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Volume 23, Issue 2 (8-2024)
Abstract
Milad Mehri, Mohammad Efatpanah, Ebrahim Jaafaripooyan, Mohammad Arab,
Volume 23, Issue 3 (11-2024)
Abstract
Background and purpose: Abuse within health insurance systems represents a significant challenge for health systems globally, leading to substantial negative repercussions. This study investigates instances of abuse in the Iranian Health Insurance Organization and proposes strategies to mitigate such abuses within its primary insurance processes.
Methods: This applied study employs a qualitative methodology, with data collected via semi-structured interviews. Experts from the Iranian Health Insurance Organization were interviewed to gather their insights. Data analysis was performed using conventional content analysis, and MAXQDA 20 software was used for coding and categorizing the findings.
Results: Instances of abuse within Iran’s health insurance system were classified into two main categories: "providers" and "service recipients," which were further divided into 18 subcategories. The underlying causes of these abuses were analyzed on two levels: macro-level factors (economic, cultural-social, legal, and technological) and micro-level factors (implementation processes, oversight, and service delivery). Based on these findings, strategies for reducing abuse were proposed in three primary areas: "planning," "execution," and "control." These strategies included revising and amending relevant laws and regulations, enhancing technological infrastructure, and improving information systems in the planning phase; verifying the identities of service recipients and providers during service delivery; and strengthening oversight personnel, alongside continuous inspections, in the control phase.
Conclusion: This study indicates that revising laws and regulations within the insurance sector, upgrading technological infrastructures, providing continuous training for claims assessors, enhancing inter-organizational communication, and strengthening oversight of service providers are essential strategies for preventing abuse in the Iranian Health Insurance Organization.
Maryam Goodarzi, Mashallah Torabi, Maryam Ahmadi, Hamideh Hamidi, Samira Elmi, Reyhaneh Sadat Karimi, Fatemeh Golmahi, Samira Mortezaie, Parisa Nezari,
Volume 23, Issue 3 (11-2024)
Abstract
Background and purpose: In the current decade, the development of intellectual capital has emerged as a key driver for enhancing both individual and organizational performance. The deployment of electronic service desks can contribute significantly to this development, particularly in strengthening structural capital. This study aimed to examine the impact of implementing an electronic service desk on the structural capital of Tehran University of Medical Sciences during the COVID-19 pandemic.
Methods: This qualitative study employed a multi-case research approach. Data were collected through semi-structured interviews with managers and experts in the domains of service desk operations and university education. Additional data were gathered by reviewing institutional documents and client feedback reports. Identified factors were subsequently validated through focus group discussions. Content analysis was used to analyze the data.
Results: The most prominent impact of the electronic service desk was improved management of client-related statistics and enhanced reporting capabilities to relevant authorities. Other significant effects included easier user access, the ability to refer documents to other departments or organizations, improved resolution of requests during initial user contact, and enhanced interactions with clients.
Conclusion: The electronic service desk played a vital role in sustaining and enhancing the quality of educational services during the pandemic, while aligning with public health protocols. Furthermore, it laid the foundation for managerial innovation within the university’s educational service delivery system.
Hasan Varmazyar, Ali Akbar Fazaeli, Taghi Torabi, Farhad Ghaffari,
Volume 23, Issue 3 (11-2024)
Abstract
Niloufar Amiri Ghale Rashidi, Farin Razaghi Kashani, Ramin Rahimnia, Ebrahim Jaafari Pooyan, Alireza Arab Yarmohammadi, Hadi Mokhtare, Masoud Rafati, Zohreh Jabari Moghadam,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: In Iran’s health system, the lack of a systematic process for selecting managers based on the specific competencies required in medical universities and the health sector has long been a challenge. To address this gap, Tehran University of Medical Sciences took the lead as the first institution to design a competency mapping framework for frontline and middle managers, aiming to align managerial selection with the strategic goals of the health system.
Methods: Firstly, a succession planning committee was formed in the university’s Vice-Chancellor for Management Development and Resource Planning. Following an extensive review of relevant models and strategies by several expert panels, this committee proposed guidelines for selecting selecting managers based on merit and developed a competency mapping process.
