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Background: This was a systematic review presenting the future competencies for hospital managers. Methods: Participants, interventions, comparisons and outcomes (PICO) strategy with MeSH terms were used for searching. Databases used were Web of Science, PsycINFO and Medline, EBSCO, ScienceDirect, Emerald, ProQuest, Social Sciences Research Network, Embase, and some Iranian database such as IRANDOC and SID. All publications were accepted if they had been published in English or Persian language and fulltexts were accessible. The study was carried out using a systematic literature search published between January 1995 and December 2018. The Endnote v.17 software was used to facilitate reference management. Quality assessment of publications were carried out independently by two reviewers using the Critical Appraisal Skills Programme (CASP) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A descriptive summary with data tables produced to summarize the literature. Data extraction was conducted by two researchers. Results: Forty seven studies were analyzed to identify the future competencies required for hospital managers. In all, 3190 publications were retrieved. 1934 citations were excluded because of irrelevant (n=2600), duplicates (n=316), and unavailable full text (n=18). After studying the 256 remaining publications, 33 citations were extracted and presented. After extracting the future competencies of hospital managers, competencies were classified into four main categories based on the qualitative meta-synthesis process. Conclusion: The most important competencies in the future are global knowledge, Key Eligibility Criteria, wide attitude and core skills that must be addressed in the face of ambiguity., (© 2020 Iran University of Medical Sciences.)

Background: Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments., Methods: In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software., Results: Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs., Conclusion: It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.

Background: Prehospital emergency care system is one of the important parts of the health system. Heavy traffic, increasing urban population, and growing demands for prehospital emergency services are challenges faced by this section of the health system. One of the approaches to deal with this issue is using motor ambulances., Aims: This study aims to investigate the missions of motor ambulances, ambulances, and the effects of motor ambulance services on response time and ambulance missions., Materials and Methods: This applied research has been designed as a descriptive and cross-sectional study. Overall, 267,836 missions carried out by ambulances and motor ambulances of Tehran emergency medical service (EMS) Center in the years 2014 and 2015 were investigated. The data were gathered personally by visiting Tehran EMS Center. The data were analyzed by Excel (2013) software., Results: The average response time for ambulances and motor ambulances were 16 min and 14 min and 13 s, respectively. Most of the ambulance and motor ambulance missions were reportedly due to weakness (20%) and heart problems (16%). In 57% of ambulance missions and 71.5% of motor ambulance missions, the patients refused to being transferred to the hospital. Most of the transport missions to hospital (24%) were caused by traffic accidents., Conclusions: According to the results, the response time was higher than the national standards. Locating motor ambulances on the streets and outside emergency stations during peak traffic times decreased the response time by 2 min and by providing the necessary services in the scene and transferring fewer patients to the hospital, it is possible to provide further services by assigning ambulances to more urgent missions. Thus, it is recommended to employ more seasoned staff, multiply motor ambulances, and locate motor ambulances precisely to decrease response time and also at a lower cost more citizens are provided with prehospital care., Competing Interests: There are no conflicts of interest.

Background: Family physician (FP) is one of the best strategies to reform health system and promote population health. Due to the different context, culture, and population, implementing this reform within cities would be more challenging than in rural areas. This study aimed to assess the challenges and strengths of Urban FP Program in Fars Province of Iran., Materials and Methods: It was a qualitative study using framework analysis for collecting and interpreting data. The participants included health policy-makers, top managers, and involved health staff selected through purposive and snowball sampling. Participating in the program or working as a physician in urban areas were among inclusion criteria. Three focus groups with experts as well as the content analysis of national documents were also performed. The research tool was a semi-structured interview guide. Interviews and focus groups were recorded and transcribed word by word. The framework of triangle for data analysis and the content was analyzed using MAXQDA 2010 software., Results: The participants' mean age was 44.9 ± 6.4 years, with a mean work experience of 13.2 ± 7.4 years. The transcripts revealed six themes and 17 subthemes. The emerging themes included three challenges and three solutions as following: social problems, financial problems, and structural problems as well as resistance reduction, executive meetings, and surveillance., Conclusion: Resolving staff shortage, decreasing the public resistance, and eliminating unnecessary referrals were among the strategies used by Fars, during FP implementation. To be successful in implementing this program, the required perquisites such as infrastructures and culture growth must be undertaken. The current study suggests the establishment of the electronic health record to improve the pace and quality of service provision as well as reducing violations., Competing Interests: There are no conflicts of interest.

