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Abstract Background One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran. Methods We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household’s capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE. Findings : The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP. Conclusion The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.

Background: Access to healthcare services is a prerequisite for societal justice. Unfair distribution of these services can lead to patient migration to cities with higher quality medical centers for better medical services. This study aimed to determine the direct and indirect non-medical costs of patients referred from Sistan and Balouchestan to hospitals in Mashhad.Methods: A descriptive-analytic study was conducted in Eastern Iran in 2020. The research sample included all patients who migrated from Sistan and Balouchestan to Mashhad for medical purposes and were hospitalized in government hospitals affiliated with Mashhad University of Medical Sciences. The total number of these patients was 2062, and they were identified using a census method in 2020. Given the large population size (2060 individuals), 350 patients were selected as a sample based on the Cochrane method. A validated checklist was used for data collection, and SPSS-23 software was used for data analysis.Results: The average direct non-medical cost for medical services in Mashhad was 61,686,857 Rials (270 USD). The highest and lowest costs were related to travel costs (26,545,714 Rials or 116 USD), and care received for children (37,142 Rials or 0.16 USD), respectively.Conclusion: According to the results of this research, an increase in direct non-medical and indirect costs due to patient migration for treatment imposes significant costs on patients and their families. It is crucial to have an equitable distribution of health and treatment resources and facilities across a country’s geographical regions to ensure access to health services.

Introduction and purpose: Policymakers can enhance personnel performance and consequently, improve the quality of healthcare by evaluation of suitable leadership styles for health organizations and establishment of effective team groups. This study aimed to determine the relationship between the leadership styles of nursing managers and the teamwork of nurses. Methods: This descriptive-analytic study was conducted among 500 nurses working in eight selected university hospitals in Mashhad and Zahedan, Iran (2022). Data were collected using two standard questionnaires on leadership styles and teamwork through interviews. Descriptive statistical methods, such as the mean and standard deviation, were employed to determine leadership style and teamwork scores. Additionally, Pearson's and Spearman's correlation coefficients were used to investigate the relationship between these two variables. Results: The dominant leadership style among the participants was transformational leadership (37.6%). The overall mean teamwork score was 3.66±0.48, with 91.8% of nurses scoring teamwork 3 or higher. Transformational and passive leadership styles exhibited the highest and lowest relationships with teamwork, respectively (P

BackgroundThe World Health Organization (WHO) declared a pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on 11 March 2020. Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality, allowing for comprehensive comparisons of the population. The purpose of this study was to estimate DALYs due to COVID-19 in Iran for the first 2 years of the pandemic.MethodsDALYs were estimated as the sum of Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) associated with COVID-19 in Iran from 19 February 2020 to 20 March 2022. The life expectancy for COVID-19 YLL estimations was based on the Global Burden of Disease (GBD) 2019 study.ResultsThere were 15,639,243 outpatients and 1,170,602 hospitalized confirmed cases, of which 120,965 deaths were as a direct result of COVID-19. DALYs were estimated to be 2,376,552. Overall, YLL contributed to 99.34% of the DALYs, while the remaining 0.66% was attributed to YLD.ConclusionCOVID-19 had a significant impact on population health in Iran during the first 2 years of the pandemic; this study provides a comprehensive depiction of COVID-19’s burden and is helpful for comparing its impact with other diseases in the population and across populations.

Background: Taxes are not only an important source of government revenue, but also one of the most important policy tools for tobacco control. The present study was designed to determine the optimal tax rate on cigarettes.Methods: A descriptive-analytical study was conducted using the survey data from the Statistics Center of Iran from 2015 to 2019. The survey is carried out every year at the national level and households are selected by three-stage stratified sampling method. The inclusion criteria for our study were based on household information in the study period and its completeness and legibility. The Poisson regression model was used to estimate the factors affecting the quantity of cigarette demand in households with smoker members. The optimal tax rate on cigarettes was calculated based on the concept of Laffer curve. Statistical analysis was performed using Stata version 15.1.Results: The study was performed on 191,648 Iranian households. The cigarette price elasticity of demand was around -0.24. There were statistically significant relationships between the cigarette demand and variables including having a member of 15-18 years in the family; having male member of 19-64 years; having a female member of 19-64 years old; the study periods; age, education level; and job status of the household head (P