Results: The competency mapping process was structured into eight steps, including: candidate eligibility screening, assessment of general and technical competencies, 360-degree performance evaluation, review of prior experience, and participation in a mentoring-based empowerment program.
Conclusion: Using this merit-based selection model, top-performing candidates could be successfully appointed to managerial roles. A key achievement of this process is fostering a culture of meritocracy and advancing the organizational maturity of the university. Competency and talent mapping can serve as a robust framework for succession planning and managerial development in medical universities and the broader health system. This approach might significantly contribute to optimizing the selection and development of future leaders for critical positions via identifying skill gaps, assessing development needs, evaluating performance, and enhancing talent identification.
Elham Haghshenas, Ali Ghangalikhan Hakemi, Samira Raoofi, Sara Akhavan Rezayat, Soheila Damiri, Saeed Nateghi, Maryam Radinmanesh,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: Given the interdisciplinary nature and multiple stakeholders involved in electronic prescribing systems, their implementation process encounters numerous complexities. This qualitative study aimed to explore and clarify the challenges associated with electronic prescribing and prescription dispensing systems.
Methods: A qualitative content analysis was conducted in 2021 (Iranian calendar: 1400). Data were collected through semi-structured interviews with 25 key informants from the treatment management sector and affiliated hospitals of Tehran University of Medical Sciences. The collected data were analyzed using conventional content analysis methodology facilitated by MAXQDA 10 software.
Results: Approximately 350 initial codes were identified, which were categorized into four main themes with eight sub-themes: policy preparation (establishing a policy secretariat and achieving political consensus), policy formulation (developing policy content and advocacy), policy implementation (planning and executing policies), and policy evaluation (monitoring and evaluating policies).
Conclusion: Ensuring public health remains the ultimate goal of the healthcare system. Electronic transformation, particularly in establishing electronic health records, can significantly improve healthcare service quality. Integrated policymaking among the various institutions involved, enhancing technical and procedural infrastructure, human resource training, and societal cultural readiness are essential factors for the effective implementation of electronic prescription systems and the enhancement of healthcare quality.
Fateme Mohammadi, Hossein Dargahi, Sara Emamgholipour Sefiddashti, Mohammad Mehdi Aladdin,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: The healthcare sector is undergoing a profound transformation driven by rapid scientific, economic, and social advancements. The World Health Organization (WHO) emphasizes the necessity of medical equipment and supplies for reducing health disparities and achieving strategic health system objectives. However, there is a notable gap in the literature regarding this cost component within the Iranian health system. This study, therefore, aims to quantify the share of pharmaceutical and medical consumable costs in Iran's total health system expenditure.
Methods: This retrospective, cross-sectional study analyzed outpatient and inpatient medical records from 2018 to 2020. Data on the costs of pharmaceuticals and medical consumables were extracted from Iran's National Health Accounts (NHA) and the SPAS dashboard. The collected data were statistically analyzed to determine the proportional costs of these items relative to total national health expenditure.
Results: Between 2018 and 2020, inpatient pharmaceutical and medical consumable costs constituted 12% of the total health expenditure, demonstrating an annual decrease of 1.8%. In contrast, outpatient costs accounted for 19.5% of the total, with an annual increase of 0.7%. Basic health insurance allocated approximately 10.3% of its budget to cover these items, which corresponds to 31.5% of the nation's total healthcare spending.
Conclusion: The findings highlight the critical need for strategic interventions within Iran's health system. Key implications include the necessity for effective supply chain management, strategic planning to reduce import dependency, and robust mechanisms for monitoring prices. Mitigating the adverse effects of inflation and sanctions is paramount. Furthermore, increasing the healthcare budget's share of the Gross Domestic Product (GDP) and expanding insurance coverage are essential for ensuring financial protection for the population and advancing towards Universal Health Coverage (UHC).
Golnoosh Babaei, Hossein Dargahi, Hojjat Rahmani,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: The migration of healthcare workers from developing countries to more developed nations is a long-standing and ongoing trend. The loss of personnel due to migration can negatively impact healthcare systems. Therefore, this study aimed to identify the causes of the tendency to migrate and strategies to reduce it among paramedics at Tehran University of Medical Sciences.
