Efficiency of hospitals in COVID-19 era: a case study of an affected country.

BACKGROUND: The COVID-19 pandemic has affected all aspects of human life and society and has damaged the global economy. Health systems and hospitals were not exempted from this situation. The performance of hospitals during the COVID-19 pandemic was affected by policies related to the pandemic and other factors. This study aimed to investigate hospital performance indicators such as admissions and revenue. METHODS: The medical records of patients with selected orthopedic and general surgical diseases were studied in two government hospitals in the capital city of Urmia in the second quarter of 2019, with the same period in 2020. Data were extracted based on the number of medical records, including length of stay, hospitalization type, sex, age, insurance, number of deaths, and readmissions from the medical records department. Payment amounts were collected from the revenue department and Hospital Information System. Two performance indicators, two result indicators, and two control indicators were used. Mean disease-specific revenue, total revenue, length of stay, and bed occupancy rate were calculated for both periods. Data were analyzed using SPSS (version 16) and the Mann-Whitney statistical test. RESULTS: 2140 cases were studied in the two disease groups. An increase was observed in the number of hospitalizations and average length of stay during the pandemic. The mean disease-specific revenue in the quarter of 2020 was higher than in 2019. However, total revenue decreased, and the difference in the mean of total revenue was significant for the two years (P = 0.00) in teaching center. The number of readmissions remained unchanged throughout in the pandemic. The number of deaths due to general surgery diseases in 2020 compared to the same period in 2019 was associated with a relative increase. CONCLUSIONS: The COVID-19 pandemic increased the slope of health care costs. The analysis of the studied variables as performance, result, and control indicators showed that hospitalization rate, bed occupancy rate, and total revenue followed a similar and decreasing pattern in the selected hospitals during the COVID-19 pandemic. Hospitals should adopt appropriate strategies so that, in conditions identical to the COVID-19 pandemic, their performance is accompanied by proper management of resources, efficiency, and minimal reduction in revenue.

Price transparency in Iranian healthcare market.

Insufficient price transparency has emerged as a pivotal contributor to patient dissatisfaction, escalating costs, and diminished productivity within Iran's health system. This study aims to delineate and elucidate a definition of price transparency, identify suitable strategies, and present the outcomes associated with establishing a health system that embraces transparent pricing while also addressing the challenges ahead. Employing a quantitative-qualitative research design, data were extracted from a semi-structured interviews with stakeholders. A purposive sampling method, encompassing sequential and snowball techniques, was employed to capture the perspectives of all stakeholders involved in the issue of price transparency in Iran. The interview data were analyzed using the grounded theory approach was classified into three categories: price transparency before, during, and after the receipt of healthcare services. Our findings reveal the causes of low price transparency, strategies to address the issue, and the consequences associated with increased levels of transparency. Ultimately, we contend that health systems can significantly enhance efficiency, patient satisfaction, and the performance of health insurance by adopting transparent pricing for health services, thus obviating the need for resource-intensive restructuring efforts.

The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society. OBJECTIVES: This meta-analysis aims to quantitatively assess the global economic burden of COVID-19. METHODS: A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference. RESULTS: The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher. CONCLUSIONS: Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.

Inequality in the distribution of resources in the health sector before and after the Health Transformation Plan in Qazvin, Iran.

