Chain Hospitals in the Health Industry: A Scoping Review of Principles and Definitions.

In order to provide quality and cost-effective health care, hospitals have used a variety of organizational models. Chain hospitals are one type of organization and service delivery model. Based on the diversity, multiplicity, and ambiguous nature of concepts related to chain hospitals, this study is an attempt to explain the concepts and components of such hospitals. Five main databases were searched for this purpose. Scopus, PubMed, WOS, ProQuest, and Wiley library databases were accessed from inception to September 2022. English-language studies describing chain hospital models were included. Two independent authors screened full-text papers, and data were extracted using a self-designed form. A thematic analysis was used to identify key components of the chain hospitals. A total of 38 papers from 8472 documents met the inclusion criteria and were included in the study. Among the selected studies, there were 23 quantitative studies, 6 qualitative studies, 5 mixed studies, 3 review studies, and 1 gray report. A review of the results revealed 55 different definitions of chain hospitals, as well as 6 main components and 16 subcomponents. Among the extracted components, 60% were related to the organization dimension, 15% to governance, 9% to decision rights, 8% to policies and procedures, and 4% to service delivery. In order to launch a multihospital system involving chain hospitals in a country, it is necessary first to define the concept of this hospital. The study's findings should be used by policymakers and officials in each country before implementing an inter-hospital cooperation system (MHS, chain hospital, etc.). Future researchers may also find inspiration in the study's findings and focus on these hospitals' establishment, effectiveness, and financial effects.

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.

Future Financing Scenarios for Iran's Healthcare System.

BACKGROUND: The financing function within a health system is considered inherently complex, so it is of utmost importance to design a suitable future for this system given uncertainties and complexities of the environment. With regard to the current and future complicated conditions, health system financing is also likely to succeed if it can anticipate the impacts of effective factors in the future and further plan appropriate interventions ahead of time. Thus, the purpose of this study was to develop scenarios for the health system financing in Iran. METHODS: This mixed-design research of exploratory future studies type was conducted using the scenario method. In this respect, the key variables were evaluated using a questionnaire from two aspects of importance and uncertainty as well as formation of a future studies group (focus group). Finally, sensitivity analysis was carried out through cross-impact balance (CIB) analysis using the Scenario Wizard (Version 4.31) software. RESULTS: A total of 25 factors were selected based on the type and the position of the variables (driving force, bi-dimensional, risk, secondary leverage or modifiable-to-secondary leverage) over the diameter of the MICMAC chart. Considering the degree of significance and uncertainty, eight variables including all four driving force variables (oil sales and economic blockade, leadership and advocacy, bureaucracy and corruption, and possibility of using information technology in providing services), as well as the variables of resource sustainability, natural disasters, regional security, and specialization culture were chosen. Then, five variables were finalized as the key changes that would create the scenario based on sensitivity analysis and final expert opinions. According to the defined conditions, 270 scenarios were developed, of which fourteen scenarios were identified as poorly adaptable and five cases as highly adaptable. CONCLUSION: The best scenario identified in this study based on the degree of adaptation included the use of massive technology and oil sales, mediocre economic conditions with high probability of occurrence, strong leadership and advocacy, high regional security, as well as bureaucracy and low corruption with medium probability of occurrence.

How Much Should We Pay to Deliver Comprehensive Mental and Social Health Services? Experiences from Iran.

Objective: Comprehensive mental and social health services is the new benefit package which had been aimed to provide mental health services to people who suffer from mental disorders. The aim of this study was to estimate the cost of plan and its drivers to provide evidence for decision-making by national policymakers. Method : We used the bottom-up costing approach to estimate the cost of plan. We identified the cost centers, services delivery process, and facilities. Data were collected via different sources and tools such as the new financial system, registration forms, and performance reporting forms. We categorized the cost into 4 groups and selected appropriate measures to estimate the cost. We estimate the total and unit cost for 3 levels in 2 scenarios by considering the 2017 prices. Results: Screening resulted in 8.9% new detection with a different incidence in urban and rural areas (urban: 16.5%; rural: 2.7%). Also, 61 842 million IRR was spent for the screening, diagnose, treatment, and rehabilitation of detected people in 2017. Personal cost is responsible for 90.6% and primary screening for 66.4% of the total cost. Conclusion: For the development of the program (from screening to rehabilitation) 530 513 IRR should be spent per capita. The cost of detection per client can vary due to differences in disease prevalence, especially treatment and rehabilitation costs. It is suggested to consider the variation of the prevalence in expanding the plan to the whole country. Integrating the services in primary health care lead to huge cost saving.

