Journal of School of Public Health and

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Background and Aim: Coronary artery disease (CAD) and its complications at a low age are more serious and more progressive than at higher age. Because of this difference in the natural history of the disease as a function of age, this study was conducted to compare CAD risk factors between two age groups, namely people below and above 45 years old.

Materials and Methods: Two groups of 200 hospitalized CAD patients each, one below, and one above, 45 years old were selected by simple random sampling between 2005 and 2007. Two groups were similar with regard to dates and duration of hospitalization. The following data were collected from the patients' hospital files and analyzed using SPSS/Win: age, sex and marital status area of residence a history of smoking, diabetes, and hypertension a family history of early-onset cardiovascular disease (CVD) weight and height and lipid profile. The logistic regression test was used to compare the variables between the two groups.

Results: The following variables were found to be positively associated with CAD in the under-45 year group: smoking history (OR=2.54 p=0.009), a history of early-onset CVD (OR=3.15 p=0.009), low high- density lipoprotein cholesterol (HDLc) (OR=5.53 p<0.001), and high blood cholesterol (OR=3.96 p<0.006).

Conclusion: The most important coronary heart disease risk factors at a lower age are smoking, a history of early-onset CVD, low blood HDLc, and high total blood cholesterol.

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Background and Aim: Responsiveness is of extreme importance in every health system, especially for policy-makers and health managers. Responsiveness relates to how the health system responds to legitimate expectations of the patients regarding non-clinical aspects of health care. Furthermore, justice in an organization requires fair treatment of the patients on the part of the health personnel. In other words, organizational justice relates to how to treat the personnel so that they feel they are treated fairly. The objective of this study was to investigate the responsiveness of hospital as perceived by patients and nurses and the relationship between the responsiveness rate and organizational justice as perceived by nurses in the hospitals.

Materials and Methods: This was a descriptive-analytical study aiming at determining the correlation between responsiveness and organizational justice in 8 elected hospitals (4 private and 4 public) in Isfahan, Iran. The study population was patients and nurses. A total of 320 individuals (160 patients and 160 nurses), selected by stratified random sampling, participated in this study. Two questionnaires, namely the adjusted WHO Responsiveness Questionnaire (for patients and nurses) and the Equity Questionnaire (for nurses), the validity and reliability of both of which had been determined, were used to collect data. The software used for data analysis was SPSS

Results: The overall score (out of 4) of organizational justice was 1.9 0.77, while the mean score of responsiveness as perceived by the nurses and the patients was 2.32 0.54 and 2.48  0.58, respectively. There was no statistically significant difference between the 2 groups with regard to responsiveness, but there was a positive association between responsiveness and organizational justice as perceived by nurses (r = 0.2, p = 0.03).

Conclusion: The variables in the hospitals studied are generally at an intermediate level and there are no statistically significant differences between private and public hospitals. There is no difference in organizational justice between private and public hospitals, but responsiveness is higher in private hospitals as compared to public ones. Thus, the public sector needs to attempt to create more incentives in health professionals in the health sector in order to guarantee higher-quality services and better responsiveness.

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Background and Aim: Iran's Health Sector Evolution Plan (HSEP) is one of the most important national health reform plans. HSEP has attracted many criticisms. An important criticism is about its service costs. This article reports the results of a project conducted to compare the costs of normal and caesarian section delivery before and after implementation of the HSEP.
Materials and Methods: This was an applied research project using hospital accounting records as data. A total of 120 delivery files (60 normal delivery and 60 caesarian section) were selected randomly from the accounting software of a large hospital in Isfahan before and after May, 2014.The data in each subject’s file ─ paid shares of the hospital, patient and insurance ─ but not hoteling, inpatient and other costs was extracted. The health service providers’ incomes based on the annual tariffs of the services and changes in payments for each service for gynecologist and anesthesiologists were calculated. Data were analyzed using the excel software.
Results: The costs of normal delivery and caesarian section after implementation of the National HSEP had increased by 193% and 226%, respectively. In addition, of the treating physicians (gynecologists and anesthesiologists) had also increased by 257% for the normal and by 130% for caesarian section. Changes in the sums of money involved in service delivery indicates shifting of parts of the costs from the patients to the health subsidy and insurance systems.
Conclusion: The health System Evolution has not lead to real reductions in the out-of-pocket money paid by the patients. Higher cost of services will imply the need for better cost management. Increased costs of services will be to the benefit of neither patients nor the health system. This would mean that in designing and implementation of the Health Sector Evolution Plan economic aspects should be taken into consideration more carefully.