BACKGROUND: The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman-Herfindahl index (HHI). METHODS: This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017. Demographic data pertaining to the cities were obtained from the statistical yearbooks of the Statistical Center of Iran, while information regarding the healthcare workforce was extracted from QUMS records. The analysis utilized two key measures, namely the Gini coefficient and the HHI, to assess the fairness of resource distribution. Data analysis was performed using Microsoft Excel 2016 and the Stata statistical software. RESULTS: The highest number of GPs, specialists, and subspecialists was observed in 2014, 2017, and 2017, respectively, while the lowest number was recorded in 2016, 2011, and 2015, respectively. From 2011 to 2017, the Gini coefficient for GPs ranged between 0.61 and 0.63. Among specialists, the lowest Gini coefficient value was observed in 2015 (0.57), while the highest was recorded in 2017 (0.60). The Gini coefficient for subspecialists remained constant at 0.52 from 2011 to 2017. The HHI revealed a high concentration of GPs in the cities of Qazvin province. Although the disparity gradually decreased in the specialties of eye, ear, nose, and throat, and pediatrics, the concentration still persists in Qazvin. In general surgery, the index value is low, indicating some level of inequality. In anesthesia and neurology, the index value decreased after the HTP and reached 5700; however, achieving equality (below 1000) still requires further efforts. No significant change in the index was observed after the HTP in specialties such as neurosurgery, rehabilitation, and nuclear medicine. Subspecialists also exhibited a concentration in the city of Qazvin. CONCLUSION: Based on the analysis of the Gini and HHI, it is evident that the distribution of GPs has not undergone significant changes following the implementation of the HTP. The Gini coefficient, which ranges from 0.4 to 0.6, indicates a high to complete level of inequality in the distribution of specialists and subspecialists. Moreover, the HHI exceeds 1000, reflecting a concentration of resources in specific areas. As a result, the HTP has not yet achieved its goal of ensuring a fair distribution of human resources. To address this issue, it is recommended to redesign distribution policies, including the allocation of physical health resources, such as specialized hospitals, beds, and medical equipment. Additionally, increasing student admissions in specialized and subspecialized fields and implementing tariff incentives can contribute to a more equitable distribution of resources. By aligning distribution policies with the principle of fairness, the healthcare system can better address the issue of resource distribution.

The impact of government subsidy programs on equity in health financing.

BACKGROUND: Iran government implemented the targeted subsidy plan in December 2010 to reduce energy consumption and inequality. In addition, the Health Transformation Plan was implemented by the Ministry of Health to reduce out-of-pocket payments. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. METHOD: In this study, data on 528,046 households were collected using household surveys during 14 years (2007-2020). The Fairness in Financial Contribution index and Catastrophic Health Expenditures index were calculated. Also, a Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of the two mentioned policies and other socioeconomic characteristics of households on their exposure to Catastrophic Health Expenditures. RESULTS: The FFC index was 0.829 and 0.795 respectively in 2007 and 2020. The trend analysis did not show significant changes in the FFC index between 2007 and 2020. TSP and HTP implementations do not reduce households' exposure to CHE significantly. Crowded households with more elder people, belonging to low-income deciles, without houses, and living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. Highly educated and employed households were exposed to less CHE. CONCLUSION: The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target households (households with more elderly people, lower incomes, without private houses, crowded, rural, and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.

The stochastic frontier analysis technique in measuring the technical and economic efficiency of hospital diagnostic laboratories: a case study in Iran.

An inefficient health system wastes scarce resources even if it makes considerable gains in accountability and equity. Such a system is expected to perform better. Therefore, it is vital to examine the current performance of health systems and their constituents and assess how to reach their maximum potential. This study aimed to evaluate the technical and economic efficiency of medical diagnostic laboratories in hospitals affiliated with Urmia University of Medical Sciences (UUMS) in 2016. In this descriptive-analytical study, data from diagnostic laboratories of the hospitals of UUMS have been inputted into Frontier4.1 software after taking the log of variables. Then, the technical and economic efficiency of the laboratories were obtained by estimating the production and cost function using the stochastic frontier analysis method, assuming input minimization for 2016. The mean technical and economic efficiency score of the diagnostic laboratories were determined to be 93.1% and 51.9%, respectively. These laboratories need to reduce their inputs and costs in order to achieve full efficiency without changing the amount of their output. Although the average economic efficiency of the diagnostic laboratories of the studied hospitals was high, there is still an increase in the efficiency of these units, given the cost of inputs at the time of allocating resources. In addition, it is possible to improve the technical efficiency of the clinical laboratories of hospitals affiliated with UUMS by 48.1% by applying the same level of inputs and without increasing the costs.

Measuring inequality in the distribution of health human resources using the Hirschman-Herfindahl index: a case study of Qazvin Province.

