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Assessment of the Performance of Health Insurance Organizations using the DEA Approach; 2014
E Ghasemi, M Barooni, R Dehnavieh, M Jafari Sirizi , Mh Mehrolhassani,
Volume 12, Issue 0 (3-2017)
Abstract

Background and Objectives: Health insurance would guarantee people security against disease and health problems. Given the key role of health insurance in achieving the goals of justice and reducing the out-of-pocket payment, this study aimed to evaluate the performance of Iran health insurance using the DEA model in 2014.

Methods: This was a cross sectional study. The study population included all Iran health insurance organizations. DEA input and output criteria were selected by targeted library and documentary review and the data were collected accordingly. The determinants of efficiency were evaluated using liner regression.

Results: The mean technical, management, and scale efficiency of Iran health insurance head offices was 0.593, 0.761, and 0.721, respectively. Considering the findings, the capacity of efficiency promotion at these head offices was approximately 41%. Regarding technical efficiency, 5 head offices had the maximum efficiency (1), 7 head offices had efficiency between 0.5 and 1, and 19 head offices had efficiency less than 0.5. In addition, the variables of population and total number of institutions had a significant impact on efficiency.

Conclusion: Based on defined variables, input oriented AP-DEA model was appropriate. The results showed a great capacity for increasing technical efficiency in the Iranian health insurance organizations which could be increased by benchmarking efficient and reference organizations and also adjusting their input. For this purpose, downsizing and agility of the Iranian health insurance organizations based on the e-government clause are proposed for administrative system reform.


Epidemiological Pattern of Diseases Requiring Hospitalization in Patients Attending Health Centers Participating in Tehran Health Insurance Organization Network in 2005-2014
Mr Jamali, A Shojaee, M Ghanadi, J Jamali,
Volume 14, Issue 2 (9-2018)
Abstract
Background and Objectives: Evaluation of the epidemiologic pattern of diseases requiring hospitalization is one of the effective factors in better management of hospitals, which can provide health managers and planners with a realistic and appropriate view on procuring the equipment and furnishing and equipping the hospitals in the country. This study was conducted to investigate this pattern based on the International Classification of Diseases (ICD-10) using the information recorded in Tehran Health Insurance Organization in a ten-year period.
 
Methods: In this descriptive research, we examined all records of hospitalized cases registered in the hospital information system of Tehran Health Insurance Organization during 2005 to 2014. The data of more than two million records, including case number, gender, and age of the patients as well as the diagnosis code were extracted from the hospital information system.
 
Results: From 2008859 cases, 51.9% of patients were male and the mean age of the patients was 24.60±44.22 years. In children less than one year, “certain conditions originating in the perinatal period”, in children aged one to four years “symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”, in children 5 to 14 years “neoplasm”, in patients 15 to 44 years “pregnancy, childbirth and the puerperium”, and in patients above 45 years, “diseases of the circulatory system” were the most common diagnostic categories in hospitalized insured patients.
 
Conclusion: Due the specialization of diseases and various causes of hospitalization, to prevent wastage of financial and human resources, health policymakers and planners should allocate resources to insurance companies according to the scope of their activities.
Personalized Medicine from the Perspective of Rural Family Physician
Reza Dehnavyeh, Mohammad Jaafari Sirizi, Vahid Yazdi Feyzabadi, Farzaneh Yousefi, Parisa Dehghanian,
Volume 20, Issue 3 (12-2024)
Abstract
Background and Objectives: Paying attention to future changes and preparing for them is one of the requirements of today's world. Personalized medicine as an emerging and expanding change will bring about changes in medical science. Family physicians as the first line of service delivery and health insurance as factors affecting the provision of services will face this issue. The aim of this study was to draw the space for applying this approach in the field of family physicians and the changes it will bring.
Methods: This study has three stages: preparing a presentation file about personalized medicine and formulating questions, holding a meeting with family physicians, completing the questions form as a group, presenting their opinions, and finally, analyzing and summarizing the views of the doctors by the research team.
Results: Implementing personalized medicine will positively affect each of the family physician's functions, including health management, comprehensiveness of services, continuity of service delivery, coordination, and research. However, like any new change in any field, implementing this approach in this part of the health system will be challenging. There are solutions to face these changes and the resulting challenges from the point of view of family doctors.
Conclusion: As one of the essential parts of facing the changes in the health field, family physicians and health insurance should monitor the issues of this field prospectively and prepare themselves to face them. Providing infrastructures according to possible challenges and considering the principles of change management can be a solution for effectively implementing this approach in this field.

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