2023 Impact Factor: 1.3
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pISSN: 2251-6085
eISSN: 2251-6093
Chairman & Editor-in-Chief:
Dariush D. Farhud, MD, Ph.D., MG.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE). 
Vol 42 No Supple 1 (2013)
Articles
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Nurses are ever-increasingly confronted with complex concerns in their practice. Codes of ethics are fundamental guidance for nursing as many other professions. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. A national code can provide nurses with culturally-adapted guidance and help them to make ethical decisions more closely to the Iranian-Islamic background. Given the general acknowledgement of the need, the National Code of Ethics for Nurses was compiled as a joint project (2009-2011). The Code was approved by the Health Policy Council of the Ministry of Health and Medical Education and communicated to all universities, healthcare centers, hospitals and research centers early in 2011. The focus of this article is on the course of action through which the Code was compiled, amended and approved. The main concepts of the code will be also presented here. No doubt, development of the codes should be considered as an ongoing process. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.
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At the aim of explaining the rights of health care recipients and upgrading ethical observance in the field of treatment-the most important field of health care-, the Patient's Rights Charter was declared by Ministry of Health and Medical Education to all medical universities in September 2009. This paper provides a report of strategic planning for implementation of Patient's Rights Charter and a summary of other projects.
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The Ministry of Health and Medical Education of Iran, along with the country movement towards achievements of Iran's Vision 2025 put compilation of the health system reform plan on its agenda. In this article, we are trying to show the method we used for developing this plan and how this method considered the general condition of the country along with maintaining the standards of scientific and technical programs. All steps of this planning are described in the paper and finally we discuss the techniques and the appropriateness of the method compare with the experience of the other countries.
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Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage.After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system.Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision.Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.
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The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing "Iran's Health System Reform Plan by 2025".A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts' opinions about important trends and their impact on health care delivery, Focus Group Discussions (FGDs) and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert's panel session.The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study.Increasing healthcare cost due to some trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored.
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Health equity is considered as one of the main objectives of health care systems. This study was carried out with the aim of determining health equity indicators in Iran. Through consideration of these indicators, differences in health status of different social groups and different geographical areas can be shown in different periods and based on that, effective interventions can be designed. This study is carried out through a main workshop and expert panels and final consensus on selected indicators. The first draft of indicators and inequity stratifying variables were prepared and then revised by working groups consisting of experts inside and outside Health system. Finally ideas were accepted or rejected after presenting enough reasons and deep examination through the Consensus-Oriented Decision-Making (COMD) model. Fifty two indicators have been determined as health equity indicators in five areas including health, social and human development, economic development, physical environment and infrastructure and governance. Furthermore, for each indicator the proper and practical stratifying variables of inequity were identified. By calculating such indicators, it becomes possible to determine differences in health status of different social groups and different geographical areas.
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Establishment of boards of trustees for all universities was legalized in 1988. It is crucial to assess the performance of the boards and to adjust them to the mandates raised by new visions of the country.Subjects were members of boards of trustees and officers in charge of board's affairs at medical universities. Furthermore, a sample of 860 resolutions adopted by the boards was selected to assess the state of their enforcement.About 70% of the resolutions addressed have been enforced. There is a consensus on focusing on policy-making and high supervision on the objectives of the institutes rather than other areas. Furthermore, ways suggested improving the performance of the boards.Despite the rather high enforcement rate of the resolution in the past ten years, several interventions are suggested to improve the current performance of the boards of trustees and to meet new directions.
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Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies
Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals' chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran's vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5(th) 5-years economical, social and cultural plan (5(th)5YDP:2011-2015), listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5(th)5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5th plan. The strategies of 5(th)5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization.
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To provide an overview of the development of health technology assessment (HTA) in Iran since 2007, and to facilitate further development of HTA and its integration into policy making.Data of this study were collected through key documents (e.g. literature, laws, and other official documentation) and analyzed by experts of opinion in form of qualitative methods.Health technology assessment entered to the political agenda in Iran only in 2007 with a strong impetus of an evidence-based medicine movement with the bellow objectives: Institutionalization of evidence-based decision making in Ministry of Health, Creating an localization for structural HTA in Health system of Iran, Setting up training courses in order to educate capable manpower to full up the capacity of the universities, Establishment of a new field in HTA subject in medical universities for MSc and PhD degree, International communication about HTA through national website and possible participation in international Congress.HTA has been established in the healthcare system of Iran but what is needed is a clear political will to push forward the objectives of HTA in Iran. Similar to other countries, advance the regulation on the adoption of new health technologies to improve not only technical or allocate efficiency, but also health equity.
