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Article
Publication date: 1 October 2018

Ali Kazemi Karyani, Satar Rezaei, Behzad Karami Matin and Saeed Amini

Poor health-related quality of life (HRQoL) is one of the important issues in the health sector. The purpose of this paper is to investigate the prevalence and…

Abstract

Purpose

Poor health-related quality of life (HRQoL) is one of the important issues in the health sector. The purpose of this paper is to investigate the prevalence and socio-economic inequality in poor HRQoL in Tehran city, Iran.

Design/methodology/approach

In total, 562 adults were included in this cross-sectional study. The cluster sampling method was used for data collection from May to June, 2016 in Tehran city, Iran. Data on HRQoL, using EuroQol 5-dimensions questionnaire, and data on socio-economic and demographic variables were gathered. Convenience regression method was performed to measure the concentration index (CI). Decomposition analysis was performed to determine the contribution of variables on socio-economic inequality in poor HRQoL. All analyses were performed by Stata v.14.

Findings

The prevalence of poor HRQoL was 28.3 percent. The value of CI for “poor HRQoL” was −0.299 (95% confidence interval: −0.402 to −0.195). Socio-economic status (SES) was the largest contributor to socio-economic inequality in poor HRQoL (69.44 percent of inequality was explained by SES). Age, obesity and race had a positive contribution to socio-economic inequality in poor HRQoL among the participants. Nonetheless, sex and smoking intensity had a negative contribution to inequality in poor HRQoL.

Originality/value

There is little evidence about the prevalence of poor HRQoL in insured people. This study provided new evidence in this area through the investigation of socio-economic inequality in poor HRQoL and its determinants among people with health insurance in Iran using decomposition analysis.

Details

International Journal of Human Rights in Healthcare, vol. 12 no. 1
Type: Research Article
ISSN: 2056-4902

Keywords

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Article
Publication date: 20 August 2018

Satar Rezaei, Abraha Woldemichael, Mohammad Hajizadeh and Ali Kazemi Karyani

Protecting households against financial risks of healthcare services is one of the main functions of health systems. The purpose of this paper is to provide a pooled…

Abstract

Purpose

Protecting households against financial risks of healthcare services is one of the main functions of health systems. The purpose of this paper is to provide a pooled estimate of the prevalence of catastrophic healthcare expenditures (CHE) among households in Iran.

Design/methodology/approach

Both international (PubMed, Scopus and Clarivate Analytics (previously known as the Institute for Scientific Information)) and Iranian (Scientific Information Database, Iranmedex and Magiran) scientific databases were searched for published studies on CHE among Iranian households. The following keywords in Persian and English language were used as keywords for the search: “catastrophic healthcare costs,” “catastrophic health costs,” “impoverishment due to health costs,” “fair financial contribution,” “prevalence,” “frequency” and “Iran” with and without “health system”. The I2-test and χ2-based Q-test suggested heterogeneity in the reported prevalence among the qualified studies; thus, a random-effects model was used to estimate the overall prevalence of CHE among households in Iran.

Findings

A total of 24 studies with a cumulative sample of 301,097 households were included in the study. The estimated pooled prevalence of CHE among households was 7 percent (95 percent confidence interval: 6–8 percent). Meta-regression analysis indicated that the prevalence of CHE was inversely related to the sample size (p<0.05). The results did not suggest a significant association between the prevalence of CHE and the year of data collection.

Originality/value

The findings revealed that the prevalence of CHE among Iranian households is significantly higher than 1 percent, which is the goal set out in Iran’s fourth five-year development plan. This warrants further policy interventions to protect households from incurring CHE in Iran.

Details

International Journal of Human Rights in Healthcare, vol. 12 no. 2
Type: Research Article
ISSN: 2056-4902

Keywords

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Article
Publication date: 17 December 2018

Satar Rezaei, Mohammad Hajizadeh, Ali Kazemi Karyani, Shahin Soltani, Heshmatollah Asadi, Mohammad Bazyar, Zahra Mohammadi, Neshat Kazemzadeh and Bijan Nouri

Appropriate access to formally-trained health workers for people living in rural and underdeveloped areas is a continuing challenge worldwide. The purpose of this paper is…

Abstract

Purpose

Appropriate access to formally-trained health workers for people living in rural and underdeveloped areas is a continuing challenge worldwide. The purpose of this paper is to investigate the willingness of formally-trained health workers to practice in underdeveloped areas and its main determinants among medical students in the western provinces of Iran.

Design/methodology/approach

A total of 753 medical students from four provinces in western Iran (Kermanshah, Ilam, Lorestan and Kurdistan) were surveyed cross-sectionally in 2017. A self-administrated questionnaire was used to collect data on sociodemographic characteristics, willingness to practice in underdeveloped areas, intrinsic (e.g. desire to help others and self-interest in medicine) and extrinsic (e.g. the high income of physicians and social prestige) motivations of the study population. Multivariable logistic regression was used to identify the main determinants of willingness to practice in underdeveloped areas among medical students after their graduation.

