Search results

High quality health-care delivery is not only the governments’ responsibility but also every prisoner’s right. Health care in prison and, particularly, of Iranian prisoners is increasingly important topic because of the rising number of the prison population. This paper aims to explore health-care managers’ perspectives and experiences of prisons and the barriers to health-care delivery in Iranian prisons.

A qualitative research design was conducted in Iran from October 2018 to August 2019. The participants consisted of 51 health-care managers (50 men and one woman) from Iranian prisons. A combination of face-to-face (N = 42) and telephonic (N = 9) semi-structured interviews were used because of the geographical distribution of the respondents. The first part of the interview guide consisted of demographic characteristics, and the second part consisted of three main open ended-questions. Interviews were recorded and transcribed, and thematic descriptive analysis was used to interpret the data.

The barriers to health-care delivery in Iranian prisons were categorized into four main topics: human resources, financing, facilities and barriers related to the health-care delivery process. Data synthesis identified the following themes for barriers to human resources: barriers to human resources planning (with eight sub-themes); barriers to education (with three sub-themes); and motivational barriers (with seven sub-themes). Moreover, barriers to financing consisted of five sub-themes. The barriers to facilities consisted of barriers related to physical infrastructures (with two sub-themes) and barriers related to equipment (with six sub-themes). Finally, barriers to the health-care delivery process included the following themes: communication barriers (with six sub-themes); legal barriers (with five sub-themes); and environmental-demographic factors (with seven sub-themes).

Identifying the barriers to health-care delivery in Iranian prisons plays a critical role in the improvement of planning, decision-making and the health-care delivery process.

Reducing health inequalities between the poor and the rich is one of the challenges that the Iranian healthcare sector is facing. One of the goals of the Iranian Government in the Healthcare Sector Evolution Plan (HSEP) is claimed to be creating an opportunity for the poor to use inexpensive services. The purpose of this paper is to provide an analysis of the status of the poor in the HSEP. Based on this evaluation, the authors will provide policy recommendations to improve the benefits of the HSEP for the poor people.

This paper is based on a qualitative study conducted in 2017. The research sample includes policymakers, experts and scholars at the macro-level of the Iranian healthcare system who were well-aware of the financial support for the poor. Overall, 35 semi-structured interviews were carried out. Data were analyzed based on the thematic analysis method.

The effects of the HSEP on the poor were studied in terms of their positive outcomes and challenges. Despite the achievements of the HSEP for all people, the most important challenge was the lack of targeted state subsidies for the poor. These subsidies should have included free insurance coverage, reducing inpatient payment and allocation of a separate budget for the poor.

Adopting some policies to target public health subsidies toward the poor such as free insurance specific for the poor (based on means testing), as well as user fee exemption and waivers could improve access to health services for them in Iran. In addition, separate funding for such policies, strengthening health prevention and health care services for marginalized populations, and improving their health literacy could help ensure the poor’s benefiting more from the health care services.

The purpose of this paper is to explore how the clinical governance policy and its main component, patient satisfaction, turned into practice and what they look like on the ground in the centralised health system of Iran.

A qualitative research stance was adopted incorporating three main sources of information: face to face in‐depth interviews and focus groups conducted with hospital senior managers at the teaching hospitals in Kerman city, Iran, as well as documentary analysis of key policy texts. Nine hospital senior managers were purposefully selected for face‐to‐face interviews as well as a purposeful sample of 15 hospital senior managers for focus groups.

The documentary analysis revealed how clinical policy has been put into practice. The interview and focus group data analysis also disclosed four key themes with respect to how policy implementers in the Iranian centralised health system perceive nationally developed policies towards clinical governance and patient satisfaction. These include: a paper exercise; opaque, ambiguous policies; unstable policies; and separation of policy making from policy implementation.

The study revealed a perceived mismatch between the official proposals for clinical governance and their application in practice. The findings of this research lend support to the idea that there should be no separation between policy making process and its implementation; they are inseparable and should be treated in parallel, rather than in sequence. The study further suggests more accountability of the state towards its policies and public alike as a better governance of the health system. State‐level sustainability followed by allocating proper resources to implementation fields and empowering policy implementers coupled with good systems of performance control are the keys to keep patient focus a top priority.

The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.

A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.

The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.

The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.

This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.

Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran’s health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing (EHCF) using the multiple streams model.

This qualitative study was conducted by 26 documents review and analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist based on the goals. All audio-taped interviews were transcribed and analyzed thematically. Data management and analysis were performed using the framework analysis in MAXQDA software.

The framework analysis identified 12 complementary sub-themes totally. Problem stream included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran World Health Organization’s report in 2000, the Targeted Subsidies Law and emphasis on equalizing healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes. Finally, political stream showed four sub-themes including strong support from the Minister of Health for HSEP, mass media, the pressure of WHO and people’s request to reduce health costs.

The limitations of the present study included paying attention to one package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of similar national and international evidence in implementation framework.

The results of this study can be used to analyze other health sector reforms around the word and can help the formulation and implementation of most practical reforms, especially in field of health system financing.

This study gives a holistic view about health system policy setting that can be used for understanding policy-making streams to population.

This is the first study that has examined HSEP (the biggest health sector reform in Iran) from the perspective of agenda setting. In addition, using the popular and well-known Kingdon’s model to explain HSEP agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views by including highly informed people increased the strength of the results of the study. In addition, the short interval between the interview and reviewing the results on reforms reduced the recall bias of the participants in the study.

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.

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.

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.

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.