Abstract Background One of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020. Methods This descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods. Results The mean scores of the participants’ "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P

Background: Informal payment in many developing countries is a serious obstacle towards to improving healthcare system and has negative effects on the function of healthcare system. In order to reduce the informal payments and direct payments from patient's pocket, the Health Transformation Plan (HTP) executed. This study was conducted to assess the informal payments in the hospital related to government. Methods: This study was a survey based on descriptive analytic method in Zahedan, the capital of Sistan-Baluchistan Province, in 2017. The study population included all patients discharged from all wards of the two general hospitals affiliated with Zahedan University of Medical Science (ZaUMS) in a one-month period (from September 23 to October 22), in which 500 patients were selected by multistage cluster sampling. Data collection tool was a standard questionnaire that was conducted by interview method. The data were analyzed using by SPSS v22 and descriptive statistics. Results: In this study 98% of patients were male, 484 (96.8%) lived in the urban area, and about 2% had informal payment. The average amount of informal payments was 51.48 $. The highest number of informal payment was in the maternity ward (n:5, 50%). The doctors didn't have any informal payment, and all of the participants disagreed this type of payments. Conclusion: The rate of informal payments in the hospitals affiliated with ZaUMS in Southeast of Iran after execution of HTP is minimal. Poor economic status of the patients and well executed HTP are the possible explanations for minimal informal payments. Solutions including constant supervision on employees and realization of the medical services tariffs and strengthening insurance companies are effective steps towards elimination of informal payments.

Introduction: Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP. Methods: A household survey was conducted in 2017 in Sistan-Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences. Results: The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence (p=0.010), having members aged more than 65 years (p=0.005) and having members with disabilities and in need of care (p=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services. Conclusion: Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.

Background: The significance of rabies is due to high mortality rate, economic damage caused by livestock loss, and high costs of treatment. Considering the economic problems in developing countries as well as the lack of resources and facilities, economic assessments will be very useful in obtaining the necessary financial information. Therefore, the present study aims to estimate the cost of prevention and control of rabies in Ahar, East Azarbaijan, during 2010-2011 and 2011-2012. Methods: This is a descriptive, cross-sectional study conducted in Ahar, East Azarbaijan. This study was carried out using available documents (Vaccine registries, Human Resources Department records, Staff daily wages) and data collection (Ministry of Health and Medical Education, Taxi Administration, Municipality Office and the Veterinary Network) to estimate the cost of prevention and control of rabies during 2010-2011 and 2011-2012. The societal perspective was taken into account to estimate costs. Data was entered into SPSS version 20 and the total cost was calculated. Also, the Mann-Whitney U test was used for data analysis. Results: The total financial burden of preventing and controlling rabies in Ahar during 2010-2011 and 2011-2012 was about 803 and 850 million rials respectively. The loss of the patient's income (240 and 260 million rials during 2010-2011 and 2011-2012), cost of rabies vaccine (approximately 231 and 237 million rials during 2010-2011 and 2011-2012), and staff costs (approximately 118 and 247 million rials during 2010-2011 and 2011-2012) had the largest share of the cost, while cost of tetanus vaccine (1.3 and 1.2 million rials during 2010-2011 and 2011-2012) had the smallest share. Conclusion: The present study showed that the prevention and control of rabies put a significant financial burden on the government through direct medical expenses, rabies control program for dogs, and care of the disease. It put a burden on the people, as well, through the loss of productivity and income, and transportation costs.

Objective (s): health transformational plan was executed as one the most important plans by the ministry of health and medical education in order to reduce admission fees. In order to evaluate the effectiveness of this plan, this study was conducted with the goal of determining the health expenditures by households after implementation of this new plan. Methods: This cross-sectional study was conducted in Zahedan, Iran in year 2015 and 2016. The study conducted on 816 families including both rural and urban households. They were selected randomly by clustering method. Data were collected by in-person interviews using the World Health Survey. The Data were analyzed using descriptive and inferential statistics. Results: In 93.1% of instances the head of household were men (n = 760) and 78 families did not have any health insurance. After implementation of health transformational plan, 12.99 percent of families were still faced with catastrophic health expenditures. However, the rural families were facing more catastrophic expenditures compared to families living in urban areas. This catastrophic expenditures have a meaningful relation with many variables including dental care (OR: 4.99), drug fees (OR: 2.927), physiotherapy (OR: 2.927), outpatient expenditures (OR: 96. 639), having a family member who needs to be taken care of at home (OR: 3.186), and a family member who needs to be taken care of at a hospital (OR: 1.866). Conclusion: The results showed that a relatively large proportion of people in families in Zahedan still are facing catastrophic health related expenditures and health transformational plan has not been able to reach its goals in this city.

