Evidence Based Health Policy, Management and Economics

Admission of Medical Students through Graduate Entry as an Alternative for Traditional National University Exam in Iran: A Policy Brief

Arya Hamedanchi — 2025-03-04

Admission of medical students holding previously obtained academic degrees through graduate entry (GE) is well underway at many creditable universities worldwide. In Iran, the GE system can lower the pressure on centralized medical student admission and reduce the problems stemming from that. The difference between GE and the traditional one is not limited to student admission and it generally involves accelerated courses in terms of duration. Moreover, the educational process is also different from that of the regular traditional system. Presently, only a small number of medical students are admitted through GE in Iran. This policy brief includes a study of student admission based on the GE method, a comparison and contrast to the traditional approach, a statement of probable problems, and a final presentation of suggestions for the improvement of this procedure. Although a scrutiny of novel educational procedures and an exact prediction of curriculums entail specialized working groups, two preliminary stages for implementation of GE have been recommended in the current policy brief. It is recommended to carefully predict and monitor GE procedures. Given the necessary superstructure and facilities, the resultant procedure should be initially employed in larger universities with students who have prior education related to health sciences, and subsequently be transferred to other universities and bachelor degrees. It is also recommended that a special working group be convened to examine the new curriculum at ministry level and be tentatively convened in one or more universities. Also, economic studies from an educational perspective are recommended to weigh the cost-effectiveness of the new method.

The Role of Tariff Setting in the Healthcare Market Equilibrium

Fereshte Karimi — 2025-03-04

Healthcare pricing is intricate and influenced by numerous factors, including market structures, government regulations, access to financial resources, service costs, supply and demand. Due to this complexity, government intervention is frequently necessary to ensure equilibrium in the system. Relying solely on market forces (invisible hand) can create challenges for both healthcare providers and patients. For example, high tariffs can deter patients from pursuing essential care, leading to poorer health outcomes and contributing to economic challenges such as decreased productivity. On the other hand, low tariffs might create excessive demand for services, resulting in resource wastage and a decline in quality. Policymakers must strike a balance that emphasizes health considerations while also taking into account the medical education system, relevant laws, and political factors when establishing healthcare tariffs. The way these tariffs are determined not only affects healthcare access but also has broader implications for economic growth and workforce productivity. This highlights the need for careful management of healthcare tariffs to support both public health and economic performance.

Performance Assessment Tool of the Surgical Technologists in Patient Safety: A Validation Study

Mohadesehsadat Mehrdad — 2025-03-04

Background: Operating room technologists are crucial in ensuring patient safety in surgical units. The study aims to assess the validation of the observational performance assessment tool related to patient safety using a tool, the World Health Organization Behaviorally Anchored Rating Scale (WHOBARS), among operating room technologists in Iran.

Methods: The cross-sectional study was conducted at Shahid Sadoughi University of Medical Sciences. The WHOBARS tool was designed based on the surgical safety checklist of the World Health Organization. In the first step, the translation-back translation process was done and the external validity of the tool was confirmed. In the next step, content and face validity were evaluated qualitatively. Quantitative content validity was evaluated through two indices: content validity ratio (CVR) and content validity index (CVI). The reliability of the tool was measured by two methods of internal consistency and test-retest. Data were analyzed using descriptive statistics (mean, percentage, standard deviation) by SPSS₂₆ software.

Results: With the agreement of all experts in the first phase of the study, the face and content validity of the tool was confirmed. All items of the tool obtained CVR higher than 0.49 and CVI higher than 0.79 which were retained in the tool. Finally, the quantitative and qualitative validity of the 15-item performance measurement tool was confirmed. The Cronbach's Alpha coefficient was 0.86.

Conclusion: According to the findings, the Iranian version of WHOBARS is a reliable and valid tool for the evaluation of safety performance among operating room technologists

Identifying Barriers to the Adoption of Electronic Prescribing: A Stakeholder Analysis Approach Using a Power-Interest Matrix

Ali Zare Horoki — 2025-03-04

Background: Identifying stakeholders and understanding their characteristics is crucial for achieving objectives efficiently. Concurrently, there is a growing movement towards utilizing technology, particularly electronic (e) prescribing, to enhance quality, safety, and efficiency within the healthcare system. To strengthen and support the e-prescribing system, collaboration among all stakeholders is essential. This collaboration will help establish a robust electronic health information infrastructure and improve healthcare delivery for all members of society.

Methods: This study aims to identify barriers to the acceptance of e- prescribing from a stakeholder perspective. It employs a mixed-methods approach, combining quantitative and qualitative research. Data collection involved focus groups to identify and prioritize stakeholders, while interviews were used to extract barriers. Following data collection, the interest-power matrix was utilized for analysis.

Results: The findings revealed that the primary barriers identified by stakeholders, including physicians, hospitals, and insurance companies were as follows: a lack of awareness among doctors regarding costs, deductibles, and billing; insufficient training for stakeholders on e-prescribing; inadequate infrastructure; lack of forecasting for necessary financial resources; insufficient training for relevant personnel; poor communication with insurance companies; intermittent system outages and slow performance; lack of insurance coverage for certain tests; the presence of multiple insurance systems; and ineffective communication channels between doctors and insurance agents.

Conclusion: Infrastructure challenges are significant barriers to the full implementation of e-prescribing which must be addressed. To improve implementation issues, continuous monitoring of prescription systems is recommended. Overall, it is advisable to reform the infrastructure, integrate insurance systems, adopt electronic signatures and standards for electronic prescriptions, and provide practical training. Health policymakers can facilitate the adoption of e-prescribing by taking measures to eliminate the barriers identified in this study.