Iranian medical university board of trustees' challenges in practice: A qualitative study.

Background: Board of Trustees (BOTs) in Iranian medical universities has been considered as one of the most important structural and managerial changes to create a revolution in decision-making and accountability. This study aimed to explore challenges facing BOTs in governing Medical Universities (MUs). Methods: In this qualitative study, 27 semi-structured interviews were conducted with current and former members of BOTs, chancellors of universities, BOTs' secretaries, and staff in the Ministry of Health and Medical Education in 2017. These participants were selected using a purposive and snowball sampling method. Data were analyzed by framework analysis and using Atlas-Ti software. Results: Five key themes were identified, including 1) infrastructure (problems in BOT laws and membership requirement), 2) planning and decision-making (evidence-based decision making and planning and meeting), 3) organizing (ambiguity in positions and lack of necessary administrative structure), 4) performance evaluation (self-reporting, lack of time allocation, lack of evaluation criteria and lack of required structure for evaluation), 5) independence and influence on performance (dependency on the Ministry of Health and Medical Education and financial independence). Conclusion: Due to obsolete laws, it seems that the structural and executive reform of BOTs is essential. The issues of university autonomy and empowerment of the boards' members should particularly be considered in such reforms. However, it appears that more delegation and empowering the position of the boards could be effective strategies in governance medicals universities.

Effective factors and drivers of Iran's health care financing system.

Background: Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends. Methods: This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software. Results: A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers. Conclusion: The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran's financing system.

Forecasting health expenditures in Iran using the ARIMA model (2016-2020).

Background: Accurate economic forecast has important effects on governmental policy and economic planning, and it can help policymakers to make decisions for future and create new infrastructures for the development of new forecasting methods. This study calculated total health expenditure, public health expenditure and out of pocket (OOP) payment for 2016-2020. Methods: Autoregressive Integrated Moving Average Process (ARIMA) is one of the most important forecasting models. In this study, five-year values were forecasted using EViews8 software according to health expenditures in Iran from 1971 to 2015. Results: Applying annual data for total health expenditure, resulted in the ARIMA (1,1,1) model being the most appropriate to predict these costs. The results of this study indicate that total health expenditures will reach from about 1228338 billion IRR in 2016 to 2698346 billion IRR in 2020 and the amount of out of pocket (OOP) will become more than 41% of total health expenditure in 2020. Conclusion: Total health expenditures in 2020 will become more than two halves in 2016. These expenditures indicated there is a need for continued governmental support of this sector during the upcoming years.

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.

Essential managerial skills for financial and budgetary management in medical universities: The top managers' perspective.

Background: Achieving organizational objectives depends on the effectiveness of administrators. However, managerial efficacy largely depends on the knowledge and skills of managers. This study aimed at assessing the skills of financial and budget management of the Ministry of Health from the perspective of resource development assistants of universities of medical sciences nationwide. Methods: This cross- sectional study was conducted in 2012. Study participants were resource development assistants of universities of medical sciences in Iran. We adopted simple random sampling method in locating participants. Data were collected using pretested questionnaires and analyzed using descriptive statistics and Mann-Whitney test (as a non-parametric test) and Friedman test. Results: The highest mean recorded under financial management skills was technical skills (3.58±0.50), followed by human skills (3.50±.048), and perceptual skills (3.32±0.52). With regards to financial and budget management and performance monitoring, the means of technical skills, as prioritized by directors, was 3.72±0.71, followed by human skills (3.72±0.70), and perceptual skills (3.66±0.75). A significant association was found between perceptual skills of financial managers and budgeting and performance monitoring managers (p= 0.014). Conclusion: Operational level managers, such as financial and budgetary managers, need to acquire more technical skills. Therefore, we support activities that promote technical skills and awareness of managers within organizations, such as organizational training courses and distribution of educational materials like brochures.

