Out-of-pocket pharmaceutical expenditure and its determinants among Iranian households with elderly members: a double-hurdle model.

OBJECTIVES: The population of older adults continues to grow in Iran, with pharmaceutical costs as a leading driver of household health-related costs. The present study was conducted to estimate the out-of-pocket pharmaceutical expenditure and its socioeconomic predictors among households with the elderly in Iran. METHOD: This study is a secondary analysis using 2019 national household expenditure and income survey data in Iran. The sample size was 9381 households with at least one member older than 65. The double-hurdle model in STATA 16 was used to examine the association between independent variables and households' out-of-pocket pharmaceutical expenditures. RESULTS: The mean out-of-pocket pharmaceutical expenditures for each household with elderly member was $8065 per year. There was a positive association between the (female) gender of the household head, urban residence, employment status, insurance expenditure and a higher level of education of the head of the household with the out-of-pocket pharmaceutical expenditures (P < 0.05). The income of elderly households did not affect these expenditures (P > 0.05). CONCLUSIONS: This study showed that the socioeconomic characteristics of elderly families not only influenced their decision to enter the medicine market, but also the rate of medicine purchase. It is helpful to manage and control the pharmaceutical costs among the elderly.

Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales.

BACKGROUND: Primary health care is the entry point to the health-care system and regarded as an essential step to achieving universal health coverage. The present study aimed at evaluating the quality of health-care services provided in health centers in Mashhad, Iran. METHODS: This was a cross-sectional study implemented among 200 health service users who were referring to four health centers in Mashhad during January to June 2019. The quality of services in health centers was evaluated with the SERVQUAL and HEALTHQUAL models. Data was analyzed by employing paired t-test and independent sample t-test using SPSS version 16 software. The Levene test was used for examining the equality of variance (homogeneity). Significance level of all the tests was considered when p ≤ 0.05. RESULTS: According to the results of SERVQUAL questionnaire, the average scores of health service users' expectations and perceptions were 4.97 and 3.26, respectively, and the quality gap in the provided services was equal to - 1.7. Based on HEALTHQUAL questionnaire, the average scores of health service users' perception and expectations were 4.72 and 3.25, respectively, and the quality gap in the provided services was equal to - 1.16. Empathy was the highest quality dimension (- 2.019) based on SERVQUAL model, and efficiency dimension was the highest based on HEALTHQUAL model (- 1.761). CONCLUSIONS: The findings of the current study showed a negative gap between the service users' expectations and perceptions in both models. Therefore, the results of this study helps the health managers and policymakers to plan effective interventions for improving the provided services emphasizing the dimensions with the wider gaps.

A new method of "student-centered formative assessment" and improving students' performance: An effort in the health promotion of community.

BACKGROUND: Improving the learning process in education will empower medical students, and also formative assessment helps improve the teaching-learning process by providing ongoing reflective information about learning gaps. OBJECTIVE: The aim of this study was to explore the effect of student-centered formative assessment by weekly reflective self-correction quizzes on medical laboratory students' performance on the final examination of hematology course in 2018. MATERIALS AND METHODS: A semi-experimental study was conducted on fifty students divided randomly into intervention (n = 25) and control groups (n = 25) using convenience sampling in 2018 from Torbat Heydariyeh University of Medical Sciences, Iran. Data analysis was performed using SPSS software version 16, two-sample t-test, Chi-square test, and analysis of covariance. RESULTS: The intervention had positive effects on students' mean test scores in hematology II so that the intervention and control groups managed to obtain 18.45 ± 1.46 and 14.57 ± 2.64, respectively (P < 0.01). CONCLUSIONS: The results suggested that weekly formative assessments along with reflective self-correction activity and active participation of students in the learning process by designing questions could improve student learning.

Technical efficiency and its affecting factors in Tehran's public hospitals: DEA approach and Tobit regression.

Background: Measuring hospital efficiency is one of the tools for determining how to use resources. Considering the necessity of measuring the efficiency in hospitals, the current study was conducted to evaluate the efficiency and its determining factors in the Hospitals affiliated to medical universities in Tehran. Methods: This was a descriptive-analytical and longitudinal study. In the first stage of the research, the variables affecting the efficiency of hospitals were extracted using the Delphi method. In the second stage, th. Efficiency of 29 public hospitals in Tehran from 2012 to 2016 was calculated using data envelopment analysis techniques. We performed a sensitivity analysis of the efficiency scores by running the DEA model several times using different combinations of input variables. At last, applying the Tobit regression, factors explaining the inefficiencies of hospitals were determined. Data analysis was done by STATA 12 and SPSS 16 software. Significance level of all the tests was set at .05. Results: In the first stage, 10 input variables and 10 output variables necessary from the mangers' point of view were identified to test efficiency. In the second stage, the mean of hospital efficiency was ascending from 2012 to 2015, and then it descending after 2015. According to the results of sensitivity analysis, despite the variability of technical efficiency during the study period (p<0.0001), the difference between the mean performance scores among different scenarios was not significant (p=0.066). Based on the third stage results, the average length of stay (Beta=-1.60E-12, p=0.030) and educational status (Beta=-2.89E+00, p=0.001) had a significant negative effect on hospitals' efficiency. Conclusion: The study results indicated that the efficiency changes during the years investigated were significant among Tehran public hospitals. The optimal use of inputs to produce hospital services should be on the agenda of health managers and policymakers.