Findings

The results indicated that 58.3 percent of students were willing to practice in underdeveloped areas. While 59 percent of the study population had a strong extrinsic motivation to study medicine, the remaining 41 percent of the study population had a strong intrinsic motivation to study medicine. The logistic regression results indicated that low parental professional and educational status, an experience of living in rural areas and having strong intrinsic motivation were associated with greater willingness to practice in underdeveloped areas.

Originality/value

This is the first study to investigate the willingness to practice in underdeveloped areas and its main determinants among medical students in the west of Iran.

Details

International Journal of Health Governance, vol. 24 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 12 April 2018

Satar Rezaei, Mohammad Hajizadeh, Mohammad Bazyar, Ali Kazemi Karyani, Behrooz Jahani and Behzad Karami Matin

The Health Sector Evolution Plan (HSEP) is the most recent reform in Iran’s health care system that was launched in May 2014 in all university-affiliated hospitals to…

Abstract

Purpose

The Health Sector Evolution Plan (HSEP) is the most recent reform in Iran’s health care system that was launched in May 2014 in all university-affiliated hospitals to reduce health care expenditure for patients, while improving the efficiency and quality of hospital services. The purpose of this paper is to evaluate the impact of the HSEP on the performance of 15 hospitals affiliated with Kermanshah University of Medical Sciences (KUMS), located in the western region of Iran.

Design/methodology/approach

The Pabon Lasso model was used to measure the performance of hospitals before and after the implementation of the HSEP in 2013-2014 and 2015-2016, respectively. Three indicators of average length of stay (ALoS), bed occupancy rate (BOR) and bed turnover rate (BTR) were analyzed by the Pabon Lasso model.

Findings

The results showed that the average ALoS, BTR and BOR before the introduction of the HSEP were 2.59 days, 92 times and 57 percent, respectively, and the corresponding figures for these indicators after the implementation of the HSEP were 2.61 days, 98.9 times and 59.9 percent. The results indicated that before the introduction of the HESP, 40 percent of hospitals were in zone 1 (poor performance: low BTR and BOR and high ALoS), 27 percent in zone 2, 20 percent in zone 3 (good performance: high BTR and BOR and low ALoS) and 13 percent in zone 4. After the HSEP, the proportion of hospitals in zones 1-4 was 33, 27, 20 and 20 percent, respectively.

Originality/value

This study is the first to use the Pabon Lasso model technique to evaluate the impact of the HSEP on hospitals affiliated with KUMS.

Details

International Journal of Health Governance, vol. 23 no. 2
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 11 March 2019

Satar Rezaei, Mohammad Hajizadeh, Bijan Nouri, Sina Ahmadi, Shahab Rezaeian, Yahya Salimi and Ali Kazemi Karyani

The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency.

Abstract

Purpose

The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency.

Design/methodology/approach

A systematic literature search was conducted using both international (the Institute for Scientific Information, Scopus and PubMed) and Iranian scientific (Magiran, IranMedex and Scientific Information Database) databases. The review included original studies that used the Pabon Lasso Model to examine Iranian hospital performance, published in Persian or English. A self-administered checklist was used to collect data. In total, 12 questions were used for quality assessment.

Findings

In total, 34 studies met our inclusion criteria. The fixed-effects meta-analysis indicated that 19.2 percent (95% confidence interval (CI): 15.6–23.2 percent) of hospitals were in Zone 1 (poor performance: low bed turnover rate (BTR) and bed occupancy rate (BOR) and high average hospital stay (ALoS)), 23.7 percent (95% CI: 20.1–27.8 percent) were in Zone 2, 31.7 percent (95% CI: 27.7–36 percent) in Zone 3 (good performance: high BTR and BOR and low ALoS) and 25.4 percent (95% CI: 21.7–29.5 percent) in Zone 4.

Practical implications

Results help Iranian health policymakers to understand hospital performance, which, in turn, may lead to promoting greater awareness and policy attention to improve Iranian hospital efficiency.

Originality/value

This study indicated that most Iranian hospitals had sub-optimal performance. Further studies are required to understand factors that explain the country’s hospital inefficiency.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 6 June 2016

Sara Emamgholipour Sefiddashti, Ali Kazemi Karyani and Sadegh Ghazanfari

Accessing adequate healthcare to all people is one of the main goals of the health sector. The purpose of this paper is to investigate healthcare services access…

Abstract

Purpose

Accessing adequate healthcare to all people is one of the main goals of the health sector. The purpose of this paper is to investigate healthcare services access development of the provinces in Iran during 2007 and 2013.

Design/methodology/approach

This is a descriptive cross-sectional study. The study population included all the provinces in Iran. The data for 13 variables, including physical and human health resources, was collected from the Ministry of Health and Medical Education and the Statistics Center of Iran. Taxonomy technique was used to determine the degree of healthcare services access development in the provinces.