BACKGROUND: Achieving equity in the distribution of health services is one major goal in the health system. This study aimed to determine equality in distributing health human resources (physicians) in the Qazvin University of Medical Sciences before and after the Health Transformation Plan (HTP) based on the Hirschman-Herfindahl index (HHI). METHODS: In this descriptive-analytical study, the statistical population was general practitioners (GPs), specialists and subspecialists in the Qazvin University of Medical Sciences from 2011-to 2017. We extracted demographic statistics of the cities from the Statistical Center of Iran. Physicians' statistics were obtained from the Curative Affairs Deputy at the Qazvin University of Medical Sciences. We assessed inequality using the HHI. RESULTS: The highest number of GPs was in 2014, and specialists and subspecialists were in 2017. The lowest number of GPs, specialists, and subspecialists were in 2016, 2011 and 2015. The HHI for GPs in 2011-2017 was between 4300 and 5200. The lowest concentration for specialists before the HTP plan was the cardiologist with 3300, and after the HTP, the internal specialist with 3900. Also, the numerical value of this index for all subspecialty physicians after the HTP was 10,000, the highest level of concentration. CONCLUSION: The values obtained from the HHI index indicate the high concentration and disproportionate and inequitable distribution of human resources in the health sector in this province. The number of specialists in some cities is still much less than acceptable, and some cities even have shortcomings in the critical specialists.

Cost-benefit analysis of kidney transplant in patients with chronic kidney disease: a case study in Iran.

BACKGROUND: Chronic kidney disease (CKD) is a health problem due to its increasing prevalence and imposes a significant economic burden on the health system. This study aimed to analyze the cost-benefit of kidney transplantation through the valuation of patients with ESRD for a kidney transplant and its costs to help decide this regard. MATERIAL AND METHODS: This study was a descriptive-analytical and cross-sectional economic evaluation study of health interventions performed in Imam Khomeini Hospital in Urmia from the patient's perspective. The records of kidney recipients were used to calculate the direct costs of kidney transplantation based on the government tariff rate in 2021. The willingness to pay for kidney transplantation (benefit) was measured through a questionnaire and with a contingent valuation method from 266 samples of patients with ESRD. The questionnaire designed by the researchers had four scenarios with different chances for kidney transplant success. Validation and test-retest methods were used to check the validity and reliability of the questionnaire. Stata software was used to estimate the regression of the factors affecting the willingness to pay and the kidney transplant demand function. RESULTS: The average cost of a kidney transplant was $877.4. The average willingness to pay for a kidney transplant for four scenarios was estimated at $4733. The mean cost-benefit ratio (BCR) and net present value (NPV) for the four kidney transplant scenarios were 5.39 and $3855. The variables of employment status, awareness of kidney function, number of years with ESRD, insurance coverage, and patients' income significantly affected their willingness to pay. However, the effect of other variables was not significant. The absolute value of price elasticity of kidney transplant demand was also equal to 2.13. CONCLUSION: According to the cost-benefit analysis indexes, the study results showed that a kidney transplant has a net positive benefit for all levels of its probability of success, so the willingness to pay or valuation of patients is about five times the cost of a kidney transplant. Also, the demand for kidney transplantation shows the high sensitivity of the demand for this service to the price. Therefore, preparations for kidney transplantation in patients with ESRD should be considered in situations where the price and cost of transplantation change. The results can help health policy-makers decide to allocate financial resources more efficiently.

Value of willingness to pay for a QALY gained in Iran; a modified chained-approach.

BACKGROUND: Due to the lack of a constant Willingness to Pay per one additional Quality Adjusted Life Years gained based on the preferences of Iran's general public, the cost-effectiveness of health system interventions is unclear and making it challenging to apply economic evaluation to health resources priority setting. METHODS: We have measured this cost-effectiveness threshold with the participation of 2854 individuals from five provinces, each representing an income quintile, using a modified Time Trade-Off-based Chained-Approach. In this online-based empirical survey, to extract the health utility value, participants were randomly assigned to one of two green (21121) and yellow (22222) health scenarios designed based on the earlier validated EQ-5D-3L questionnaire. RESULTS: Across the two health state versions, mean values for one QALY gain (rounded) ranged from $6740-$7400 and $6480-$7120, respectively, for aggregate and trimmed models, which are equivalent to 1.35-1.18 times of the GDP per capita. Log-linear Multivariate OLS regression analysis confirmed that respondents were more likely to pay if their income, disutility, and education level were higher than their counterparts. CONCLUSIONS: In the health system of Iran, any intervention that is with the incremental cost-effectiveness ratio, equal to and less than 7402.12 USD, will be considered cost-effective.

Physician induced demand for knee replacement surgery in Iran.

