ORIGINAL_ARTICLE
Unintended Consequences of Hospital Payment: The Case of Swiss Diagnosis Related Groups
Background: In 2012, Switzerland changed from retrospective to prospective hospital payment based on diagnosis related groups (DRGs), following the example of the United States, Australia, and Germany. As in these countries, the objective of this transition was to motivate hospitals to improve efficiency by making them bear financial risk to some extent.Objective: This contribution seeks to find out whether SwissDRG, the Swiss version of DRG payment, indeed provides hospitals with appropriate incentives, thus creating a level playing field enabling workable competition between them.Methods: Three conditions for creating a level playing are stated, of which the first is tested using data on some 757 000 patient cases treated by 93 hospitals in the year 2012.Results: The evidence suggests that hospital payment as currently devised by SwissDRG fails to create a level playing field. Differences in margins over cost of treatment can be traced to a hospital’s portfolio of specialties and mix of patients, both of which are largely beyond their control. The findings of this paper are subject to several limitations. The true DRG-specific cost distributions (and hence expected values) are not known; moreover, emphasis has been on variable cost, neglecting fixed (capital user) cost. Finally, hospitals with a high amount of capital user cost may well benefit from modern technology contributing to their efficiency in terms of variable cost.Conclusion: The finding that current hospital financing by SwissDRG fails to create a level playing field is likely to be robust, calling for an expeditious adjustment be-cause hospitals are exposed to financial risk to a greatly differing degree. It may be appropriate for them to purchase insurance against their financial risk, which is largely driven by influences beyond their control.
https://www.jhpr.ir/article_34223_82e5e8d4c72d155f0691857a7f03e5df.pdf
2016-11-01
105
113
10.21859/hpr-0104105
Hospital financing
DRG payment
Cost efficiency
Financial risk
Incentive problems
Philippe
Widmer
philippe.widmer@polynomics.ch
1
Senior Health Economist, Polynomics AG, Baslerstr. 60, 4600 Olten, Switzerland
AUTHOR
Peter
Zweifel
peter.zweifel@uzh.ch
2
Department of Economics, University of Zurich, Switzerland
LEAD_AUTHOR
Widmer PK. Does prospective payment increase hospital (in) efficiency? Evidence from the Swiss hospital sector. Eur J Health Econ. 2015;16(4):407-419. doi:10.1007/s10198-014-0581-9
1
Lüthi HJ, Widmer PK. DRG system design: a financial risk perspective (Working paper). Zurich: Eidgenössische Technische Hochschule (ETH); 2016.
2
Ellis RP. Creaming, skimping and dumping: Provider competition on the intensive and extensive margins. J Health Econ. 1998;17(5):537-55. doi:10.1016/S0167-6296(97)00042-8
3
Ellis RP, McGuire TG. Hospital response to prospective payment: Moral hazard, selection, and practice-style effects. J Health Econ. 1996;15(3):257-277. doi:10.1016/0167-6296(96)00002-1
4
SwissDRG. Berechnungsmethode: Ermittlung der Kostengewichte, Ausreisser, Tarifstruktur (Method of calculation: cost weights, outliers, and fee structure). Bern: SwissDRG AG; 2011.
5
Spika S, Zweifel P. Internal decision-making processes and hospital behavior: hierarchical principal-agent vs. bargaining models. University of Konstanz working paper; 2016
6
Widmer PK. SwissDRG: Ein Vergütungssystem mit ungleichen finanziellen Risiken für die Spitäler (SwissDRG: a payment system with unequal financial risk for the hospitals). Swiss J Bus Res Pract. 2016;3:210-226.
7
Widmer PK, Spika S, Telser H. Leistungsorientierte Vergütung mit dem Fallpauschalensystem SwissDRG - Gleicher Preis für gleiche Leistung? (Prospective efficiency-based hospital payment by SwissDRG: Same fee for same service?) Olten: Polynomics; 2015.