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Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science). Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country.
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Based on Iran by 2025 defined vision, we must to receive the first grade of science position in south western Asian region. Thus we need to have a comprehensive evaluation program.A comprehensive WHO Health Research System Analysis (HRSA)- based evaluation system was developed to evaluate the HRS in Iran. This article has explored the results of the five-year evaluation (2003-2008) and aims to introduce this method to other developing countries. Here we explore the results of research performance evaluation from 2002 to 2010 and by comparing the results with previous available information, we reveal the probable role of this method in research promotion and proposed approach to facilitate and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025.All of the indicators of stewardship and capacity building axes are received to their predefined levels. Moreover all of the medical science university research policies are based on their strategic plannings which are extracted from national visions of Iran by 2025. Most of the predefined goals in knowledge production domain had a significant grow trend but for more growth for commitments they should be closely follow.We developed an HRS-based comprehensive evaluation program to our national vision as well as our regional and international research competition.
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Due to the high incidence of deaths from breast cancer, high cost of treatment and limited resources, the need to formulate and implement effective programs in reducing the burden of disease is obvious. Care, control and creation of cancer information system having an infrastructure from collection of minimum data sets (MDS) are the top priorities of research in Iran's Ministry of Health.This is an applied descriptive research with comparative approach implemented in 2010. MDS for breast cancer on selected countries were searched and reviewed and proposed model based on the country's need was designed. Research data were implemented in 2 stages; assessment of MDS on selected countries and the validation of the proposed model through several meetings that has been carried out by the Undersecretary for Research and Technology and several oncologists and pathologists.The MDS is composed of 11 parameters in the form of fields in closed structured arrangements with consideration to coding responses. These parameters include: hospital data, demography, referral, physical examination and investigation, diagnostic information, pathology, treatment, palliative care, completion of primary treatment, clinical trials and follow-up. This form is available for use in the cancer registry database.MDS provides an opportunity to strengthen communication between performed researches and research results for the improvement of programs, policies and strategies and provides positive effect on equality in the health system. Although the stages of creating the MDS for breast cancer has been successful, but many challenges has been met until its completion.
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Regarding the need for scientific development and achievement our national goals, it is clear that international cooperation has the main role in this way. Here is a report on what we have done during past almost 10 years (2001-2011) in the field of international medical research activities in Deputy Ministry for Research & Technology, Ministry of Health, Iran. Our effort was focused to identify and contact with the prominent scientific centers among the world where could make a connection between our researchers in medical science universities with those centers.
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Iranian Health Research Networks and Vision of Iran by 2025: A Case of Virtual Health Network in EMR
The present paper aims to explore the role of Health Research Networks (HRN) in facilitating and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025.Aiming to the main function of HSR to achieve the targeted conducting of health sciences research; more cooperation and coordination between health science researchers; avoid parallel investigations; and optimum utilization and appropriate distribution of resources, in 2000 the deputy of Research and Technology of Ministry of Health and Medical Education defined and developed a comprehensive HRN.There are currently 27 research networks operating under the supervision of the Deputy of Research and Technology at MOHME. All of the HRN policies are following based on their strategic planning's which are extracted from national visions of Iran by 2025.Promoting the current position needs a reliable and feasible new strategies. The present article introduces the lessons learned of our experience in virtual web-based health research networking in Endocrinology and Metabolism Research Institute (EMRI).
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The Islamic Republic of Iran, in her 20 year vision by the year 2025, is a developed country with the first economic, scientific and technological status in the region, with revolutionary and Islamic identity, inspiring Islamic world, as well as effective and constructive interaction in international relations. Enjoying health, welfare, food security, social security, equal opportunities, fair income distribution, strong family structure; to be away from poverty, corruption, and discrimination; and benefiting desirable living environment are also considered out of characteristics of Iranian society in that year. Strategic leadership towards perceived vision in each setting requires restrictive, complete and timely information. According to constitution of National Institute for Health Researches, law of the Fifth Development Plan of the country and characteristics of health policy making, necessity of designing a Health Observatory System (HOS) was felt. Some Principles for designing such system were formulated by taking following steps: reviewing experience in other countries, having local history of the HOS in mind, superior documents, analysis of current production and management of health information, taking the possibilities to run a HOS into account. Based on these principles, the protocol of HOS was outlined in 3 different stages of opinion poll of informed experts responsible for production on management of information, by using questionnaires and Focus Group Discussions. The protocol includes executive regulations, the list of health indicators, vocabulary and a calendar for periodic studies of the community health situation.