BACKGROUND: The structure of the Iranian health system has raised this hypothesis that a part of the Knee Replacement Surgery (KRS) services are provided due to Physician-Induced Demand (PID). METHODS: This paper used an unbalanced individual panel data covering the steady-state 15,729 KRSs performed by 995 surgeons provided by the Armed Forces Insurance Organization at the provincial level over the 60 months (2014-2018). We use a generalized method of moment's system (GMM-SYS) to obtain consistent and asymptotically efficient estimates, which provide a vital instrument for our dynamic panel data. RESULTS: The outcomes show that with unequal increasing orthopedic surgeons to population ratio, both the number and size of KRS services were increased significantly at a 1 % level. Given that the positive elasticity obtained for the service size was significantly larger than the number of services, the findings give strong support for the existence of PID in the Iran system for KRS care. Also, the raw and population-adjusted number of KRS, cost, and the surgery per active physician increased significantly at the monthly province level. CONCLUSIONS: This is the first time that the existence of PID in the Iranian health system is investigated using approved econometric models. The findings indicate that the health system structure has been provided the conditions for aggressive, costly, and high-risk services such as KRS to be exposed to PID.

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran.

BACKGROUND: Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. METHODS: In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models. RESULTS: This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan. CONCLUSIONS: The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.

Study of the ex-post moral hazard of laboratory services in Iran.

The basic health insurances cover more than 90% of the Iranian population but have failed to organize the referral system and created favorable conditions for the ex-post moral hazard. Five hundred fifty people older than 15 years were randomly selected in five districts of Urmia city and completed the questionnaire to study the existence of Ex-post moral hazard in utilizing the high-consumption laboratory services (blood and urine tests). In this population-based cross-sectional study, utilization of the services in two groups of insured and uninsured people was analyzed using odds ratio statistics and logistic regression. The findings showed that being female (OR: 2.38) and having health insurance (OR: 2.03) played a very determinative role in obtaining selected laboratory services, and about 9% of the laboratory services provided were caused by ex-post moral hazard. The predicted size of ex-post moral hazard is significant, so its control requires modifying health insurance policies in determining the premium and cost-sharing schemes and controlling physicians' behavior as the principal applicants for these services.

Work environment factors and provider performance in health houses: a case study of a developing country.

OBJECTIVE: Primary Health Care has determined the path to the goal of "Health for All". Defining standards in health facilities play a crucial role in achieving acceptable performance by Community Health Workers. The study aimed to assess the relationship between physical Work environment factors and performance in primary healthcare facilities named health houses in Urmia district health network in North West of Iran. Thirty-five health houses were selected and studied with simple random sampling method. Data collection instrument were a standard checklist. RESULTS: The results highlighted a statistically significant and positive correlation between technical equipment layout (P = 0.01, r = 0.641) with the performance of CHWs and the area of workplace (P = 0.05, r = 0.359) in health houses. Correlation between office equipment layout and performance was negative (P = 0.01, r = - 0.44). Multiple linear regression analysis showed that the performance level was influenced by the staff-mix of CHWs in health houses, layout of technical equipment and layout of office equipment.

The economic efficiency of clinical laboratories in public hospitals: A case study in Iran.

INTRODUCTION: Clinical laboratories are identified as one of the most important and expensive units of the health system. Therefore, it is essential to pay attention to these units' cost efficiency. This study purpose was to evaluate the economic efficiency of hospitals' laboratory units affiliated to Urmia University of Medical Sciences (UMSU), in order to assess their performance. METHODS: This research was a descriptive-analytic study that was accomplished in 2017. The statistical population of the study included all of the hospitals' clinical laboratories affiliated to UMSU. Moreover, DEA method and Deap2.1 software were used to analyze data. In this study, technical and allocative efficiencies of the studied laboratory units were also calculated in addition to the determination of the economic efficiency of the laboratories. RESULTS: The average economic efficiency of clinical laboratories calculated by DEA in 2017 was 0.676. This value was lower than the allocative and technical efficiency scores, which indicates that these units could attain full efficiency by reducing their costs without having any effect on output values. Moreover, about 14 percent of the clinical laboratory units were economically efficient. In addition, it is noteworthy to state that, from total of university hospital laboratories, only three hospitals had no economic excess or deficiency values of inputs. CONCLUSION: Considering that 76% of laboratory units have not been economically efficient, it is necessary for the laboratory managers to consider optimum allocating of resources, with respect to the cost of laboratory equipment and inputs in order to increase their units' economic efficiency.