Analysis of development levels in the cities of Tehran province regarding health infrastructural index: the strategy of standardized score and Morris' inequality index.

BACKGROUND: One of the main indexes of development is health index or the degree to which a society enjoys health and therapeutic services. The present study was done with the aim to analyze development levels in cities in Tehran regarding health infrastructural index using the standardized score and Morris' model. METHODS: This is a descriptive and pragmatic study which ranks 14 cities in Tehran province using the standardized score and Morris' models based on 10 selected health indexes. The required data were gathered using a researcher-made information list and the information gathered from the Statistics Center and Tehran University of Medical Sciences. The data were analyzed using Excel software. RESULTS: The development coefficient in the studied cities varies from 0.595 to -0.379 so that Rey city has the highest level of development and Pishva city has the lowest level of development among the studied cities. The more number of the cities (43%) was among the rather undeveloped group and none of the cities (0%) was in the rather developed group. CONCLUSION: Regarding the findings, there is a big gap and difference regarding enjoying health and therapeutic infrastructural indexes among the cities in Tehran province. Therefore, it is suggested that development-oriented plans consistentent with development levels should be implemented in these cities.

Distribution of hospital beds in Tehran Province based on Gini coefficient and Lorenz curve from 2010 to 2012.

INTRODUCTION: Fair distribution of hospital beds across various regions is a controversial subject. Resource allocation in health systems rarely has focused on those who need it most and, in addition, is often influenced by political interests. The study assesses the distribution of hospital beds in different regions in Tehran, Iran, during 2010-2012. METHODS: This cross-sectional study was conducted in all regions of Tehran (22 regions) during 2010 to 2012. All hospital beds in these regions are included in the study. Data regarding populations of each region were obtained from the Statistics Center of Iran. According to the data, the total number of beds (N.B) and population (P) in 2010 (N.B=19075, P= 7585000), 2011 (N.B=21632, P= 9860500), and 2012 (N.B=21808, P=12818650). The instrument was a form, including the name of the hospital, the district in which the hospital was located, the number of staffed beds, the name of each region, and its population. Data analysis was performed using DASP software version 2.3. RESULTS: The results demonstrate that the Gini coefficient of distributed beds in 22 regions of Tehran was 0.46 in all three years and specifically calculated 0.4666 in 2010, 0.4658 in 2011 and 0.4652 in 2012. The Gini coefficient of beds in 22 regions of Tehran is not fair in comparison with the population of each region during the years 2010 to 2012. CONCLUSION: The results demonstrate that the distribution of beds in regions in Tehran is not fair in relation to the population of each region-and some regions had no hospitals. Therefore, it is essential for policymakers to frequently monitor this issue and investigate the fair distribution of hospital beds.

Assessing health inequalities in Iran: a focus on the distribution of health care facilities.

BACKGROUND AND OBJECTIVE: Equality in distribution of health care facilities is the main cause for access and enjoyment to the health. The aim of this study was to examine the regional disparities in health care facilities across the Markazi province. METHODS: This was a cross-sectional study. Study sample included the cities of Markazi province, ranked based on 15 health indices. Data was collected by a data collection form made by the researcher using statistical yearbook. The indices were weighted using Shannon entropy. Finally, technique for order preference by similarity to ideal solution (TOPSIS) was used to rank the towns of the province in terms of access to health care facilities. RESULTS: There is a large gap between cities of Markazi province in terms of access to health care facilities. Shannon entropy introduced the number of urban health centers per 1000 people as the most important indicator and the number of rural active health house per 1000 people as the less important indicator. According to TOPSIS, the towns of Ashtian and Shazand ranked the first and last (10th) respectively in access to health services. CONCLUSION: There are significant inequalities in distribution of health care facilities in Markazi province. We propose that policy makers determine resource allocation priorities according to the degree of development for a balanced and equal distribution of health care facilities.

Financial Management Reforms in the Health Sector: A Comparative Study Between Cash-based and Accrual-based Accounting Systems.

BACKGROUND: Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management. OBJECTIVES: The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. PATIENTS AND METHODS: This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables. RESULTS: Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting. CONCLUSIONS: There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector.