relation to the population of each province and lost DALY caused by burns in Iran. For each province, the number of burn beds in 2012 was collected from credible and authoritative sources at the Ministry of Health, and the population of each province was obtained using data from the National Center of Statistics. The data were analyzed and presented using Microsoft Office Excel. RESULTS: Isfahan and Khorasan Razavi Provinces had approximately 11 and 10.4% of the country's burn beds, respectively. The Provinces that had the most DALY were Sistan Baluchestan, Fars, and Kerman with 10.75%, 10.34%, and 9.54%, respectively. The Gini coefficients of burn beds in relation to population and DALY were calculated as 0.09 and 0.16, respectively. CONCLUSION: The Gini coefficients in relation to population and DALY were less than 0.2. Although the Gini coefficient of the burn beds in relation to DALY was more than that for the population, the difference was not significant, and the distributions of beds regarding the two calculated coefficients were equal. It is recommended that healthcare policymakers distribute burn beds in proportion to the populations of the provinces.