The effect of study preparation on test anxiety and performance: a quasi-experimental study.

Background: Health care education is an important issue in the development of countries, and student's academic achievement plays an important role in this respect. Test anxiety can affect the academic performance of students. This study aimed to investigate the effect of study preparation on test anxiety and performance of public health students. Methods: This quasi-experimental study investigated the effect of study preparation on reducing test anxiety and improving the performance of public health students at Urmia University of Medical Sciences, Urmia, Iran, in the academic year 2016-2017. All second- and third-year bachelor's students in public health major were assigned into the intervention (n=20) and control groups (n=25). The assignment was based on the study preparation items and the defined benchmark. Data on general stress and test anxiety were collected by subjective self-assessment via paper-and-pencil surveys in the first week of the semester and before the final exam, respectively. Results: No significant difference was found in the level of general stress between the two groups at the beginning of the semester (p=0.55) based on the study preparation items. The level of test anxiety in the intervention group (47.90) was lower than in the control group (34.64) at the end of the semester (p=0.001). The mean value of exam scores was higher in the intervention group (p=0.015). Conclusions: The intervention reduced the level of test anxiety and improved the performance of students. Faculty members and heads of the departments should help students learn about the study preparation over the semester with engagement in learning-oriented approaches and class activities.

The Structure of the World Pharmaceutical Market: Prioritizing Iran's Target Export Markets.

Iran`s pharmaceutical products market has faced fluctuations over time. Suitable market selection is necessary for stability of pharmaceutical exports. This study aimed to determine the structure of the world pharmaceutical market and to identify the target of Iranian pharmaceutical export. T do so, concentration ratios and Herfindahl index were used to address the world pharmaceutical market from 2001 to 2012. Also, a composite index was used to identify the target markets of Iran's pharmaceutical industry. The results showed that the export side of world pharmaceutical trade has shifted to open oligopoly, thereby decreasing the monopolistic power of exporters. The import side, however, follows monopolistic competition. It has been observed that the structure of Iran's pharmaceutical export is shifting to open oligopoly; though, pharmaceutical importers from Iran have not been stable. Moreover, 27 countries were identified as target markets. Due to significant differences between the current and potential export destinations of Iran's pharmaceutical products, exporters should choose suitable strategies in order to diversify export markets. Such mechanisms as setting preferential tariffs on the basis of bilateral agreements, following effective advertisment, and paying attention to global consumers'preferences can be used to develop Iran's pharmaceutical export to target countries.

The Study of Effective Factors on Iran's Pharmaceutical Export Supply and Demand.

The importance of drug as a valuable export product in the global economy becomes clearer every day. Understanding the problems of exports and factors affecting it, can be an important step to keep Iran's position in the world markets and further export development of this product. In this study, Iranian pharmaceutical exports' supply and demand functions were calculated using co-integration and error correction techniques through time series quarterly data of 2000-2014 in order to identify the factors affecting pharmaceutical exports (short run and long run relationships among the variables) and price and income elasticities. The long run price elasticity of demand of -2.28 indicates that an increase in Iran's export price relative to competitor's export price will have a negative impact on pharmaceutical export volume. Also, the long run income elasticity of foreign demand for pharmaceutical exports of Iran is 1.11. That is an increase in income of foreign countries will have a positive impact on Iran's pharmaceutical export. On the other hand, the long run price elasticity of export supply is 1.09, indicating that the supply of pharmaceutical export is sensitive to the relative price changes. In other words, an increase in export price relative to domestic price as well as an expansion of the pharmaceutical production capacity will increase its export supply. Being aware of the factors affecting the pharmaceutical exports can prepare the ground to develop the pharmaceutical industry and balance the supply and demand in the long run. Therefore, the results of this study can help Iran's policymakers and managers to choose a clearer path for the pharmaceutical trade policies.

Provider knowledge and performance in medication injection safety in anesthesia: A mixed method prospective crosses sectional study.

