Journal of

---

As health care delivery systems develop, and their cost - as a percentage of total society expenditure - increases, policy-makers are more and more concerned about how to control these spiraling costs. An important section of policy makers' efforts to reduce costs is concentrated on preventing wastage in the health system. While a significant part of the resource wastage is due to inefficiencies in health system delivery, corruption and health care fraud and abuse are also to blame. The nature and the rate of corruption in the health care differ from one country to another. Still all countries encounter this problem and invest in interventions to combat corruption. Here we provide the readers with translated version of a very useful and readable paper by Vian. The paper reviews and summarizes the theories, methods, and interventions to combating corruption in health care.

---

Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals.
Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data.
Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.

---

Background: The elderly population in Iran is increasing .  The aim of this study is the survey of satisfaction rate and the effective factors on the elderly - aged peoples  satisfaction regarding to the given services in the hospitals affiliated to the Tehran university of medical sciences.

Materials & Methods: This research is a descriptive - analytical study with applied results. It shows the problems cross - section ally.The research society involves the whole elderly - aged people whit 65 years old   and more than that used the bedridden services of the hospitals affiliated to the Tehran university of medical sciences. The sample involves 360 elderly. For collecting the data, a questionnaire with three parts was used. The validity of questionnaire by the content measurement and the reliability of questionnaire by test re test (r = 0.84) were achieved. And also we used SPSS software for data analysis.

Results: : Results showed that 25/6%patients from management type, 41/9%from facilities ,17/2% from behavior personality and 30/3% from public services are dissatisfaction.  A total of 12 variable were analyzed, and the results showed that: The education level, age, sex, type of refer, dealing with the bed shortage and occupations have the meaningful relation with their satisfaction rate. The one - variable - analyzers in the logistic regration  model showed that among the whole meaningful variables, the education level has the strongest relation with satisfaction. With increasing the education level, the satisfaction rate have been decreased.

Conclusion: Due to results satisfaction rate among participant of this study is good and accepted. Using of results is effective step in increase productivity services and further evaluation needed to be done for functional styles patient elderly satisfaction.

---

Background: Insurance coverage has a tendency to alter the consumer and provider's behavior. Moral hazard is a serious problem in all risk pooling systems, such as insurance and taxes-based financial systems that cause negative consequences as increased costs in the health system. Therefore we decide, at this review article, to discuss about moral hazard, in different classifications and effects on the insurance marketing and health system.
Materials & Methods: This is a review article. Relevant materials selected from published articles, studies, and sites. The databases of Medline, Web of Science, Science Direct, Google Scholar, and Springer were explored to use the key words of moral hazard and health insurance.
Results: Insurance covered individuals, knowing that their health expenditures will be reimbursed by insurance in the time of illness, and their demand medical services are more than un insurance covered individuals. On the other hand the providers have financial incentive to provide unnecessary and excess medical services. Different types of moral hazard like as ex ante and ex post moral hazard hidden information and hidden action moral hazard provider and consumer moral hazard may arise due to insurance coverage. These lead to negative consequences such as consumption of unnecessary care services, alteration of consumption pattern for inefficient use of resources, welfare loss, and an increase in the health expenditures.
Conclusion: Studying and controlling the effects of moral hazards seems necessary to prevent unwelcome outcomes as well as misallocation of financial resources.

---

Background: The purpose of this study is to survey the Working Life Quality of specialists working in affiliated hospitals of Tehran University of Medical Sciences.

Materials & Methods: The statistical population of this study includes 400 specialists and a crosssectional Descriptive & analytical method has been used to gain credible results.. Van lar working life quality questionnaire was used to gather the data needed.. The data were analyzed with the SPSS software through T-test and Anova statistical tests. In addition, the simultaneous effect of independent variables in the model was evaluated using the Backward Regression Model.

Results: The average total working life quality of specialists working in affiliated hospitals of Tehran university of medical sciences is estimated to be 48.75 percent. Total working life quality of male specialists is higher than the females and the index is higher in specialists resident in Tehran compared to the other ones but these differences are not significant statistically.. Working life quality of specialists which are satisfied with the facilities in their working places are higher compared to the others and these differences are significant statistically. In addition working life quality has decreased with the increase in the experience.

Conclusion: Working life quality of the Specialists studied is not in a satisfying level, thus more attention and effective plans are needed from responsible authorities in the ministry of health and the managers of the hospitals studied in order to improve specialist`s working life quality.

---

Background: Achieving equitable financial contribution and removing the risk of households' exposure to catastrophic expenditures are the most important challenges for health systems all over the world. This study aimes to measure Iranian households' exposure to catastrophic health care expenditures and surveying the factors affecting this expenditure, based on the World Health Organization and the World Bank approach.
Materials & Methods: Sectional data of the World Health Survey in Iran in 2001 has been analyzed. This survey covered 10300 urban and rural households across the country. The catastrophic expenditure has been calculated based on the ability to pay in the thresholds of 40, 50, and 60 percent and the income at the threshold of 20 percent. Logistic regression model was used to examine factors influencing catastrophic health expenditures.
Results: The proportion of families confronting catastrophic health expenditures was estimated at 9-15 per cent. Facing catastrophic expenditures showed a statistically significant relationship with variables such as having a family member suffering from a chronic disease, family`s financial condition, and living in rural areas regardless of the thresholds used. The insurance coverage showed a statistically significant relationship with exposure of catastrophic health expenditure just in case it was measured using the 40% threshold.
Conclusion: Political interventions and policies of the government such as implementing fee exemptions for certain target groups, designing benefits packages, extending population coverage through prepayment mechanisms and protecting the poor and disadvantaged groups can protect households from experiencing catastrophic health expenditures.