8
Widmer PK, Trottmann M, Telser H. Das Fallpauschalenmodell Leistungsbezogene Basispreise unter SwissDRG (Efficiencybased prospective payment using base fees as calculated by SwissDRG). Olten: Polynomics; 2015.
9
ORIGINAL_ARTICLE
Evaluation of Quality of Life and Symptoms of Menopause in Women with and Without Breast Cancer
Background: Breast cancer is one of the most common cancers in women. Objective: This study was performed to determine the symptoms of menopause and quality of life in women with and without breast cancer. Methods: This descriptive-analytical and cross-sectional study was performed in hospitals of Babol, Mazandaran province, Iran, in two groups of women with and without breast cancer. The study population included all women with menopausal symptoms who were divided into two groups containing 100 women apiece. A checklist containing menopausal symptoms was collected from these two groups and the standard questionnaire EORTC-QLQ-C30 was utilized to assess the quality of life in the case group and the standard questionnaire SF-36 was used in the control case. Data were analyzed by SPSS software. Results: Depression and insomnia were significantly higher in the case group and control group, respectively (p <0.05), but other symptoms of menopause were not significantly different in the two groups (P>0.05). In the case group, the overall quality of lifewas assessed as good in 36.3% of patients. Also, the quality of life in the control group had the lowest score relevant to the item Neshat with an average of 55.6 and the highest score related to the item of social performance with an average of 73.25. Conclusion: According to the results, the symptoms of menopause in women with breast cancer were not much different from women without breast cancer. Meanwhile, the quality of life of women with a history of cancer was good.
https://www.jhpr.ir/article_124867_11a339ec8b615b8454aa3d97d905b168.pdf
2016-11-01
114
120
Quality of Life
menopause
Breast Neoplasms
Women
Maryam
Javadian KutanaeeI
javadianmaryam@yahoo.cam
1
Department of Obstetrics and Gynecology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
AUTHOR
Azra
Sadeghi
sadeghiazra@yahoo.com
2
Department of Obstetrics and Gynecology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
AUTHOR
Donya
Sheibani Tehrani
abi_6891@yahoo.com
3
Department of IT Management, School of Management, Shahid Beheshti University, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Access of Discharged Schizophrenia Patients to Employment and Association Memberships in Turkey
Background: Patients with schizophrenia can experience a deteriorated performance in many of the skills needed in daily life, the workplace, the family circle, or in social interactions.Objective: This definitive study used comparison to evaluate the functionality, treatment compliance to therapy, and styles of coping with stress of schizophrenic patients who work and are members of an association.Methods: The individuals participating in this study were divided into four groups. Group 1 were members of an association and employed; Group 2 were members of an association and unemployed; Group 3 comprised non-members who were employed; and group 4 were non-members and unemployed. A total of 60 patients (15 in each group) comprised the sample. Data was collected by means of the Individual Information Form, the Adaptation Rate Scale for Medical Therapy, the Functional Recovery Scale in Schizophrenia Patients, and the Scale for Coping with Stress. Statistical analyses and interpretations were conducted using frequency and percentage, t test, and analysis of variance (ANOVA) to assess the data.Results: It was observed that being a member of an association and working at a job affected the social and occupational functionalities in schizophrenia patients participating in the study, but the styles of therapy adaptation and coping with stress did not affect these areas.Conclusion: Results indicated that the use of current antipsychotic drugs did not affect functional areas, therapy adaptation, or styles of coping with stress.
https://www.jhpr.ir/article_34221_386ef90ebc3ce7eabe68d9bcb39a6f84.pdf
2016-11-01
121
128
10.21859/hpr-0104121
Schizophrenia
Functional behavior
psychology
Therapeutics
Psychological
Commerce
Nermin
Gürhan
nermingurhan@gmail.com
1
Psychiatric Nursing Department, Health Science Faculty, Gazi University, Ankara, Turkey
LEAD_AUTHOR
Neşe
Uğurlu
ugurlunese@hotmail.com
2
T.C Gülhane Military Medical Academy, Department of Nursing, Psychiatric Nursing Department, Ankara, Turkey
AUTHOR
Burhanettin
Kaya
burha65@yahoo.com
3
Antalya Specialty Medical Center, Antalya, Turkey
AUTHOR
Yıldız M. Schizophrenia Treatment of Mental and Social Initiatives. In: Ceylan ME, Cetin M, eds. Schizophrenia. Istanbul: İncekara Kağıt Typography; 2009:1403-1413.