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Social health is important to be assessed as a dimension of health. The aim of study was to determine domains and sub-domains of individual social health of Iranians.This study was carried out with a qualitative approach, using thematic content analysis. Twenty five experts participated in interviews, using individual semi-structured interviews between November 2010 and June 2011.This data supported with strong search.Two main areas extracted from these interviews including social support and social function. The social support domain contained seventeen sub-areas, including social support at the time of disease; disability; daily life issues, etc. And the social function as second domain contained twelve sub-areas, including: financial aids to others; emotionally aids to others; participating in social groups, etc.We developed a conceptual framework for social health in the individual level in Iranian population. It makes preparations for providing a valid and reliable measurement scale for social health in next studies and evidence-based policy-making.
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Mortality rate indicator for children under 5 years old is one of the important indicators in countries' development. Identifying the most common causes of mortality is one of the most important attempts to reduce mortality in children less than 5 years. The purpose of this study was to identify distribution of the mortality causes in Iranian children less than 5 years.This cross-sectional study has been carried out based on the results of data from the Child Mortality Surveillance System since 2007 to 2008. To determine the causes of death questionnaires have been designed which include personal data of the deceased child, medical history, and information on procedures at the time of hospitalization or death.Of 5926 deaths on children under 5 years which the questionnaires were filled out, 63.2% were postneonatal deaths (1-11 month). Totally 60% of mortalities occurred in the rural areas and 52% of them had been among boys. The most common causes of mortality were the congenital and chromosomal abnormalities with 23.4%. The most incidences among diseases were respiratory system diseases.Carrying out more epidemiologic studies, providing health programs to control and prevent diseases with high incidences and delivering more specialized health facilities and services could be the proper strategies to reduce under 5 mortality rates in Iran.
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Human immunodeficiency virus (HIV) is a public health challenge facing both developing and developed nations. Although injecting drug use is even the main route of HIV transmission in Iran, sexual route is rising gradually. Vulnerable women have been considered as important bridging population for driving HIV epidemics. To increase the access to vulnerable women, in 2007, 5 pilot centers were established in risky areas to deliver comprehensive services to women who themselves or their spouses are engaged in drug use, risky sexual behavior or have history of imprisonment. Management of Sexually Transmitted Infection, psychological counseling and harm reduction are provided by female staff. The aim of this study was to report the activities conducting in 2008.Registered information was used to assess the demographic characteristic, HIV/ AIDS related risk factors and services delivered to clients.Till March 2008, 442 clients have been admitted. Most of them (36.2%) had 25-34 years old. 14.3% were illiterate and 31% were totally jobless. The most prevalent risk factors were risky sexual behavior (27.1%) and non-injecting drug use (23.2%). Injecting drug use was detected in 11.3% of attendees. Dividing clients according to marital status, risky sexual behavior was the main risk factor in unmarried (40.2%) and divorced (26.9%) but in married and widow ones, non-injecting drug use was the most (25.8% and 36.5% respectively). Harm reduction (40.5%) and counseling (36.6%) were the most delivered services.Since vulnerable women play a critical role to spread HIV-epidemic to general population, increasing centers provide more access to this population.
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According to the last existing documents, the prevalence rate of mental disorders is about 20% which is considered to be 14% of all country's burden of disease. In the fifth economical, social, and cultural development plan of the country in accordance with the 20 year vision, "healthy human being" and "comprehensive health" approaches and also improving of mental health indicators are emphasized. Aim of study was preparing national policy and interventions for promoting mental health.Using secondary data, analytical review of country's mental health programs, recommendations of WHO, descriptive situation of mental health and its trend during the last decade were drafted and a group of experts and stakeholders was formed following a sound stakeholder's analysis. After three Focus Group Discussions (FGDs), main points of the meetings, influencing factors of present situation, and oncoming strategies were agreed upon.Based on different studies and the experts' opinions, the prevalence of mental disorders in the last decade has increased. Coverage of mental health programs in two last decades in the best could be equal to rural population. Urban areas have been deprived of these services. Analysis of mental health system of the country shows that internal environment is weak and the external one is concede to be in threat. Eight principal challenges in country's mental health are considered.Improving current situation requires increasing internal capacity of mental health system and developing inter-sectoral cooperation. During next five years, the Ministry of Health, Iran should mainly focus on improving mental health services particularly in urban and peri-urban areas, promoting mental health literacy of different groups and minimizing mental health risk factors.