Background: Medicine is considered as strategic goods worldwide and, therefore, a huge amount of health care budget is spent on it. To prepare universal access to appropriate health services and achieve the health-related millennium development goals, rational use of drugs is an essential goal in the health system. This study aimed to investigate the proportion of drug prescription in three categories of injections, antibacterials agents and corticosteroids in a 10 year period. Methods: This is a descriptive study using data from an Iranian national insurance organization and National Center of Drug Use. The data about prescribed drugs during 2003 to 2013 were collected and analyzed by Excel Microsoft software, version 2010. Result: Results indicated that injections were decreased from 49.25% in 2003 to 46% in 2013; also, antimicrobials had a decrease from 64.25% in 2003 to 42.2% in 2013. Totally, it was reduced about 16% in the period of 10 years. Corticosteroids increased 10 % from 13% to 23% in 2013. Conclusion: According the present findings that indicate irrational and increasing use of corticosteroids and antimicrobials, it seems necessary for Iranian policy makers to pay specific attention to customizing clinical and pharmaceutical guidelines along with improvement of medical education system and rational prescription, holding scientific committees of prescription supervision, arranging continuous and effective education of health personnel, and improving public culture and community education.

Background: Anemia is the most common blood disorder observed in vulnerable groups and affects their efficiency in their everyday activities. Possible complications of the disease may be reduced or prevented by screening of patients. Screening programs impose certain costs upon the health system, which may offset their positive effects. Whether the positive impacts of screening outweigh its costs is a subject of debate among policy-makers. In this research, we have conducted a systematic review of the cost-effectiveness of anemia screening. Methods: The Pubmed, Science Direct, SCOPUS, EMBASE, and CINAHL databases were searched for relevant results dating between 1962-2010 using key words. The references of the related articles were gone over manually. In the end, Persian databases were also examined for results. Results: Using data from the four mentioned databases, a total of 722 articles were elected, which, after evaluation, were narrowed down to 4. Of these, 3 focused on newborns and infants. Disparity existed among obtained results, such that no two articles were similar, and this made making comparisons between them cumbersome and sometimes even impossible. Only one study evaluated cost-effectiveness of anemia screening in vulnerable target groups. Conclusions: Research findings show that there is not enough evidence of cost-effectiveness of screening for decision-making. Bearing in mind the importance of the matter to health policy-makers, due to high prevalence of iron-deficiency anemia in low- and middle-income countries, conduction of research in this field seems necessary.

Background: Breast cancer is the leading cause of malignancy among women. Screening using mammography is proposed as an effective intervention for reducing early deaths due to breast cancer. We conducted a systematic review to assess the cost-effectiveness of such screening programs. We searched Medline, Scopus and Google Scholar and complemented it by other searches using sensitive search terms from 1993-2010. We screened the titles and abstracts, assessed the full texts of the remaining studies, and extracted data to a pre-designed data extraction sheet. Studies were categorized according to the age groups of the target population. We used narrative synthesis approaches for analyzing the data. Twenty-eight articles met the minimum inclusion criteria, mostly from high income settings. All studies used secondary data, and a variety of modeling techniques, age groups, screening intervals and outcome measures. Cost per life year gained, ranging from $1,634 (once at the age of 50 in India) to $65,000 (extending the lower age limit of screening to 40 Australian study), was the most commonly used outcome measure. Biennial screening test for those aged 50-70 years seems to be the most cost-effective option ($2685). Biennial screening for aged 50-70 years is the most cost-effective option among alternative scenarios. Screening those aged less than 50 is not recommended. Further studies in low-income and middle-income countries, and cost effectiveness studies along with randomized trials are required. To improve the comparability of the findings, future studies should include biennial screening in 50-70 age groups as an alternative strategy.