Findings

The findings show that Semnan was the province with the most developed healthcare services access with development score of 0.342 while Sistan Balocehstan province was the least developed with development score of one in 2007. In the year 2013, Chahar-Mahal Bakhtiari and Sistan Baluchestan were the least and most developed provinces with scores of 0.551 and 0.989, respectively. The mean and standard deviation of the development scores in access to healthcare services in 2007 and 2013 were 0.7463±0.1268 and 0.7766±0.1058, respectively.

Originality/value

Most previous studies that examined disparities in access to healthcare resources in Iran only considered one resource. This study applied a taxonomy technique to investigate the disparity and changes in access using 13 main healthcare resources. This approach helped the authors to investigate whether the decisions of the policy makers were intended to eliminate the disparities.

Details

International Journal of Human Rights in Healthcare, vol. 9 no. 2
Type: Research Article
ISSN: 2056-4902

Keywords

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Article
Publication date: 21 September 2015

Ali Kazemi Karyani, Enayatollah Homaie Rad, Abolghasem Pourreza and Faramarz Shaahmadi

Health can be influenced by many factors. One of the factors is the political context of the country and democracy. The purpose of this paper is to examine the effects of…

Abstract

Purpose

Health can be influenced by many factors. One of the factors is the political context of the country and democracy. The purpose of this paper is to examine the effects of freedom in press and polity index in overall, public, private and out of pocket health expenditures.

Design/methodology/approach

A long-term panel data approach has been used to examine the relationship between democracy and health expenditures. The authors inserted polity and freedom into press indexes in the health expenditure model.

Findings

Increase in freedom of the press and democracy will increase the overall, public and private health expenditures while they decrease out of pocket health expenditures.

Originality/value

Polity and freedom index has a significant impact on all the health expenditure models.

Details

International Journal of Human Rights in Healthcare, vol. 8 no. 3
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 18 July 2019

Rasoul Tabari-Khomeiran, Elham Ehsani-Chimeh, Ali Davoudi Kiakalayeh, Enayatollah Homaie Rad and Sajad Delavari

Equal distribution of health human resources is a major issue to achieve human rights in healthcare. Rural family physicians (RFPs) as a part of health human resources…

Abstract

Purpose

Equal distribution of health human resources is a major issue to achieve human rights in healthcare. Rural family physicians (RFPs) as a part of health human resources play an important role in delivering health services, so the purpose of this paper is to calculate amount of inequity in distribution of RFPs in Iran.

Design/methodology/approach

In this study, the authors tried to find inequity in the distribution of RFPs in the provinces of Iran. For this purpose, inequity indices containing concentration curves and indices were calculated by ranking health-adjusted life expectancy (HALE). Furthermore, a regression model was estimated to find the pattern and influencing factors of inequity in the distribution of RFPs.

Findings

The number of male RFPs was significantly higher in Sistan va Baloochestan, and in the same line, the number of female RFPs was higher in Zanjan province. Concentration index of total RFPs was 0.0568 (not significant) (males= 0.041, females= 0.0718). The results of regression model showed that HALE and per capita GDP did not have any significant relationship with RFPs distribution (HALE p=0.753, GDP p=0.792).

Originality/value

The RFP plan was successful in enhancing equal access to physician and health care services relatively. However, gender imbalance in distribution of RFPs was high especially in less-developed regions.

Details

International Journal of Human Rights in Healthcare, vol. 12 no. 4
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 16 September 2019

Satar Rezaei, Mohammad Hajizadeh, Sina Ahmadi, Sadaf Sedghi, Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad and Enayatollah Homaie Rad

Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to…

Abstract

Purpose

Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to measure and decompose socioeconomic inequality in CHE among households in Kermanshah province, Western of Iran.

Design/methodology/approach

This cross-sectional study was carried out among 1,188 households in 2017. Data were extracted from the Household Income and Expenditure Survey which is conducted by the Statistical Center of Iran. The CHE is defined as household healthcare expenditure greater than or equal to the 40 percent of household’s “capacity to pay.” The concentration curve and the Wagstaff (W) and Erreygers (E) indexes were used to illustrate and measure the extent of socioeconomic inequality in CHE. In addition, the authors decomposed the W and E indexes to identify the main determinants of socioeconomic inequality in CHE.

Findings

The results indicated that the prevalence of CHE among households was 4.12 percent (95% confidence interval (CI): 3.13 to 5.42 percent). The estimated value of the W and E indexes were −0.2849 (95% CI: −0.4493 to −0.1205) and −0.0451 (95% CI: −0.0712 to −0.0190), respectively; suggesting the concentration of CHE prevalence among the poor households. Decomposition analyses indicated socioeconomic status as the most important factor contributing to the concentration of CHE among the poor. In contrast, health insurance coverage was found to increase the concentration of CHE among the rich in Iran.

Originality/value

The current study demonstrated a higher concentration of CHE among the poor households in Kermanshah province. These results call for the government’s efforts to reduce healthcare expenditure among socioeconomically disadvantaged populations. Further studies are required to understand the mechanisms through which health insurance coverage increased the probability of CHE among rich in Kermanshah province.

Details

International Journal of Social Economics, vol. 46 no. 9
Type: Research Article
ISSN: 0306-8293

Keywords

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