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The prevalence of non-communicable diseases such as hypertension and diabetes including obesity has increased over the past few years in Iran. The increase in these diseases has been associated with increased urbanization and lifestyle changes. The burden of non-communicable diseases (NCD) is increasing in low and middle-income countries. The aim of this report is to address the threat of NCDs in the capital city of 6 big provinces of Iran.A community based cross sectional study was carried out between March 2010 to January 2011 in 6 provinces' capital cities (Isfahan, Karaj, Mashad, Shiraz, Tabriz, and Tehran). Participants were men and women of 30 years and older who had been screened through the National Diabetes Prevention and Control Program. BMI, blood pressure, fasting blood glucose and lipids were measured.439406 cases (60% female & 40% male) were studied. The prevalence of pre-diabetes (13%), diabetes (13%), hypercholesterolemia (14%), hypertension (11%), overweight (27%) and obesity (20%) was higher than expected. Only 35% of participants were healthy.This study reveals a high prevalence of NCDs in urban living population in those capital cities. It also shows that increasing urbanization may be an important threat to public health regarding NCDs especially in developing countries. It is crucial to implement a comprehensive NCD program (across the life time) in the health system with a strong collaboration with all stakeholders (governmental and non-governmental sector, academic, research centers and scientific associations) in the community (Multisectoral Approaches).
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Molecular diagnostic methods have played and continuing to have a critical role in clinical laboratories in recent years. Therefore, standardization is an evolutionary process that needs to be upgrade with increasing scientific knowledge, improvement of the instruments and techniques. The aim of this study was to design a quality assurance program in order to have similar conditions for all medical laboratories engaging with molecular tests.We had to design a plan for all four elements; required space conditions, equipments, training, and basic guidelines. Necessary guidelines was prepared and confirmed by the launched specific committee at the Health Reference Laboratory.Several workshops were also held for medical laboratories directors and staffs, quality control manager of molecular companies, directors and nominees from universities. Accreditation of equipments and molecular material was followed parallel with rest of program. Now we are going to accredit medical laboratories and to evaluate the success of the program.Accreditation of medical laboratory will be succeeding if its basic elements are provided in advance. Professional practice guidelines, holding training and performing accreditation the molecular materials and equipments ensured us that laboratories are aware of best practices, proper interpretation, limitations of techniques, and technical issues. Now, active external auditing can improve the applied laboratory conditions toward the defined standard level.
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After four years of publishing the Iranian National Laboratory Standard and following a strategic plan to implement its requirements, it was decided to review the taken actions, evaluating the achievements and the failures, as well as analyzing the gaps and planning the interventional activities to resolve the problems. A thorough evaluation revealed that the progress of implementation process varies considerably in different provinces, as well as in laboratories in different public and private sectors. Diversity and heterogeneousity of laboratories throughout the country is one of unresolvable problems. Although we encounter shortage of resources in the country, improper allocation or distribution of resources and budgets make the problems more complicated. Inadequacy of academic training in laboratory sciences has resulted in necessity of holding comprehensive post-graduate training courses. Revising academic curriculum of laboratory sciences could be mostly helpful, moreover there should be organized, training courses with pre-determined practical topics. providing specific technical guidelines, to clarify the required technical details could temporarily fill the training gaps of laboratory staff. Inadequate number of competent auditors was one of the difficulties in universities. Another important challenge returns to laboratory equipment, developing the national controlling system to manage the laboratory equipment in terms of quality and accessibility has been planned in RHL. At last cultural problems and resistance to change are main obstacles that have reduced the pace of standardization, it needs to rationalize the necessity of establishing laboratory standards for all stakeholders.
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Based on the current emphasis on competency-based education, as a part of need assessment phase of dental curriculum revision in Iran, in the present study the dental graduates' perspective concerning the minimum competency requirements for an Iranian general dentist has been investigated.Based on the three available major competency documents in the literature a questionnaire was developed in which the participants were asked to indicate their opinion about the necessity of each of the 142 stated competencies for an Iranian general dentist (Yes/No), and to state the degree to which they believed the current curriculum covers each competency (Completely, Partially, Not at all). In an annual meeting in June 2008, the provincial chief dental managers were asked to distribute the questionnaires among general dentists in their province (10 questionnaires in each province). The managers posted back the completed questionnaires to the researchers.Of 300 questionnaires distributed in the 30 provinces of the country, 250 questionnaires (83%) were returned. While most of the participants considered the competencies as necessary for an Iranian dentist, less than 40% of the respondents believed that the graduates acquire the most required competencies of the profession during the current educational program.A necessity exists for curriculum revision. In addition to clinical skills, in this revision more emphasis also should be placed on the non-clinical part of the curriculum.