Study of the Extent and Causes of Surgical Cancellations at the Largest Educational Medical Center in the Southeast of Iran

Hasan Jafari — 2025-03-04

Background: Last-minute cancellations of surgical procedures not only disrupt operating room schedules but also cause anxiety for patients and their families, in addition to wasting hospital resources. This study aims to analyze the frequency and causes of surgical cancellations at Shahid Sadoughi Hospital in Yazd city.

Methods: This is a descriptive and applied study. To obtain the results, we compiled a report on the number of surgeries performed and those canceled during the specified time period. Data were collected using a researcher-designed form and the hospital Health Information System (HIS) software, followed by data analysis using SPSS₂₁ with descriptive statistics such as frequencies and percentages.

Results: At Shahid Sadoughi Hospital, from March 2020 to March 2022, a total of 35,396 surgical procedures were scheduled across various specialties, including obstetrics and gynecology, orthopedics, ophthalmology, otolaryngology, general surgery, vascular surgery, neonatology, thoracic surgery, urology, and neurosurgery. Out of this number, 35,152 surgeries were performed, while 244 were canceled (0.68%). The analysis indicated that the highest rate of cancellations occurred in general surgery, with 61 surgeries canceled (25%), whereas the lowest cancellation rates were observed in neurosurgery and urology (0%).

Conclusion: Given the higher rates of cancellations in certain specialties and during specific months of the year, investigating the effective factors and necessary planning in this regard is crucial.

Performance Evaluation of Iran University of Medical Sciences Hospitals Based on the PABON LASSO Model and its Comparison with National Standards

Irvan Masoudi Asl — 2025-03-04

Background: Evaluation of hospital performance plays an important role in improving the quality and quantity of services provided. The purpose of this study is to evaluate the performance of Iran University of Medical Sciences hospitals using the PABON LASSO model in 2022.

Methods: This descriptive and cross-sectional study was conducted in 2022. Thirteen hospitals affiliated to Iran University of Medical Sciences formed the study population. Data were analyzed by SPSS₂₂ software using PABON LASSO model. A one-sample t-test was used for comparison.

Results: Out of 13 hospitals, 38.46% were in the first region, 23.07% were in the third region, and finally 30.76% were in the fourth region of the matrix. Based on the results, in the studied hospitals, the average length of stay (ALS) was 4 days, the bed occupancy rate (BOR) was 72.89%, and the bed turnover rate (BTR) was determined 72.14 times a year.

Conclusion: The BOR index in the studied hospitals had a higher level of desirability compared to the national standard. Using one of the active methods of problem identification in hospitals and by understanding the relationship between performance indicators, it is possible to provide a platform for policy-making and revision of current policies in order to use the maximum performance capacity.

Exploring Paradox: Moderating and Mediating Mechanisms in the Effect of Abusive Supervision on Employees' Helping Behavior (Case Study: Public Hospitals in Yazd City)

Roghye Hekmat Nasab — 2025-03-04

Background: Typically, researchers believe that abusive supervision decreases employees' helping behavior. However, according to the emotional process theory of abusive supervision, subordinates show more helping behavior under certain conditions. The purpose of this study was to examine the impact of abusive supervision on employees' helping behavior, with a focus on the mediating role of self-blame and guilt as well as the moderating effects of core self-evaluation (CSE) and power distance.

Methods: The present study is applied in purpose and descriptive in method, classified as a semi-experimental study regarding its design. The statistical population comprised all administrative and medical staff working in public hospitals of Yazd. Sampling was conducted using a convenience sampling method, with the sample size determined through G-Power software. After removing outliers, 381 participants remained for analysis. Data were collected via a questionnaire, and after confirming its reliability and validity, hypotheses were tested using SPSS₂₁ software and the PROCESS module.

Results: The direct association between abusive supervision and employees’ helping behavior was significantly negative (-0/235). The mediation by self-blame and guilt was negative too. The relationship between abusive supervision and self-blame was positively correlated to CSE (0/224), while the association between self-blame and guilt was negatively correlated to power distance.

Conclusion: In the context of abusive supervision and its aftermath, this study introduced self-blame and guilt as two mediators that can affect subordinates’ reactions to abusive supervision. Also, for the first time, CSE was tested as a moderator between abusive supervision and self-blame. Finally, in response to previous calls for research, the moderating role of subordinates’ power distance orientation in the relationship between self-blame and guilt was investigated.

Economic Burden of Sickle Cell Disease at Tertiary Health Facilities in Tanzania: Financial Impact on Patients at Muhimbili National Hospital

Joshua Lembris Noah — 2025-03-04

Background: Sickle cell disease (SCD) affects thousands in Tanzania, causing high healthcare costs and economic burden. This study estimates the annual cost of SCD care for patients at Muhimbili National Hospital.

Methods: This descriptive, cross-sectional study was conducted from June 2021 to May 2022 at Muhimbili National Hospital, Tanzania. A systematic sampling method was used to select 207 patients. Data were collected through structured interviews. Direct cost was also obtained from individual perspective and indirect costs were assessed using the Human Capital Method. Finally, data processing was done in Microsoft Excel, and analysis was performed using SPSS₂₀.

Results: A total of 207 patients participated, with 91.3% under 18. The average annual cost of SCD care was TZS 847,186.01 (USD 367.62), with direct costs accounting for 76.4%. Medications, tests, and consultations were the major contributors to these costs (48%), and health insurance reduced costs by 64.4%.

Conclusion: SCD in Tanzania creates a significant financial burden, primarily due to direct medical costs, along with indirect costs like lost productivity. Addressing this requires better health insurance access, reduced indirect costs, and improved healthcare infrastructure.