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In May 2014, a new reform in the health sector of Iran was implemented called “health evolution plan.” In the first phase of this reform, the government reduced out-of-pocket payments for service delivery by paying subsidies to the services and after that a revision was done to the medical services values book to improve equity and increase motivation of health professions. One of the affected services in this reform was coronary artery bypass surgery. The purpose of this paper is to show the effects of HEP on costs of coronary artery bypass surgery.

A before-after study was done for this purpose and 167 patients’ total costs and out-of-pocket payments were calculated for the years 2013 (before) and 2014 (after) the reform in three private hospitals of Rasht city, Iran. Econometrics models were estimated after adjustment of confounding variables.

The results of this study showed that surgery costs increased significantly from $1,643.3 to 2,119.5. Nursing and other costs increased significantly from $290.3 to 414.2 and anesthetize costs increased from $619.2 to 947.01. The results of regression model showed that total costs increased $3,008.6 after adjustment of confounders (p-value=0.037). However, no significant changes were found for out-of-pocket payments and out-of-pocket percentage.

The study findings revealed that HTP was not successful enough in financial protection in the private sector.

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.

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.

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).

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.

As a human right, people need to arrive early at the hospitals when they are injured in traffic accidents. Both the mean and equality of the time of arriving at the hospital are important. This study aimed to investigate inequality in arrival time of emergent traffic accident patients to the hospital in 2018–2019 in a city in the North of Iran.

The authors extracted the data from the Guilan province trauma system databank in Poursina Hospital in Rasht in 2018 and 2019. The Gini coefficient was used to calculate inequality, and a regression model was estimated for determining the reason for inequality in time to receive hospital services.

The study showed that patients’ arrival time from the time of the accident to the time of arrival to the hospital was 64.48 ± 47.63 min (minimum of 9 min and maximum 462 min). Gini coefficient was 0.31 (p <0.001), which does not show high inequality. Regression results showed that the transfer time of patients by car was 40 min longer (p-value <0.001) than ambulances (p = 0.036). In children, the transfer time was 42 min less (p = 0.003). Other variables did not explain the inequality (p > 0.05).

According to the time of arrival of patients and Gini index, in Rasht, inequality in providing services is not in a bad condition. This indicates that the emergency department does not systematically transport people to the hospital late.

Mental health is an inevitable and vital dimension when it comes to providing a global definition for the appropriate health status. This highlights the importance of investigating factors influencing utilization and out-of-pocket payments (OOP) for mental health services. Thus, the purpose of this paper is to assess the determinants of the utilization and OOP for psychiatric healthcare in Iran.

A total of 39,864 households were included in this cross-sectional study. Data on the utilization and OOP for psychiatric healthcare as well as all their determinants (e.g. wealth index of households, geographical area, household size, etc.) were extracted from the Household Income and Expenditure Survey (HIES). The HIES was conducted by the Statistical Center of Iran in 2016. A zero-inflated Tobit model was used to identify the main factors affecting utilization and OOP for psychiatric healthcare utilization.

The average of utilization and OOP for psychiatric services was found to be 14.67 times per 1,000 households and $7.783 per month for service users, respectively. There were significant positive relationships between income and utilization (p=0.0002) and OOP (p<0.0001) for psychiatric services. Significant negative associations were found between the number of illiterate people in the household and OOP (coefficient=−1.56) and utilization (coefficient=−0.2002) for psychiatric services. Utilization and OOP for psychiatric services were statistically significantly higher among households with higher wealth status.

Despite the higher rate of mental disorders, the utilization of psychiatric services in Iran is very low. Due to financial barriers and insufficient insurance coverage, high socioeconomic status (SES) households utilize more psychiatric services than low-SES households. Thus, the integration of mental health services in public health programs is required to improve the utilization of psychiatric services in Iran.

Studying the relationship between crime and traffic accidents in different geographical regions is very critical since varying relationships have been reported to exist in diverse areas. The purpose of this paper is to determine the relationship between crime with injuries and deaths due to road traffic accidents in Iran.

In this study, macro-level panel data between 2007 and 2013 were used. The number of folders due to crimes in each province was used as explanatory variables to show the amount of crime in each province. The number of fatal and injury death was used as outcome variables. The models were estimated using fixed effect panel regression estimator.

The results of this study showed that the number of records in courts (Cr) had a significant positive relationship with fatal accidents (coefficient=0.006). In the injury accidents model, Cr coefficient was 0.008 and significant. In addition, GINI had positive relationship with fatal accidents (coefficient: 1.396), while it had no significant relationship with injury accidents.

A positive association was found between crime and mortalities and morbidities due to traffic accidents. Traffic accidents and crimes are derived from a similar nature. So traffic accidents could be categorized as crime and it is important to increase more prohibitions to decrease traffic accidents. Prevention programs should focus on population groups with high social distinction and criminals, especially traffic offenses.

The main aim of this study is to investigate the effects of marketing and costs and research and development (R&D) investments on profitability of pharmaceutical companies of Iran.

In this study, pharmaceutical companies that have been accepted in Tehran Stock Exchange until March 19, 2013 were investigated. Random-effect panel data estimator was used for this purpose.

The findings indicate that variables such as company size, capital-to-total asset ratio and debt-to-asset ratio have an effect on profitability. But, company life, advertising cost and R&D investment are ineffective on profitability.

Legal issues like not having patent law and pricing mechanism are reasons for the ineffective relationship between R&D and marketing costs and its effect on profitability of the Iran pharmaceutical industry.

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.

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.

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.

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.

Mental health is one of the most important factors for evaluating the health of different age groups in the community. The most common forms of mental health disorders are depression and anxiety. Health status of students as an important age group has positive consequences in the community. To provide special recommendations for preventing mental disorders, the purpose of this paper is to determine the correlations among the individualism and family orientation and mental health.

A meta-analysis was conducted to find scores of mental health. International databases of Scopus and PubMed as well as Iranian databases of IranMedex and SID were systematically searched in September 2014 for studies conducted on Iranian students. Of 379 reviewed studies, 58 were selected for meta-analysis. A meta-regression model was estimated to show the effects of individualism and family orientation on mental health.

Eight studies were conducted in Tehran. Eight studies were published in English. In nine studies, school students, and in one study both school and university students were surveyed. General Health Questionnaire-28 score varied from 13.77 in Arak to 47.78 in Tehran. The results of this study showed that the pooled mental health score for Iranian students was 23.725, indicating that Iranian students had poor mental health. In meta-regression, the coefficient of family orientation was −0.2893 and it was significant. Other variables did not have any significant relationship with mental health scores.

Improvement of living conditions and enabling the youth to positively communicate with different social groups are recommended.

The purpose of this paper is to study, inequalities between general physicians’ and specialists’ visits in Shiraz. Also, the factors effecting the utilization of visits were determined.

Concentration index and curves, ranked by income and quality of life were used to estimate the amount of inequality in the utilization of services. Health utilization data which had been gathered already were used for this purpose. Poisson regression was used to construct the models.

Results of the study showed that, inequalities in specialists’ visits were higher than GPs’. Complementary insurances users and females used more specialist services. People with higher quality of life utilized fewer GPs’ and specialists’ services.

New evidences about inequality in health services utilization and its components in Iran was surveyed.

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.

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.

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.

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