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In order to improve the quality of education in universities of medical sciences (UMS), and because of the key role of education development centers (EDCs), an accreditation scheme was developed to evaluate their performance.A group of experts in the medical education field was selected based on pre-defined criteria by EDC of Ministry of Health and Medical education. The team, worked intensively for 6 months to develop a list of essential standards to assess the performance of EDCs. Having checked for the content validity of standards, clear and measurable indicators were created via consensus. Then, required information were collected from UMS EDCs; the first round of accreditation was carried out just to check the acceptability of this scheme, and make force universities to prepare themselves for the next factual round of accreditation.Five standards domains were developed as the conceptual framework for defining main categories of indicators. This included: governing and leadership, educational planning, faculty development, assessment and examination and research in education. Nearly all of UMS filled all required data forms precisely with minimum confusion which shows the practicality of this accreditation scheme.It seems that the UMS have enough interest to provide required information for this accreditation scheme. However, in order to receive promising results, most of universities have to work intensively in order to prepare minimum levels in all required standards. However, it seems that in long term, implementation of a valid accreditation scheme plays an important role in improvement of the quality of medical education around the country.
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To explore the trend and composition of post-graduate Iranian students who received governmental scholarship during the last two decades.Detailed information about the awarded scholarships and also about the number of post graduate students in clinical and basic sciences in domestic universities were collected from the related offices within the ministry of health and medical education and their trends were triangulated.A sharp drop was observed in the number of awarded scholarships, from 263 in 1992 to 46 in 2009. In the beginning, almost all of scholarships fully supported students for a whole academic course; while in recent years most of scholarships supported students for a short fellowship or complementary course (more than 80%). Students studied in a wide range of colleges within 30 countries; more than 50% in Europe. Although one third of students studied in UK in the first years, only 4% of students selected this country in recent years. conversely, the number of scholarships to Germany and sweden have increased more than 10 and 3 times during this period. In parallel, the capacity of domestic universities for training of post-graduate students has been expanded dramatically.Although expanding post-graduate education has been one of the main strategic objectives of the ministry of health and medical education in last two decades, it was obtained using different approaches. By time, more attention was to expanding the capacities of Iranian universities, and choosing less but more targeted students to continue their studies abroad.
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The present article reviews the significance of accreditation standards while emphasizing the necessity of implementation of such standards by basic medical science council, with an eye on such international standards as those published by WFME. This review article had to decide on the key words and expressions, data bases, to review relevant literature, review higher and medical education journals at GOOGLE, ELSEVIER, PUBMED, and such web sites as those of WFME and WMA's. Accreditation is a powerful leverage for institutional change and improvement and must be actively supported by academic and national health authorities worldwide. Considering the mission of the Basic Medical Science, Health and Post grad. Education, Ministry of Health and Medical Education, Tehran, Iran as accountable medical education, all specialists of the spectrum of disciplines agreed on the necessity of formulating the medical education standards for all disciplines of their interest. It is important that all efforts be joined in the endeavor to create effective and reliable instruments for quality assurance of Basic Medical Sciences Education.
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This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately.This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied.The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution.While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.
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Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The fair allocation of human resources is one of the dimensions of equity, which was evaluated in this study.We evaluated the equity of human resources' distribution among Iran's medical science universities between 2005 and 2009 by inequality measures including Lorenze curve, Gini coefficient and Rabin hood indexes.In the distribution 60403 recruitment licenses among medical universities with 72456140 covered populations, Gini coefficient was 0.167 and Robin Hood Index 0.11.Calculations indicated Recruitment licenses are equitably distributed in MOH&ME of Iran. However a portion of recruitment licenses should redistributed for achieving perfect equal distribution among all public medical universities of Iran.
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Due to consuming about 50%-80% of health resources, hospitals are the greatest and costly operational units in Iranian Health system. so allocation of resources specially human and space resources as the most expensive ones is really important for further controlling of costs, analysis of costs and making suitable policies for increasing the profitability and allocation of resources and improvement of quality.This paper intends to describe and analyze any allocation of resources in 530 university hospitals in Iran. The final goal of this research is to provide a data bank according which there is a basis for more scientific budget allocation of state's hospitals from the size and type of application points of view.The relevant index of person to bed was 2.04 for human resources. All hospitals more than 300 beds are located in benefiting areas from which 17 cases are educational and 2 cases are therapeutic. This is necessary to mention that the rate of management group forces to total personnel at deprived areas is about 2.5% more than benefiting areas.Because 60-80% of hospital costs are applied for human forces, all managers of hospitals are obliged to revise their policies in attraction and employment of human force in order to benefit from such a valuable resource and prevent from expensive costs. So any employment of personnel should be based upon real needs of hospital.