According to the importance of strategic purchasing as an effective tool for resource allocation and service procurement, this study examines national laws, regulations and other related documents related to the strategic purchasing of health services related to the advanced medical equipment in Iran.

It was a national qualitative document analysis conducted in 2019 applying content analysis approach. The four-step Scott method was used to include the documents in terms of authenticity, credibility, representation and meaningfulness. After retrieving the related documents, they were coded with the implicit and explicit approach. MAXQDA₁₀ was used for content analysis.

The findings show that according to the framework of effective factors on the strategic purchasing of health services, seven main factors are determined as the main essential factors in purchasing advanced medical equipment. These factors consist of health care providers, health service buyers, purchaser and service provider contracts, payment mechanisms, organization and management evaluation of health technology including expensive medical equipment and technology-related.

The study had some limitations as follows: the proposed method should be tested and its feasibility has to be investigated through appropriate tools for Iranian insurance companies and those with the similar settings.

The results of this study can shed more light for policy makers affiliated in Ministry of Health as the main service provider, Ministry of Welfare and the insurance agencies as the main purchasers of health services on paying attention to these seven main themes extracted from the upstream documents and laws and regulations of the Islamic Republic of Iran.

The strategic purchasing of expensive high technology-based medical equipment is a necessity for Iranian public health insurance organizations that is emphasized in national documents in the way of implementing this necessity.

This study examines all the laws and regulations and all related documents in the strategic purchasing of health services related to advanced medical equipment, giving an analysis of the most important challenges and requirements of implementing strategic purchasing in the health services provision sector with expensive medical equipment.

Recent invasions, coups, civil wars, and ethnic crusades have caused many individuals and families around the world to flee their homelands for fear of their own safety. The exodus of refugees to foreign nations causes a strain on those nations’ health care systems and resources. With the assistance of outside organizations, these countries can develop a health care management system for refugees that provides for both their immediate survival and long-term health stability, while preserving critical national resources. This chapter reviews the refugee problem and presents the short-term tactics and long-term strategies undertaken by seven very different national governments to care for the refugees that cross their borders. A model of a sound health care management system is used to incorporate the best practices of each country into a framework for approaching this multi-billion dollar issue.

Health is a human right and a fundamental building block of sustainable development, economic prosperity and poverty reduction. To realize people’s right to health, evaluating the situation of the right and its determinants is necessary. This paper aims to analyze Iran’s conduct in realizing its population’s right to health.

A qualitative case study design involving a structured review of relevant laws, policy documents, reports and academic literature was undertaken. The data were collected from electronic databases and the official Web pages of the United Nations (UN) and Iran’s Government and analyzed by a framework suggested by the UN.

Iran’s law and policies intend to combat health inequalities and to provide an adequate standard of living for everyone, particularly disadvantaged groups and individuals. However, not all laws and policies protecting disadvantaged groups are adequately implemented. There are disparities in health status and access to health care among different socio-economic groups. International economic sanctions and government policies decreased people’s ability to access the necessities of life including health care. Moreover, social determinants of health, such as cultural beliefs regarding women’s rights have not been addressed sufficiently in the country’s laws.

This study includes a broad range of subjects and provides an overview of the health-care system of Iran. However, more detail is needed to describe every aspect of the right to health. It was not feasible to address them all in this paper and needs more research. In addition, as with the majority of qualitative studies, the design of the current study is subject to limitations. Firstly, the research quality of narrative reviews is dependent on the researcher’ skills and more easily can be influenced by his/her personal biases. Second, the rigor is more difficult to maintain, assess and demonstrate. Nevertheless, narrative studies often complement quantitative studies and are informative.

To fulfill the right to health, Iran should improve affordability and quality of care and the situation of the determinants of health. The gaps in people’s access to health care need to be identified, and all necessary means and scarce resources be allocated to remove access barriers and to improve the situation of disadvantaged people. The adoption of relatively low-cost targeted programs, the proper management of resources and the prevention of unnecessary costs are suggested.

This paper uses a unique nationwide survey data derived from the 2003 Utilisation of Health Services Survey (UHSS) in Iran (n=16,935) to analyse inequities of health care utilisation.

Concentration indices are used to measure socioeconomic inequality in actual use of the five types of health services, and in unmet need for two of those types of service (any ambulatory care and hospital admissions). Horizontal inequity indices are employed to examine inequity in ambulatory and hospital care. Generalised linear model (GLM) was employed to investigate factors contributing to the phenomena of “unmet need” and “met unneed”. Moreover, a decomposition analysis of inequality is performed to determine the contributions of each factor to the inequality of “unmet need”.

Results suggest that self‐reported need for ambulatory and inpatient care is concentrated among the poor, whereas the utilisation of ambulatory and inpatient care were generally distributed proportionally. Results of horizontal inequity indices show that the distributions of any ambulatory care and hospital admissions are pro‐rich. The probability of “unmet need” for ambulatory care was higher among wealthier individuals. The decomposition analysis demonstrates that the wealth index, health insurance, and region of residence are the most important factors contributing to the concentration of “unmet need” for ambulatory health care among the poor. Results also illustrate that higher wealth quintiles used more unneeded ambulatory care than their poorer counterparts.

A special characteristic of the UHSS is that it contains questions about the need for medical services use and about actual services use. This characteristic provides an opportunity to measure the inequality of health care consumption against self‐assessed treatment needs, as well as an analysis of which observables are associated with “unmet need”. Moreover, the incidence of health care use when it is reported as not needed can be analysed with this dataset. The analysis of this phenomenon – which we refer to as “met unneed” – is another novel aspect of this work.