Quarterly Journal of Management Strategies in Health System

Assessing Experts' Perspectives on Challenges and Health Priorities Based on One Health Framework in Yazd Province

Saeed Hosseini — 2024-12-15

This study employed One Health Framework to identify and prioritize health challenges in Yazd Province, Iran. By combining qualitative and quantitative methods, the research explored various factors influencing health outcomes, including access to healthcare, quality of services, disease prevalence, and social determinants of health. Key findings revealed that water scarcity, cancer, cardiovascular diseases, air pollution, and nutritional support for vulnerable groups were the most pressing health issues. The One Health approach offers a comprehensive strategy to address these challenges by integrating human, animal, and environmental health. By fostering intersectoral collaboration and promoting interdisciplinary education, policymakers can implement effective interventions to improve public health in Yazd Province and beyond. The study's findings can serve as a valuable resource for developing evidence-based health policies and programs.

Digital Health Equity and Patient Education: A New Paradigm in Patient Empowerment

Nafiseh Valaei Sharif — 2024-12-15

The COVID-19 pandemic significantly impacted global healthcare, heightening vigilance among individuals with chronic disease and increasing levels of fear and depression. As a response, digital technologies, especially telehealth, have emerged as promising tools to address these challenges, facilitating health information access and supporting patient education and decision-making. The digital health landscape now includes electronic health records, remote monitoring, digital therapeutics, AI, and machine learning, which together enhance patient care, improve diagnosis accuracy, and streamline healthcare operations. Digital health tools, by presenting information interactively, engage patients cognitively and foster autonomy in health management. Additionally, social media and mobile health platforms contribute to health equity by promoting healthy behaviours and reducing barriers to access. However, disparities in digital health access, termed "digital health equity," remain a challenge. Digital health equity involves addressing “digital determinants of health," including technology access, digital literacy, and infrastructure, which interact with traditional social determinants of health. In this context, e-health literacy has become a critical factor in enabling individuals to retrieve and appraise electronic health information effectively, ultimately enhancing health literacy. Health literacy, therefore, serves as a foundation for reducing health inequalities and fostering population health.

Investigating the policy Effect of Medicine Subsidy Plan (Daruyar) on Patients' Out-Of-Pocket Payments :A Case Study of the General Health Insurance Administration of Isfahan Province

Farshid Aslani — 2024-12-15

Background: The policy of removing the preferred drug currency (Daruyar plan) has been with the approach of increasing the coverage ratio and insurance obligations and paying attention to patients' out of pockets, especially incurable, chronic and low-income patients. Therefore, the purpose of this research is to investigate the effect of this plan on price and consumption ,and ultimately, the out of pocket payments after its implementation.

Methods: The research method of this study was descriptive-analytical. Primary sampling included 5 pharmacies selected non-randomly and purposefully. After extracting the drug data of the insured persons related to these pharmacies from the database of the Health Insurance Organization, a sample of 384 people determined from the Morgan table was determined randomly and the number of 1803 items of medicine received by them was checked. Then the data was analyzed using SPSS ₁₇ software and Mann-Whitney test.

Results: The survey of 1803 items of medicine in the two periods of November 2021 and 2022 showed that the maximum amount of out-of-pocket payment in November 2021 was equal to 184,000,000 Rials and the average of this variable was 1,357,000 Rials and the median was 177,250 Rials. This number in 2022 was 92,000,000 Rials, 1,805,000 Rials respectively and 181,050 Rials. The results of the analysis of these data showed that after the implementation of Daruyar plan, due to the allocation of compensatory subsidies, there has been no significant change in the total out-of-pocket payment of the patients.

Conclusion: This study investigated the effect of Daruyar plan on price changes, consumption and out-of-pocket payments of patients. The comparison of out-of-pocket payment data in the two time frames of November 2021 and 2022 showed that eliminating the preferred drug currency and implementing the drug subsidy plan has not made a significant change regarding patients' out-of-pocket payments.

Investigating the Impact of the Hospital Information System on the Performance of Management Units at Pasteur Hospital in Bam from the Perspective of Managers

Mohammad Javad Akbarian Bafghi — 2024-12-15

Background: The Hospital Information System (HIS) is a comprehensive information management system in hospitals that plays a significant role in the quality of managers' decisions. Therefore, this study aimed to examine the impact of the HIS on the performance of management units at Pasteur Hospital in Bam from the managers' perspective in the year 2023.