OBJECTIVES: Injection safety during anesthesia is a challenging health care issue in Iranian hospitals. Anesthesia is one of the most medication-intensive procedures in healthcare and injecting patients are an integral part of that care. The present study aimed to assess the status of medication injection safety practice in a teaching center. DESIGN, SETTING, PARTICIPANTS: A prospective cross-sectional study was done in 2014-2015 at a 500-bed secondary level teaching hospital affiliated with Urmia University of Medical Sciences, Iran. The study population included providers of anesthesia in two groups of operating rooms (ORs) with different types of surgeries at the center. Data were collected using valid and reliable observation and a questionnaire instruments in two consecutive phases. Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests were used for data analyses. RESULTS: A total of 345 injections were observed and recorded during the study period, 53% in group A ORs, and 47% in group B ORs. Eighty-two questionnaires were completed (96.5% response rate) to determine hospital injection practices and personal knowledge of injection safety. Adherence to safety requirements was observed in 58.5% of injections. Fifty five percent of respondents knew that hepatitis B, C, and HIV are blood borne diseases. Observed compliance with injection safety requirements was determined significant by OR groups (P = 0.00). Correlation was significant between observed injection safety practices by age and work experience (P = 0.00). The Kruskal-Wallis test showed a significant difference (P = 0.000) in observed safe injection practices among four job groups but not in reported adherence. Knowledge of respondents was significant by job groups about blood borne diseases and receiving three doses of hepatitis B vaccine. CONCLUSIONS: The study revealed that some of safe injection procedures were well carried out in our ORs, but that others were not. The reported adherence of staff was acceptable but their actual practices were unsafe. It is suggested to implement audits, provide safer supplies, and complete Hepatitis B vaccination of injection providers.

Pabon Lasso and Data Envelopment Analysis: a complementary approach to hospital performance measurement.

BACKGROUND: Performance measurement is essential to the management of health care organizations to which efficiency is per se a vital indicator. Present study accordingly aims to measure the efficiency of hospitals employing two distinct methods. METHODS: Data Envelopment Analysis and Pabon Lasso Model were jointly applied to calculate the efficiency of all general hospitals located in Iranian Eastern Azerbijan Province. Data was collected using hospitals' monthly performance forms and analyzed and displayed by MS Visio and DEAP software. RESULTS: In accord with Pabon Lasso model, 44.5% of the hospitals were entirely efficient, whilst DEA revealed 61% to be efficient. As such, 39% of the hospitals, by the Pabon Lasso, were wholly inefficient; based on DEA though; the relevant figure was only 22.2%. Finally, 16.5% of hospitals as calculated by Pabon Lasso and 16.7% by DEA were relatively efficient. DEA appeared to show more hospitals as efficient as opposed to the Pabon Lasso model. CONCLUSION: Simultaneous use of two models rendered complementary and corroborative results as both evidently reveal efficient hospitals. However, their results should be compared with prudence. Whilst the Pabon Lasso inefficient zone is fully clear, DEA does not provide such a crystal clear limit for inefficiency.

The efficiency and budgeting of public hospitals: case study of iran.

BACKGROUND: Hospitals are the most costly and important components of any health care system, so it is important to know their economic values, pay attention to their efficiency and consider factors affecting them. OBJECTIVE: The aim of this study was to assess the technical scale and economic efficiency of hospitals in the West Azerbaijan province of Iran, for which Data Envelopment Analysis (DEA) was used to propose a model for operational budgeting. MATERIALS AND METHODS: This study was a descriptive-analysis that was conducted in 2009 and had three inputs and two outputs. Deap2, 1 software was used for data analysis. Slack and radial movements and surplus of inputs were calculated for selected hospitals. Finally, a model was proposed for performance-based budgeting of hospitals and health sectors using the DEA technique. RESULTS: The average scores of technical efficiency, pure technical efficiency (managerial efficiency) and scale efficiency of hospitals were 0.584, 0.782 and 0.771, respectively. In other words the capacity of efficiency promotion in hospitals without any increase in costs and with the same amount of inputs was about 41.5%. Only four hospitals among all hospitals had the maximum level of technical efficiency. Moreover, surplus production factors were evident in these hospitals. CONCLUSIONS: Reduction of surplus production factors through comprehensive planning based on the results of the Data Envelopment Analysis can play a major role in cost reduction of hospitals and health sectors. In hospitals with a technical efficiency score of less than one, the original and projected values of inputs were different; resulting in a surplus. Hence, these hospitals should reduce their values of inputs to achieve maximum efficiency and optimal performance. The results of this method was applied to hospitals a benchmark for making decisions about resource allocation; linking budgets to performance results; and controlling and improving hospitals performance.