Methods: The present study is an applied research conducted using a mixed-methods approach in three phases: literature review, Delphi method, and expert panel. It was carried out at Tehran University of Medical Sciences in 2024. Based on the literature review, a questionnaire on the causes of and solutions for reducing paramedical staff migration was developed. After confirming its validity and reliability, the questionnaire was distributed among students. The most important strategies for reducing migration were identified through the expert panel. Quantitative data were analyzed using SPSS version 22, while qualitative content analysis was used for the literature review and expert panel data.
Results: The main causes of paramedics’ migration included contextual factors, work-related factors, health system-related factors, individual-related factors, and factors related to the destination countries. According to the findings, increasing salaries and benefits, improving welfare facilities, and enhancing economic conditions were the most important strategies for reducing migration from the perspective of students and experts.
Conclusion: Although some actions, such as raising awareness about the hardships of migration, may influence individuals’ decisions, more fundamental measures—such as improving economic conditions, reforming the healthcare system structure, creating equal job opportunities, and enhancing the social status of paramedics—are essential to control and reduce the migration trend.
Taher Malaki, Dr Abasat Mirzaei, Sanaz Zeydabadi, Akbar Rasouli,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: One of the health system reform programs is the Family Physician and Referral System Program. Therefore, the purpose of this study is to review how family physicians and referral systems are financed in selected countries and Iran.
Methods: This study was conducted as a comparative review in 1403. Information was extracted using related keywords and their English equivalents based on specific subject headings (Mesh) in various databases. In addition, data from the World Health Organization and health system reports of selected countries were also reviewed. Information was extracted based on a data extraction form (researcher-made). Finally, the information was categorized and analyzed by subject.
Results: The study results showed that the main source of financial resources was through the budget and public taxes, and the payment system in the family physician program in the majority of the countries studied was based on performance-based per capita payments. Finally, in addition to the weaknesses and challenges of the countries studied in implementing The family physician program, in Iran, lack of public awareness, poor supervision and management, incorrect policymaking, and challenges in implementing electronic health records were also identified as weaknesses of the family physician program.
Conclusion: Despite the many similarities in the implementation of the family physician program among the selected countries, there are differences in terms of policymaking, implementation methods, and funding methods. Based on the research findings, it is suggested that in order to successfully implement the family physician program, the successful experiences of other countries at the international level, as well as evidence and information in implementing this program, be used.
Majid Safaei Lari, Ali Akbar Mohammadi, Hamid Raeisi, Zakiyeh Raeisi,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: The Student Welfare Fund of Iran's Ministry of Health is a public institution tasked with providing financial aid to medical students. Amid growing demand for these services and constrained government resources, a comprehensive analysis of the full cost of loan disbursement is crucial for ensuring operational efficiency and financial sustainability.
Methods: This applied, descriptive study conducted a retrospective cost analysis from the perspective of the Student Welfare Fund. The study population comprised all student loan records processed during the 2024 fiscal year. A hybrid top-down and bottom-up costing methodology was employed to determine the full cost of the loan disbursement process. Data were extracted from the Fund's internal financial records, annual reports, and publicly available price lists for equipment and consumables, and subsequently analyzed using Microsoft Excel.
Results: The full cost per loan processed was lowest for single-student academic and essential-needs loans, at IRR 33,538,137, and highest for housing deposit loans, at IRR 56,743,475. The total cost for all student loans disbursed during the 2024 fiscal year amounted to IRR 124,222,283,295.
Conclusion: Processing times were shortest for academic loans and longest for housing deposit loans. Human resources constituted the largest cost component in the disbursement process. Despite the significant personnel costs, a comparison between the full costs and the service fees collected suggests that the Fund's operational processes and staff performance are acceptably efficient.
Newsha Poursaadat, Mohammad Ali Cheraghi, Maryam Esmaeili, Fatemeh Hajibabaee,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: A key aesthetic dimension of nursing leadership involves embedding aesthetic principles into the formulation of organizational documents and artifacts. These elements embody beauty in both visual design and semantic content within the healthcare environment, created by providers and perceived by all stakeholders. This study aimed to explore the role and manifestation of aesthetics in such organizational materials from the perspective of nursing leaders at Tehran University of Medical Sciences.