Method: The present study was an applied, descriptive, and cross-sectional study conducted in 2023. The performance of management units was examined in three clinical, human resources, and financial indicators. The study population consisted of all the managers at Pasteur hospital in Bam at three levels: executive, middle, and top management, who were entered into the study through a census (38 individuals). Information was collected using a standardized questionnaire, and for data analysis, SPSS ₂₇software and appropriate descriptive and analytical statistical tests (independent t-test and ANOVA) were used.

Results: Participating managers were 76.30 % women and 23.70 % men. 73.70 % of them had a bachelor's degree and most of them were in the category of operational and middle managers. From the point of view of the managers of the HIS, the greatest impact on the indicators of the trend of treatment activities (28.60 ± 5.35), cost (50.00 ± 3.60), productivity and training (32.35 ± 12.81) and the least impact on the indicators of information exchange (25.50 ± 4.67), income (32.33 ± 0.57), salary and wages (10.50 ± 5.00). In this study, three components—clinical, financial, and human resources—were examined separately by gender, education level, and management levels. The results of the independent t-test indicated that there was a significant difference only in the clinical component based on gender (p = 0.04)

Conclusion: To enhance the effectiveness of the HIS on managers' performance, it is essential to first conduct a comprehensive needs assessment of all management units. This needs assessment should identify the essential tasks and specific needs of each unit, and based on that, the enhancement of the HIS should be aligned with these needs. Moreover, paying special attention to the dimensions and indicators that receive less impact from this system can help improve the overall performance of the system and enhance its effectiveness in all aspects.

Recognition of effective Factors on Social Health in Iran (Systematic Review of Persian Research from 2019 to 2024)

Mahdiye Barkhordari Firouzabadi — 2024-12-15

Background: Social health along with physical and mental health is one of the pillars of society's health. The issue of social health and its influential factors is one of the topics of attention among Iranian researchers in the last two decades. The aim of this research is to identify factors affecting social health in studies conducted in Iran. Current research can help researchers of different sciences, find research gaps, and discover new research fields in this subject.

Methods: The present study is a systematic review and all Persian articles related to the subject, during the period 2019 to 2024, with a systematic search among the available reliable databases, including Google Scholar, University Jihad Scientific Database (SID), Comprehensive portal of the humanities, Noor Specialized Magazines Database (Normagz), and Country Magazines Database (Magiran) using the keywords “Health” and “Social health” were retrieved. From 798 articles found, finally 71 articles were selected as the final researches related to the subject using Prisma checklist in terms of quality and according to the input criteria.

Results: Based on the results of this research, the influential factors on social health can be classified into 8 main groups including individual, occupational, economic, cultural, environmental, physical-psychological, social and religious-political factors. Among the main factors, the most number of studies were related to the social factors and among the sub-factors, respectively, social support, social trust, social security and religiosity have had the most positive impact on social health.

Conclusion: The results of the study indicate that among the various scientific fields, the majority of researches were conducted by researchers in the fields of sociology and social sciences, and among the factors affecting social health, the least number of studies were related to the environmental factors. Therefore, it is suggested that the researchers of fields that have contributed less to the promotion of this aspect of health in scientific sources take an effective step in this field of study, and in practical field, policy makers and social health researchers put this program at the top of their activities, and in planning system, education and policy of the country, special attention should be paid to this issue.

The Policy-Making Model Based on Conflict of Interest Management in Crisis Conditions in the Country's Health System (Case of Study: The Experience of COVID-19)

Mahnaz Sabzi — 2024-12-15

Background: Policy-making is one of the management functions in the health system, and according to the main goal of the health system, which is health promotion, health system approaches are advancing in the light of presenting a policy-making model based on conflict of interest management. Therefore, the purpose of this research is to present a policy-making model based on conflict of interest management in crisis conditions in the country's health system during the period of the COVID-19 crisis.

Methods: This research is an applied research in terms of purpose, and has a qualitative approach, and the multi-grounded theory method was used as the research method. This study was conducted by collecting data, through library studies and semi-structured interviews with 12 experts of the country's health system through theoretical sampling until the saturation point was reached. The inclusion criteria were familiarity with the policy-making process in the health system and having at least a master's degree related to policy-making, and the exclusion criterion was lack of desire and motivation. Data analysis was done in three stages of open coding, axial coding, and selective coding using MaxQDA₁₀software. In order to obtain the reliability and validity of the data, 2 methods of reviewing the participants and Lincoln and Guba (1985) approach were used.

