Journal of

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Background: The different effective factors on out of pocket payment (OOP)have been introduced as follows: low salary of the employee's, low governmental tariff, chronic disease, gifts to personnel, physician and other cadre's requests, fear of bad or no services. In addition OOP has negative effects on the accessibility of services .This article studies the distribution of effective factors on OOP (formal and informal) through cardiac patients and its side effects.
Materials & Methods: This is a descriptive-exploratory study. The data were collected byinterviews and questionnaires reliability of which was approved by specialists and their validity were approved by simulation-in Shahid Madani hospital in Tabriz in the winter of 2010.
Results: all the persons studied had an experience of OOP. Formal payments included the free cost of the services with no insurance cover and the margin between the tariff and the rate that the physician or the hospital declares (83% of OOP). In addition 10% of persons encountered informal payments 80% of which was due to the physician's request and 20%as a gift. The results describes the OOP`s side effects so that 52% of patients faced a postpone in getting services because of the OOP and 72% pointed that OOP has had an enormous effect on providing the necessary needs of the families.
Conclusion: The high rate of OOP and the weak performance of insurance system will result in injustice and intensifies the unfavorable effects of OOP on the health system and society.

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Background: Providing high quality, safe and effective health care services requires competent and motivated employees. Employee’s creativity plays a significant role in motivation and health care system productivity. Various individual and organizational factors influence employees’ creativity. This study aimed to examine the relationship between managers’ leadership style and employees’ creativity in Qazvin hospitals.

Materials and Methods: Creativity and leadership questionnaires were used to conduct this descriptive and cross-sectional study. The questionnaires were distributed among 800 employees in ten hospitals using stratified sampling method. Descriptive and analytical methods utilized for data analysis using SPSS software.

Results: The mean score of hospital employees’ creativity was 47.5 out of 60 (moderate level). The prevalent leadership style of managers was transformational. There was a significant statistical association between employees’ creativity and managers’ transformational leadership style.

• Since, leadership styles of hospital managers influence employees’ creativity, they have to apply appropriate leadership style to motivate employees and develop their creativity in order to improve hospital productivity.