---

Background: Informal payments are paid to individuals /health care providing organizations offering as cash or non-cash and are formed out of formal payment channels. This study aim at identifying the types of informal payments, causes, effects and policies to deal with them.

 Materials and Methods: This study was a review  one and relative  published articles identified by searching valid database ( Medlib, SID, Pub Med, Science Direct and Google Scholar)using keywords with their equal in Persian (informal payment and unofficial payment) and 128 articles were extracted. The articles refined step by step. In conclusion, 20 articles were selected according to study aims.

Results: The study findings consist of five main sections including the definition and form of informal payments, the existent causes of informal payments, effects of informal payments, statistics of informal payments in Iran and the world and policies to dealing with this important issue.

Conclusion: Due to the high prevalence of informal payments and severe negative effects on justice and respectable governance, policy-makers should focus on this issue and reduce its effects. Although, strategies to control informal payments are limited but strategies including regulation payment and medical tariffs, regulating power abuse, providing incentives and increasing responsibility of healthcare professionals, and changes in public perception are proposed.

---

Background: This study aimed at assessing and economic analysis of the existing market of treatment devices of infectious waste in Iranian hospitals.

Material and Methods: In the current descriptive- analytical study which was performed in 2013, the data resulting from national cross- sectional study in Center of Environmental and Occupation Health in 2012 and interview with relevant authorities in 14 Tehran's hospital with at least three years experience using the facilities were utilized.

Results: Until 2012, 883 hospitals have been active in nationwide that more than 64% of them owned by university of medical sciences and SBMU and TUMS with 114 and 45 centers have the highest number of hospitals respectively. Also hospital beds per 1000 population in the country were calculated 1.78. About 80% of hospitals utilized wet thermal and mostly based on autoclave machines for treatment which market share of domestic products is about 55% that Koosha Company, TEM and KAZU have the largest share with 39%, 23.5% and 12.9% respectively.

Conclusion: Existence a large heterogeneity in the type and function of the studied devices has created possible of Cartel in an oligopoly atmosphere  which  with a targeted regulation and policy making toward protectionism, it can be observed price decreasing, enhancing effectiveness, quality and safety increasing of infectious waste treatment facilities

---

Background & Aim: The purpose of this study was to investigate the current organizational culture in Tehran University of Medical Sciences, which is to be considered in order to strengthen organizational culture.
 
Material & Method: The present study is a descriptive cross-sectional study and an applied research-based survey that was conducted in Tehran University of Medical Sciences in 2019. The sample size was calculated and analyzed using Cochran's formula for 306 people. In this study, Denison's Organizational Culture Questionnaire was used to collect data. Data were analyzed using SPSS software, descriptive statistical methods, one-sample mean and Pearson Correlation Tests.
 
Results: The average of organizational culture in Tehran University of Medical Sciences, in each component, culture of Involvement (2.29), culture of consistency (2.63), culture of adaptability (2.66) and culture of mission (2.58), Which represented a higher-than-average culture in all aspects of Denison's view.
 
Conclusion: The organization should do some corrective actions with respect to the components of adaptability (subculture of organizational learning) and Involvement (Capability Development), which has earned a lower score.
 

---

Introduction: The operating room is one of the most sophisticated workplaces, consisting of a vast array of electrical, gas and radiation equipment that are more susceptible to accident than other hospital departments. Therefore it is important to observe safety tips in this section. The purpose of this study was to evaluate the standard of safety in operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences in 2019.
Method: This study was a descriptive cross-sectional study. The statistical population consisted of all operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences. The tool used was a checklist that was completed by researchers by observation and interviewing on-site. Safety standards have been evaluated in terms of the physical space of the operating room, fire safety, personnel safety, patient safety, infection control. Data were analyzed by SPSS version 21.
Results: The operating rooms of university-affiliated hospitals were 80.10% secure in overall safety. The patient's safety area, with 83.34%, had the shortest distance from the standards and the infection control safety area, with 74.24%, had the highest distance from the standards. The highest and lowest scores were related to the safety standard related to the operating room of hospitals (2) and (1).
Conclusion: According to the findings, the operating rooms of the studied hospitals are generally in desirable compliance with safety standards. However, it is essential to pay attention to problem areas to increase the safety factor for staff and patients in the operating room, so appropriate remedial measures should be taken to ensure complete safety of the operating room for all components.

---

Background: The Family Physician Program, one of the most important efforts of the Iran health system to establish a referral system, was developed and implemented in several provinces, but it faced challenges due to several reasons that prevented the program's progress. So This study was conducted to analyze the family physician program to identify the causes and challenges of the program failure.
Materials & Methods: This retrospective study of policy analysis is a qualitative study with Purposive sampling. Semi-open interviews and document analysis were used for data collection. Data analysis was performed through thematic analysis in the policy triangle framework using MAXQDA software.
Results: According to the study framework, the challenges of the Family Physician Program in the context are conflict of interest, dependency of plans to oneself, instability in management and plans, insufficient attention to culture, resources, and infrastructure. In terms of content include disproportionate executive approach, Lack of localization, selection of inappropriate tools, insufficient transparency, and ambiguity in goals, tasks, and responsibilities; The challenges of the process were examined based on the policy cycle.
Conclusion: The implementation of the family physician program is influenced by cultural, social, political, managerial, and economic factors. As the Ministry of Health officials has re-introduced this crucial program, reviewing the content and methods of program implementation seems necessary.