Results: The findings showed that the policy-making model based on conflict of interest management includes 74 sub-categories in the form of 18 main categories of causal, contextual, intervening conditions, central phenomenon, consequences, and strategies. It indicates that selecting policy-maker, the personality characteristics of the policy-maker, the principles of health system policy-making, and medical resources and equipment are causal factors affecting policy-making based on conflict of interest management, which predicts consequences at the micro and macro levels.

Conclusion: The policy-making model based on conflict of interest management comprehensively identifies factors such as the personality characteristics of policymakers and health system resources as influential factors. This model shows that considering these factors, consequences can be predicted at the micro and macro levels. Therefore, effective conflict of interest management requires attention to various conditions and factors, so that decisions can be made optimally and without conflict.

Identifying and prioritizing the key factors affecting waste management in the healthcare sector using the Fuzzy Dematel method

Mehdi Kabiri Naeini — 2024-12-15

Background: Hospital wastes are very important as one of the most dangerous pollutants. With the ever-increasing amount of healthcare waste and the increasing awareness and demands of the people, sustainable management of healthcare waste has become increasingly important. The purpose of this research is to identify and prioritize effective and efficient factors on sustainable waste management in the healthcare sector.

Methods: The current research is a quantitative-qualitative (mixed) research. First, by reviewing the available literature, 10 factors affecting the sustainable management of health waste were identified. Sampling in both quantitative and qualitative parts has been done purposefully and through available observations. The qualitative part included open interviews with experts and managers. Then, these factors were prioritized by collecting opinions and using the fuzzy Dimetal technique.

Results: In this study, by reviewing the existing literature and conducting interviews, 10 factors were identified. These factors were divided into two general categories of influential factors and influential factors by implementing the fuzzy DEMATEL technique, which were prioritized as follows; Influential factors include green healthcare organization culture and encouraging waste recycling, promoting best practices for sustainable waste management, strengthening sustainable waste management training programs, improving environmental awareness of healthcare workers, planning for sustainable waste management, and creating a positive attitude towards sustainable waste management; influential factors include appropriate legal framework to support sustainable waste management, creating the necessary infrastructure for waste management, environmentally friendly waste management technologies, and purchasing based on environmental requirements.

Conclusion: Based on the findings of this research, in order to reduce the risks related to health pollutants, it is necessary to design educational programs related to this issue in hospitals, so that on the one hand, a positive attitude towards the importance of paying attention to health waste control for employees is created, and on the other hand, appropriate activities is taught to them. Also, the government should implement controlling laws and periodic audits related to this issue.

Planning for the Realization of the Demographic Dividend and Leveraging Iran's Demographic Dividend Window in the Health Sector

Alireza Amini — 2024-12-15

Background: Iran's economy is among those experiencing a "demographic dividend window," a period extending to the next two decades (2040). Capitalizing on this golden opportunity plays a crucial role in the country's economic and social development. This study aims to identify strategies and solutions, and propose implementable health sector programs to realize this demographic dividend.

Methods: This qualitative study employed structured interviews with 11 health experts, purposively sampled in 2021. Following a presentation of demographic theory, experts were asked to explain strategies and solutions for achieving demographic dividend in the health sector. Interview content was analyzed using axial coding with MaxQDA ₂₀₁₈ software.

Results: Based on research conducted in the field of health policy, including expert interviews and a review of World Health Organization documents, 4 key areas for achieving demographic dividend in health are: "reducing premature mortality," "reducing disability caused by diseases and accidents," "increasing the quantity and quality of births," and "improving the quality of life for the elderly." Target setting and monitoring for achieving the demographic dividend are facilitated by 11 indicators across the following areas: monitoring of leading causes of death (2 indicators), reproductive and maternal health (2 indicators), health financing (3 indicators), public health and sanitation (2 indicators), and access to healthcare (2 indicators).

Conclusion: Achieving and sustaining demographic dividend gains requires developing a preventive system based on policies for "active disease detection and monitoring of risk factors," "population-based nutritional policies," and "health education and health promotion." Simultaneously, it necessitates strengthening health system infrastructure, including "transforming the role and status of health insurance," "improving equity in access to health services," "reforming health financing structures," and "developing health services based on demographic needs."