Introduction: This study was designed and implemented with the purpose of identify and analyze the stakeholders in Iran's Health Insurance System (HInS)., Materials and Methods: This study was a mixed method study. The study setting was in the field and consists of all organizations in the HInS. The study steps designed according to the Kammi Schmeer stakeholder analysis model. The information was collected through semi-structured and structured interviews with 16 stakeholder representatives. The data collection tool was checklist and matrixes that determined the characteristics of the stakeholders. Analysis of data was done by Maxqda 10 and Mactor software., Results: A total of 34 stakeholders were identified that were involved in nine main activities of HInS. Major stakeholders have governmental nature. The Government, the Planning and Budget Organization, the Ministry of Health, the Welfare Ministry, the Higher Health Insurance Council, and the Medical Council were stakeholders who have high financial, decision-making, and political power simultaneously. The Parliament and the Health Commission, the Government, the Planning and Budget Organization, and the Ministry of Health were stakeholders that had the most influence on other stakeholders. Most of stakeholders have same position to the objectives of the HInS. The insurer organizations had opposed position with the objective of integrity of the funds., Conclusions: Stakeholders of Iran's HInS are multiple and involved in various activities that sometimes they are overlapping and parallel. Regarding the same position of the majority of stakeholders to the objectives, reforms are possible, provided that influential stakeholders participate in policies making., Competing Interests: There are no conflicts of interest.

Background: Out-of-pocket (OOP) expenditure directly impacts on poverty and household welfare, especially when there is a decline in healthcare financing. This study was aimed to describe the temporal pattern of OOP expenditures related to Iranian healthcare services during 1995-2014., Methods: For describing the trend of OOP spending in Iran, the database of the World Bank was mined for the period under study. Further, the trend analysis has been complemented by an exhaustive and comprehensive review of the extant literature., Results: From 1995 to 2014, out-of-pocket decreased from 53.59% to 47.8% of the total health expenditure, probably because of the different health reforms implemented throughout the years. However, out-of-pocket expenditure in Iran remains higher than the world average (roughly 3 times higher)., Conclusion: It is an onus of the Iranian government to make serious attempts in order to reduce out-of-pocket expenditure, as well as to protect particularly poor and vulnerable subjects against catastrophic health expenditure. In order to ensure an equitable and affordable access to the healthcare system, decision- and policy-makers in Iran should implement a review of health care costs, insurance tariffs, and healthcare services packages covered by insurance organizations as well as introduce a progressive tax-based financing scheme as soon as possible., Competing Interests: Conflict of Interest The authors declare that there is no conflict of interest.

Gastroesophageal cancer is one of the most common types of cancer worldwide. Despite significant developments in management, 5-year survival in the developing world is less than 20 percent. Due to restricted research about the impact of preoperative chemotherapy (POC) on tumor resection, pathological response and postoperative complications in Iran, we designed and implemented ‎the present retrospective cross- sectional study on 156 patients with gastroesophageal cancer (GEc) between 2013 and 2015 at Shariati Hospital of Tehran. Two groups were included, the first group had previously received preoperative chemotherapy and the second group had only undergone surgery. All patients were followed for at least one year after the operation in terms of tumor recurrence, relapse free survival and one-year survival. The two groups were eventually compared regarding tumor resection, pathological response, postoperative complications, recurrence rate and survival. The mean age was 66.5± 7.3 years and 78 percent were male. The tumor resectability, pathological response and postoperative complications in the group which received POC were 93.5%, 21.8% and 12.8%, respectively, and in the surgery alone group figures for tumor resection and postoperative complications were 76% and 29.5%, respectively. Also based on our study the 5-year survival in the POC group was better (79.5% vs. 66.5%). Using standard neoadjuvant regimens (preoperative chemotherapy/ chemoradiotherapy) beforesurgery could increase tumor resectability, pathological response, and improve the general status of the patients. Therefore using POC may be recommended over surgery alone.

Background: To estimate and compare prevalence of overweight and obesity among adult people across the 22 districts of Tehran in 2011., Methods: This was a cross-sectional study using data on 47,406 women and 47,525 men aged≥ 15 years from a large population-based survey (Urban HEART-2). Age-standardized prevalence (ASP) of overweight (25≤BMI<30) and obesity (BMI≥30) were estimated for the Tehran's districts. Pearson Chi2 tests and logistic regression were used to examine any significant differences in prevalence of these disorders across sociodemographic groups., Results: ASPs of overweight were 36.5% and 32.0 % among men and women, respectively (p<0.001). These figures for obesity were 10.7% and 15.3% among men and women, respectively (p<0.001). Crude prevalence of overweight and obesity rose with age up to the age of 54 years and decreased thereafter. Across education groups, the lowest prevalence of overweight/obesity was seen among most educated people. The results showed that being young, single and student were associated with lower odds of overweight/obesity., Conclusion: This study showed a high prevalence of overweight and obesity among adult in Tehran. There were significant associations between sociodemographic characteristics and prevalence of overweight/obesity among adults in Tehran. The results of this study might be used in identifying high risk groups of overweight and obesity in Tehran.