Journal of

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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.

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Background: Nowadays Social health insurance does not cover all health expenditures because of increasing cost of diagnosis and treatment services which results in private insurer entry to health market. This study is aimed to determine key indicators which have important effect on the demand for private health. This identification of indicators leads to better planning for prospering private health insurance. Material & Method: This is a a descriptive and analytical study. The data were collected by questionnaires which has been filled by a sample of 950 households .The samples had been chosen by three-stage cluster sampling. The model had been estimated by econometric methods based on models of Probit and extreme value distribution.. Result: The result indicated that having basic health insurance, doing exercise each day routinely, having regular medical checks, being landlord and being retired raised the probability of demand for private health insurance. On the other hand, demanding private health insurance is less common among older adults and people who use to wear seat belts. Conclusion: Identification of important factors which influence the demand for private health insurance would assist policy makers to provide essential structures for expanding private health insurance coverage.

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Introduction: Inappropriate admission and inappropriate hospital days are two undesirable indicators in terms of controlling hospital costs. This study was conducted to determine the rate of inappropriate admission and hospital days and related factors in Shohada Hospital in Kermanshah.
Methods: This is descriptive-analytical study.The statistical population included patients admitted of Kermanshah shohada Hospital in 1397. 245 Inpatient records were selected using Cochran's formula and stratified random sampling. Appropriateness evaluation protocol was used to evaluate the inappropriate admission and inappropriate hospital days. The relationship between age, sex, type of admission, type of ward, type of treatment, coverage of cost hospitalization, place of residence, with rate of inappropriate admissions and inappropriate hospital days was assessed using spss16 software.
Results: 5.7% of admissions and 21.4% of hospital days were inappropriate. Inadequate admission was significantly related to gender, type of surgical or medical treatment, type of hospital ward in chi-square test in contingency tables with 95% confidence.  Inappropriate hospital days were related to the type of hospitalization ward in kruskal-Wallis test , type of treatment and place of residence in Mann-Whitney test.
Conclusion: By determining the amount of inappropriate admissions and inappropriate hospital days and related factors for policy makers and managers of hospitals and insurance organizations, it is possible to avoid unnecessary costs without reducing the quality of hospital services.

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Background: The outlook for hospital care is changing rapidly. Supply and demand stimuli in the health service system are changing dramatically. The health department of the Social Security Administration has also been challenged by the growing number of patients. This study was conducted to help this organization with the aim of designing a conceptual causal model of the interaction between supply and demand of health care.
Materials and Methods: This research is a qualitative study that was conducted in 2020. It presented a conceptual model in two steps in the first step, semi-structured interviews were used to extract important factors in the supply and demand of health services in hospitals. In the second step, the system simulation approach was used and the feedback relationships between the patient's routes to the hospital and the provision of medical services were presented.
Results: According to the study hypothesis, the prevalence of disease and budget allocation as an indicator of medical need and expected medical demand, positively affect the number of visits to hospitals of the Social Security Organization. Accordingly, four sub-models of patient flow, health care budget, treatment staff (physician, nurse) and hospital capacity were extracted.
Conclusion: Medical budgets allocated to hospitals to improve medical facilities and increase the number of staff, have created positive expectations among social security insured regarding the use of hospital services. Paying attention to providing sufficient manpower (doctor, nurse) and bed capacity with the budget which is spent for this service are the indicators of improving the quality of services.