Measuring universal health coverage to ensure continuing care for older people: a scoping review with specific implications for the Iranian context.

BACKGROUND: To measure progress towards universal health coverage (UHC) in the context of ageing, it is necessary to develop suitable monitoring frameworks. The global UHC monitoring framework is focused on priorities for younger populations and does not adequately address issues relevant to ageing populations. AIMS: This study aims to propose a framework to measure UHC in a way that is relevant to health systems responding to population ageing. METHODS: Based on a search strategy focusing on measures of UHC in relation to older people's care, we searched electronic databases and screened the records to qualitatively analyse the data. We also conducted 2 rounds of expert panel consultations to discuss the findings and examine the feasibility of the recommended indicators using the case of the Islamic Republic of Iran as an example. RESULTS: We identified main themes and classified core indicators under each theme. Besides 25 indicators for quality of care, there were 22 indicators for financial protection. Ten indicators were retrieved measuring coverage and access to long-term care. Some indicators were excluded owing to limited data availability or absence of related programmes and some alternate indicators were proposed. CONCLUSIONS: We identified several indicators which could be used to measure progress toward UHC in the context of population ageing. However, not all of these indicators are feasible in context of low- and middle-income countries. This study could offer useful general guidance on how to define the exact set of measures in a specific country context.

Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study.

BACKGROUND: The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs. METHODS: This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case. RESULTS: The health impacts are calculated in terms of healthy life years gained for 2020-2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018. CONCLUSIONS: Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran.

Study of health resource and health outcomes: Organization of economic corporation and development panel data analysis.

CONTEXT: There are numerous factors which affect the health status in different ways, including financing mechanisms, health-care expenditures, socioeconomic characteristics, and health-care resources. One of the most important factors which contribute to the health status of a population is health-care resource which includes number of beds or health-care professionals for instance. AIMS: The objectives of this study were as follows: to examine the regression of the life expectancy and health-care inputs and also to investigate the regression of death rate and health-care inputs. SETTINGS AND DESIGN: This study was a panel dataset analysis of OECD countries. MATERIALS AND METHODS: A generalized method of moment (GMM) regression models with country-level health outcomes (death rate and life expectancy) as dependent variables were estimated. A panel dataset with n = 26 (the number of countries) and T = 12 (the number of time periods) was used. The GMM regression model was used to estimate the effect of health-care resources on health outcomes. RESULTS: Findings showed that there are strong reverse correlations between immunization rate and number of physicians with crude rate of death (-2.64 [P < 001] and -76.50 [P < 001], respectively). There were also positive correlations between immunization rate and number of physicians with life expectancy at birth (0.01 [P < 001] and 1.03 [P < 001], respectively). Moreover, there were negative correlations between inpatient rate and beds with life expectancy (-0.00003 [P < 001] and -0.12 [P < 001], respectively). CONCLUSIONS: It is essential for policymakers to consider the optimal level of health resource to achieve better health outcomes. Oversupply of hospital beds and specialist doctors could lead to induced demand and put the patients at risk of unnecessary procedures.

Multiple Sclerosis and Catastrophic Health Expenditure in Iran.

BACKGROUND: There are many disabling medical conditions which can result in catastrophic health expenditure. Multiple Sclerosis is one of the most costly medical conditions through the world which encounter families to the catastrophic health expenditures. This study aims to investigate on what extent Multiple sclerosis patients face catastrophic costs. METHOD: This study was carried out in Ahvaz, Iran (2014). The study population included households that at least one of their members suffers from MS. To analyze data, Logit regression model was employed by using the default software STATA12. RESULTS: 3.37% of families were encountered with catastrophic costs. Important variables including brand of drug, housing, income and health insurance were significantly correlated with catastrophic expenditure. CONCLUSIONS: This study suggests that although a small proportion of MS patients met the catastrophic health expenditure, mechanisms that pool risk and cost (e.g. health insurance) are required to protect them and improve financial and access equity in health care.

Estimating the marginal effect of socioeconomic factors on the demand of specialty drugs.

Given the growing importance and role of drugs in the treatment of diseases, as well as replacement of them rather than expensive and often unsafe procedures, study of socioeconomicfactors affecting future demand for them seems necessary.we seek to examine the extent of to which socioeconomic factors affect specialty medicine use by the patients.using data from questionnaires completed by 280 patients with multiple sclerosis, hemophilia, thalassemia, and chronic kidney disease, we estimate marginal effect of significant variables in probit model.We found that the need for the patient(ME = 0.858), deterioration of the patient (ME = -0.001), household size (ME = 0.0004), House Ownership (ME = -0.002), gender (ME = -0.04), income (ME = -0.0007), education (ME = -0.0021) and job (ME = -0.0021) are significant variables affecting demand for specialty drugs. We conclude that it can be programmed to promote and protect the welfare of patients by specific factors such as income, and largely affect the demand of medication and medical services. Therefore economic aid to these patients should not be limited only to medical subsidies, especially in patients with MS, income and welfare can reduce drug demand.