Methods: This qualitative study, conducted in 2023, utilized a conventional content analysis methodology guided by the Graneheim and Lundman approach. The participants were nursing managers and leaders from hospitals affiliated with Tehran University of Medical Sciences. A total of 28 participants were recruited via purposive and snowball sampling. Data were collected through in-depth, semi-structured interviews, supplemented by photovoice and field observations, to explore the guiding principles and prevailing atmosphere shaping organizational aesthetics.
Results: The analysis of the data yielded 191 initial codes, which were abstracted into six main themes: (1) Preservation and Maintenance, (2) Standardization, (3) Cleanliness and Beautification, (4) Order and Arrangement, (5) Organization, and (6) The Sublime.
Conclusion: The study concludes that the aesthetic vision championed by nursing leaders—as manifested in organizational documents and the workplace environment—is palpable to all stakeholders. This perceived aesthetic fosters a sense of grace and compassion in the thoughts, speech, and actions of both care providers and recipients. Ultimately, it facilitates a more holistic form of "aesthetic nursing care" and helps to create a comforting, home-like atmosphere for patients.
Sara Emamgholipour, Fateme Mohammadi, Behzad Raei,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: Evaluating hospital efficiency serves as a critical tool for assessing the preparedness and responsiveness of health systems in times of crisis. Accordingly, this study examines the performance of hospitals affiliated with Tehran University of Medical Sciences in response to the COVID-19 pandemic during the years 2019 to 2022.
Methods: This analytical study assessed hospital efficiency using the Pabon Lasso model over the period 2019–2022. Additionally, statistical correlation analysis was employed to explore the relationship between changes in COVID-19 admissions and variations in hospital expenditures, revenues, average length of stay, and bed occupancy rates.
Results: The outbreak of COVID-19 led to a temporary improvement in performance indicators and more optimal utilization of hospital resources. However, following the subsidence of the crisis, hospitals reverted to their previous inefficient structures. In 2022, the operational structure of hospitals returned to pre-pandemic conditions, with only 14% of hospitals falling within the efficient zone. Compared to 2019, a 33% increase in hospitals located in Zone 1 and a 17% decrease in those in Zone 4 indicated a lack of progress in enhancing systemic efficiency. Moreover, the rise in COVID-19 admissions was associated with increased expenditures and subsidies, yet had no significant impact on hospitals’ direct income from patients. Functional effects were limited to a slight reduction in average length of stay and a modest increase in bed occupancy rates.
Conclusion: The findings highlight the absence of mechanisms necessary to sustain crisis management achievements and promote long-term efficiency. Health system preparedness for future crises requires continuous integration of crisis experiences, proactive planning, resource allocation, and the establishment of frameworks to maintain and enhance productivity under all conditions. Therefore, crisis management should not be viewed as a temporary response but rather as an integral component of the strategic and permanent structure of healthcare organizations.
Forough Saraee, Fatemeh Zahra Ahmadi, Mahboube Gholami,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: The prevalence of mental health disorders among children and adolescents is on the rise, exerting profound effects on individual development, academic performance, and social well-being. This study aims to map the current landscape of mental health services for this demographic in Iran, identify existing challenges, and propose strategies to enhance service accessibility and quality.
Methods: This scoping review was conducted in 2025 using the six-stage framework developed by Arksey and O’Malley. A comprehensive search was performed across international databases (Scopus, Web of Science, PubMed) and national databases (MagIran, SID), as well as Google Scholar and relevant organizational websites (e.g., WHO, Ministry of Health and Medical Education). Data were extracted using a narrative approach and analyzed thematically.
Results: Nineteen studies met the inclusion criteria. The review identified a multi-level service delivery system encompassing primary care, specialized care, school-based, community-based, family-based, and national-level interventions. These services utilized diverse modalities, including education, screening, and therapeutic interventions. Key barriers to effective service delivery included structural constraints (e.g., inefficient referral systems, resource scarcity), socio-cultural challenges (e.g., stigma, low public awareness), and human resource shortages (e.g., lack of specialists).
Conclusion: Leveraging the capacities of the primary healthcare network and the educational system, alongside workforce capacity building and public awareness initiatives, is essential for expanding access to and improving the quality of mental health services in Iran.
