Network analysis of Iranian’s health insurance ecosystem before and after the introduction of Universal Health Insurance law

Introduction The policy-making process in health reform is challenging due to the complexity of organizations,overlapping roles,and diversity of responsibilities.The present study aims to investigate and analyze the network of actors in the Iran health insurance ecosystem regarding the laws before and after the adoption of the Universal Health Insurance(UHI).Methods The present study was done by sequential exploratory mixed method research,consisting of two distinct phases.During the qualitative phase,the actors and issues pertaining to the laws of the Iranian health insurance ecosystem from 1971 to 2021 were identified through a systematic search of the laws and regulations section of the Research Center of the Islamic Legislative Assembly website.Qualitative data was analyzed in three steps using directed content analysis.During the quantitative phase,in order to draw the communication network of the actors in Iran’s health insurance ecosystem,the data related to the nodes and links of the networks was collected.The communication networks were drawn using Gephi software and the micro-and macro-indicators of network were calculated and analyzed.Results There were 245 laws and 510 articles identified in the field of health insurance in Iran from 1971 to 2021.Most of the legal comments were on financial matters and credit allocation,and the payment of premiums.The number of actors before and after the enactment of the UHI Law was 33 and 137,respectively.The Ministry of Health and Medical Education and the Iran Health Insurance Organization were found the two main actors in the network before and after the approval of this law.Conclusions Adopting a UHI Law and delegating various legal missions and tasks,often with support to the health insurance organization,have facilitated the achievement of the law objectives.However,it has created a poor governance system and a network of actors with low coherence.Based on the results of the study,it is suggested to reduce actor roles and separate them for better governance and to prevent corruption in health insurance ecosystem.Introducing knowledge and technology brokers can be effective in strengthening governance and filling the structural gaps between actors.

Effect of cognitive behavioral therapy on anxiety and depression of infertile women: A meta-analysis

Objective:To investigate the effect of cognitive behavioral therapy on anxiety and depression in infertile women.Methods:This study was performed in 2019 by searching Google Scholar,Scopus,PubMed/MEDLINE,Cochrane library,EMBASE,Proquest,ISI Web of Science,MagIran,SID and IranMedex.Eligible studies were selected by two reviewers and outcomes of interest were extracted.The meta-analysis was performed using the random effect models.Ⅰ-square statistic test was used for heterogeneity analysis.Presence of publication bias was also checked.Results:Eleven studies were included in this review.Between-group differences(cognitive behavioral therapy and control groups)in risk ratio for infertile women's depression was d=-1.36;95%CI=-1.81,-0.90;P<0.001.For infertile women's anxiety,between-group differences in risk ratio wasd=-0.83;95%CI=-1.18,-0.47;P<0.001.Conclusions:Cognitive behavioral therapy is effective in the reduction of depression and anxiety in patients with or withoutin vitro fertilization/intracytoplasmic sperm injection treatment.However,the lack of high-quality studies makes it challenging to make a solid and precise conclusion.Well-designed studies should be undertaken in the future to confirm these results.

Predicting cutaneous leishmaniasis using SARIMA and Markov switching models in Isfahan, Iran: A time-series study

Objective:To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average(SARIMA)models and Markov switching model(MSM).Methods:This descriptive study employed yearly and monthly data of 49364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province,located in the center of Iran from January 2000 to December 2019.The data were provided by the leishmaniasis national surveillance system,the meteorological organization of Isfahan province,and Iranian Space Agency for vegetation information.The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics.Results:The minimum relative humidity,maximum relative humidity,minimum wind speed,and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags(P<0.05).Comparing SARIMA and MSM,Akaikes information criterion(AIC),and mean absolute percentage error(MAPE)in MSM were much smaller than SARIMA models(MSM:AIC=0.95,MAPE=3.5%;SARIMA:AIC=158.93,MAPE:11.45%).Conclusions:SARIMA and MSM can be a useful tool for predicting cutaneous leishmaniasis in Isfahan province.Since cutaneous leishmaniasis falls into one of two states of epidemic and non-epidemic,the use of MSM(dynamic)is recommended,which can provide more information compared to models that use a single distribution for all observations(Box-Jenkins SARIMA model).

