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The Quality of Services Perceived and Expected by Those referring to Private Labs Under the Health Insurance Contract
Mohammad Arab, Ebrahim Jaafari Pooyan, Abbas Rahimi Forushani, Azam Sadat Rivandi,
Volume 12, Issue 2 (7-2018)
Abstract
Background and Aim: The quality of healthcare services is determinant in patients’ improvement process, upgrading their satisfaction, ranking healthcare centers, and preventing patients’ repeated referrals leading to more costs for healthcare centers and insurance companies. The purpose of this study was to evaluate the quality of services -- from the perspective of patients -- given by the laboratories having contract with Iran Health Insurance Organization (IHIO). 
Materials and Methods: In this cross-sectional study, the opinions of 302 patients having referred to the laboratories in contract with IHIO in Tehran were surveyed with a researcher-developed questionnaire. Descriptive and inferential statistical tests were used to analyze and report the results.
Results: The sample included 43.5% males and 56.5% females. Most of the participants were married (71/3%). Based on the results, the patients' perception of the quality of laboratory services was 78%. Their expectation of services was 85%. The gap between perception and expectation of clients in all dimensions was statistically significant (p<0/001).
Conclusion: The gap between clients’ perception and expectation in all dimensions suggests that there is some room for improving the quality of laboratory services. The results of this assessment can surely affect the way IHIO treats with laboratories in terms of extending contracts and strategic purchase of services from these centers. In addition, patients' opinions will be important in improving the quality of services. 

Cost-Effectiveness of Growth Hormone (Somatropin) for the Treatment of Children with Short Stature
Mohammad Tasavon Gholamhoseini, Mohsen Barouni, Nooshin Afsharzadeh, Mohammad Jafar Isirizi,
Volume 12, Issue 4 (11-2018)
Abstract
Background and Aim: One of the common problems of children all over the world is short stature. Due to the high costs of treatment, the present research studied the cost-effectiveness of growth hormone (Somatropin) for the treatment of children with short stature in Kerman Province.
Materials and Methods: This research is an economic evaluation. The population of the study consisted of all persons who had medical records in the health insurance office of Kerman province, of whom 49 were selected as samples. The cost was calculated from the perspectives of patients and insurers. This information was collected through a researcher-made form by interviewing the patients and reviewing the records of health insurance office. To calculate the outcomes, QALY and Increase in Height were used. For cost effectiveness analysis, the ICER formula and TreeAge software were employed and compared with a threshold of 3 times GDP per capita.
Results: The findings showed that the share of patients' treatment costs was 5,092,964,520 and the expenses of Health Insurance Organization of Kerman province was 71,175,443,448 rials. Based on Qaly criterion, incremental cost-effectiveness ratio was 743,133 and 9,846,567 rials from the perspective of the patient and of the health insurance organization, respectively. Sensitivity analysis of non-deterministic parameters of the model showed that they had no effect on the cost-effectiveness of treatment with growth hormone.
Conclusion: According to the results, the treatment of short-stature children with growth hormone is cost-effective, and this result can be considered by health system policy makers.


Evaluation of the Analytical Dashboard of Designed Health Insurance Deductions, based on Business Intelligence
Eng. Meisam Fallahnezhad, Reza Safdari,
Volume 15, Issue 3 (8-2021)
Abstract
Background and Aim: Large amounts of hospital costs are not reimbursed annually by health insurance as deductions. Therefore, reducing deductions is very important for the hospital. In the study of design and implementation of analytical dashboard of insurance deductions based on medical intelligence business, to improve financial management with the aim of focusing on assessing the level of satisfaction and its applicability has been done.
Materials and Methods: To design the questionnaire, first 27 questions were prepared through library studies and interviews with members of the hospital board of directors, and the validity and consistency of its items were determined through content validity and Cronbach’s alpha coefficient. Data were analyzed in SPSS software and the results were used to design and implement the dashboard.
Results: The study is of development-applied type. In the first phase, to determine Content Validity Ratio CVI (Content Validity Index), and CVR (Content Validity Ratio) a researcher-made questionnaire was provided to 20 experts. In the second phase, by building a data warehouse in SQL (Structured Query Language), the information of the tables related to the deductions of the hospital HIS system was transferred to it and the operational information of the organization was extracted and converted into DW format and the map information was tested. OLAP (Online Analytical Processing) services were then loaded on the created analytics database. In the last step, Power BI tool was selected and used to create business intelligence mechanisms, display and visualize information. In the third phase, using the QUIS (Questionnaire for User Interface Satisfaction) standard questionnaire, the level of satisfaction and usability of the dashboard was evaluated by 15 experts.
Conclusion: In this study, two questionnaires were used. CVR was measured in all items of the first questionnaire, more than 0.50 and CVI was measured in the upper areas of 0.90 and Cronbach’s alpha coefficient was obtained between 0.8 and 0.9, which indicated a good level. The second questionnaire was to evaluate the level of satisfaction and usability of the dashboard that the average of the total evaluation based on the indicators of the QUIS questionnaire is equal to 85.40. Therefore, the level of satisfaction and usability of the dashboard was “very good” for the evaluators.

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