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Justice in the healthcare system: payment and reimbursement policies in Iran
Hannan Hajimahmoudi, Farzaneh Zahedi,
Volume 6, Issue 3 (8-2013)
Abstract
Justice is one of the main principles of ethics in the healthcare system, and its establishment at macro level depends on formulation of appropriate policies by policy-makers and healthcare providers. Health care policies and payment and reimbursement systems have a significant impact on health systems’ efficiency and cost control. In this paper, payment and reimbursement policies and their impact on financial incentives will be reviewed moreover, financial policies in the national health care in Iran and related challenges will be mentioned in brief. There is no doubt that none of the payment and reimbursement policies is perfect and each of them has the potential to put caregivers or health care providers financially at risk. Therefore, policy-makers should select a combination of the best approaches, considering socioeconomic factors, in order to provide a maximum coverage of health services and ensure fairness in the health system. Efficient payment and reimbursement approaches should undoubtedly preserve the rights of all parties in a fair and logical manner. Current national policy shows that a high percent of health care expenditures are financed through out-of-pocket payments, and therefore appropriate policies should be adopted to lighten this burden. Considering the accelerated trend toward the Family Doctor Plan in big cities in Iran, the present paper would be helpful for many health care providers, physicians and other health care professionals.
COVID-19: An Opportunity to Restore Lost Trust? A Narrative Review of Trust Trends Before and After the Pandemic
Hanieh Karimi, Ali Farahmand Asil, Saeedeh Saeedi Tehrani,
Volume 17, Issue 0 (12-2024)
Abstract
Trust between doctors and patients is a cornerstone of improved health outcomes and quality medical care. However, this trust has eroded in recent decades due to various factors. The global crisis of the COVID-19 pandemic presents a unique opportunity to examine and analyze changes in public trust towards the healthcare system. This narrative review explores the state of public trust in healthcare before and after the COVID-19 pandemic, analyzing the factors influencing this trust and proposing strategies for its maintenance and rebuilding. A narrative review was conducted, with information gathered from searches in reputable national and international scientific databases like PubMed, ScienceDirect, Springer, and Scopus. Relevant articles from Iranian databases such as Magiran and IranMedex were also included. The review focused on the components of trust, factors affecting it, and challenges faced by the healthcare system during the pandemic. The review revealed significant changes in the components of trust in doctor-patient relationships due to the COVID-19 pandemic. Prior to the pandemic, public trust in physicians had been declining due to factors such as perceived inequities in treatment, medical errors, and unprofessional behavior by some healthcare professionals. For example, surveys indicate a decline in public trust in healthcare professionals in the United States, dropping from 73% in 1966 to 34% in 2012. The COVID-19 pandemic significantly exacerbated this decline, with many people distrusting governmental institutions, pharmaceutical companies, and media outlets perceived to be providing misleading information. A study in Poland found that 31% of respondents viewed the pandemic as an exaggerated threat, while 3% considered it entirely fictional. However, the dedicated service and transparent communication of some institutions and healthcare personnel during the COVID-19 crisis partially restored public trust. This led to the emergence of a concept known as "dual trust," where people not only trust individual physicians but also pay closer attention to the overall performance of the healthcare system and governments. Dual trust has implications not only for the quality of healthcare services but also for the success of prevention and treatment programs. The COVID-19 crisis has had a profound impact on public trust in the healthcare system. To maintain and rebuild this trust, effective measures are essential. These measures should focus on enhancing service quality, fostering scientifically informed citizens, ensuring transparent communication, and promoting positive interactions between doctors and patients.

Telehealth: Ethical and Legal Challenges in the Healthcare System
Hooman Heydary, Shakila Belkafeh, Mohammadreza Dinmohammadi,
Volume 17, Issue 0 (12-2024)
Abstract
Telehealth has emerged as a rapidly expanding method for delivering healthcare services, especially during the COVID-19 pandemic. This approach has opened new avenues for accessing medical care and contributed to reducing healthcare costs. However, the growth of telehealth has introduced significant legal and ethical challenges that warrant thorough investigation. This review study employed keywords such as "telemedicine," "telehealth," "ethical challenges," "legal challenges," and "healthcare system" to search scientific databases including PubMed, Scopus, CINAHL, and Google Scholar. Articles published in English and Persian between 2010 and 2024 were reviewed. Eligible sources included research articles, systematic reviews, and case reports focusing on legal and ethical issues related to telehealth. Following an initial screening, articles were assessed based on quality and scientific credibility, and the selected works were analyzed for the final synthesis. Telehealth presents several critical challenges that must be addressed to ensure safe and equitable care delivery. One of the foremost concerns is patient privacy and data protection; the exchange of sensitive health information necessitates robust security protocols and adherence to data protection regulations to uphold patient confidentiality and trust. Another key issue is informed consent, which must be adapted to the virtual context to ensure patients are adequately informed of both the benefits and potential risks associated with telehealth services. While telehealth enhances healthcare accessibility, it may also deepen existing health disparities due to unequal access to digital technologies. Therefore, investments in communication infrastructure and digital literacy are essential to promote inclusivity and equal access to care. Although telehealth offers substantial benefits—including improved access, convenience, and enhanced coordination of care—its legal and ethical implications must not be overlooked. To fully realize its potential, stakeholders must collaborate in developing comprehensive regulations and ethical frameworks. Addressing these challenges is imperative to advancing telehealth in a manner that ensures patient safety, protects rights, and promotes health equity.

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