Health services utilisation and responsiveness profiles in Iran:a provincial household study

Objective The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province,Iran.Design A cross-sectional household study as part of a larger research on primary healthcare system.setting We carried out the study in East Azerbaijan Province,northwest Iran from July to September 2015.Participants A total of 1318 households were included.results Most of the participating households had social security health insurance.Heart failure or hypertension care,general outpatient care and arthritis care were the most used services.High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample(PRS),respectively.Health system responsiveness mean score(the maximum is 100)was 33.71±16.15(95%CI 32.45 to 34.97)in Tabriz and 32.02±14.3(95%CI 30.9 to 33.13)in PRS,which showed significant difference(p≤0.02).Conclusions Differences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS.Evidently,health system responsiveness in both Tabriz and PRS was at low level.The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.

A Composite Endpoint Measure to Consolidate Multidimensional Impact of Treatment on Gouty Arthritis

Objective: To create a multidimensional composite outcomes endpoint for gouty arthritis treatment in order to consolidate disparate measures of comparative effectiveness. Methods: One solution is to create a multidimensional composite endpoint that consolidates the complexity of outcomes into a single scale, as was done in this study. The psychometrics of the multidimensional scale and subgroup differences were investigated. Results: Cronbach’s alpha for the multidimensional composite endpoint created in this study was 0.76, indicating good internal reliability. Similar results were found across age, race, and gender. Removing any single item did not increase Cronbach’s alpha beyond 0.77, indicating that none of the items were interfering with the reliability of the scale. However, a reduction in serum urate levels was not significantly correlated with the overall multidimensional endpoint scale with that variable removed, r = 0.03, p > 0.05. Conclusion: This study demonstrated the feasibility and usefulness of creating a composite multidimensional endpoint for assessing treatment outcomes among individuals with gouty arthritis.

Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China:a model of West China Hospital

The novel coronavirus pneumonia(COVID-19)epidemic has brought serious social psychological impact to the Chinese people,especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions.To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic,we developed a new psychological crisis intervention model by utilizing internet technology.This new model,one of West China Hospital,integrates physicians,psychiatrists,psychologists and social workers into Internet platforms to carry out psychological intervention to patients,their families and medical staff.We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.

Stage Division and Pattern Discovery of Complex Patient Care Processes

This paper studies the design of a clinical pathway that defines medical service activities within each stage of a patient care process. Much prior research has developed clinicM process models that consider the trajectory of services occurring in a care process, by using data mining techniques on process execution logs. A novel approach that provides a more efficient way of clinical pathway design is introduced in this paper. Based on the strategy of TEI@I methodology, the proposed approach integrates statistical methods, optimization techniques and data mining. With the preprocessed data, a complex care process is subsequently divided into several medical stages, and then the patterns of each stage are identified, and thus a clinical pathway is developed. Finally, the proposed method is applied to the real world, using archival data derived from a hospital in Beijing, about three diseases that involve various departments, with an average of 300 samples for each disease. The results of real- world applications demonstrate that the proposed method can automatically and efficiently facilitate clinical pathways design. The main contributions to the field in this paper include （a） a new application of TEI@I methodology in healthcare domain, （b） a novel method for complex processes analysis, （c） tangible evidence of automatic clinical pathways design in the real world.

Does probiotic supplementation affect pulmonary exacerbation and intestinal inflammation in cystic fibrosis:a systematic review of randomized clinical trials

Background:Patients with cystic fibrosis (CF) usually have abnormal intestinal microbiota due to massive exposure to antibiotics.Probiotics could modify the gut microbiota and hence may affect CF management.So the aim of present systematic review was evaluation of the efficacy and safety of probiotic supplementation for the management of cystic fibrosis.Data sources:We searched PubMed,Science Direct,Google Scholar,Springer Cochrane Library Databases until January 2016 for randomized controlled trials (RCTs) performed in pediatric or adult populations related to the study aim.Key words were selected based on Mesh terms.Based on the Critical Appraisal Skills Programme checklist,eligibility of included articles was evaluated.Results:Five studies included in this review represent 188 participants with a follow up period ranging from 1 month to 6 months.The results of the included studies supporting the use of probiotics in management of pulmonary exacerbation and intestinal calprotectin in patients with cystic fibrosis.However the level of evidence was limited.Conclusion:The lack of high quality RCTs makes it impossible to support a general recommendation about the use of probiotics in the treatment of CF pulmonary exacerbation and intestinal inflammation.

Experts’ perspectives on the application of public-private partnership policy in prevention of road traffic injuries

Purpose: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts’ perspectives.Methods: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method.Results: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustain-ability, government’s financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention.Conclusion: This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.