1
Güneş D. Objective and Subjective Evaluation of the Quality of Life and Social Functioning of Şizofr new patients. [Thesis]. Istanbul: Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital; 2010.
2
Emiroğlu B. Validity and reliability study of the Turkish version of the Functional Remission in Schizophrenia Patients [Master’s thesis]. Istanbul: Maltepe University; 2009.
3
Olfson M, Mechanic D, Hansell S, Boyer CA, Walkup J, Weiden PJ. Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatr Serv. 2000;51(2):216-222. doi:10.1176/appi.ps.51.2.216.
4
Eryıldız D. The day hospital and rehabilitation center on the ongoing rehabilitation of chronic schizophrenic patients with chronic schizophrenia patients who participate in the program compared in terms of functionality and quality of life [Dissertation]. Istanbul: Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital; 2009.
5
Işık E. Current Schizophrenia. Ankara: Format Typography; 2006.
6
Yıldız M. Psychiatric rehabilitation. In: Community Mental Health of Individuals. 1st ed. Istanbul: Erler Typographyk; 2005:151-164.
7
Gülseren L. [Schizophrenia and the family: difficulties, burdens,emotions, needs]. Turk Psikiyatri Derg. 2002;13(2):143-151. [Turkish].
8
Sadock BJ, Sadock VA. Comprehensive textbook of psychiatry. Aydın H, Bozkurt A, Trans. Ankara: Sun Bookstore; 2007.
9
Öztürk MO, Uluşahin A, eds. Mental Health Disorders. 11th ed. Ankara: Tuna Typography; 2008 :306-317.
10
Alıcıkuşu HA. Attitudes with the psychiatric treatment of schizophrenia [Master’s thesis]. Gaziantep: Gaziantep University; 2009.
11
Yazıcı A, Coşkun S. (Bakırköy Mental Health and Diseases Hospital) day hospital and rehabilitation centre patient profile and study program. Anatolian Journal of Psychiatry. 2008;9(1):21-23.
12
Andreasen NC, Carpenter WT Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162(3):441-449. doi:10.1176/appi.ajp.162.3.441.
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Myin-Germeys I, Krabbendam L, Jolles J, Delespaul PA, van Os J. Are cognitive impairments associated with sensitivity to stress in schizophrenia? An experience sampling study. Am J Psychiatry. 2002;159(3):443-449. doi:10.1176/appi.ajp.159.3.443.
14
Akpınar Ş. Applies to Schizophrenia Quality of Life Problem Solving Skills Development Program and Effects of Social Functioning Levels [Master’s Thesis]. Sivas: Cumhuriyet University; 2008.
15
Barlas ÜG, Işıl Ö. Evaluation of the Effectiveness of Patient with Chronic Schizophrenia Psychosocial Skills Training. Maltepe University School of Nursing Science and Arts Magazine, Special Issue Symposium; 2010:312-317.
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Dilbaz N, Darçın EA. Treatment of schizophrenia and substance use disorder comorbid patients. Clin Psychopharmacol Bull. 2011;21:80-90.
17
Angell B, Test MA. The relationship of clinical factors and environmental opportunities to social functioning in young adults with schizophrenia. Schizophr Bull. 2002;28(2):259-271.
18
Yıldız M, Kutlu H, Tural Ü. Demographic and clinical characteristics of cognitive function is affected in schizophrenia? Clin Psychopharmacol Bull. 2011;21(2):131-139.
19
Cobanoglu D, Aker T, Çobanoğlu N. Schizophrenia and other psychotic disorders in patients with treatment compliance issues. Dusni Adam. 2003;16(4):211-218.
20
Henry AD, Lucca AM, Banks S, Simon L, Page S. Inpatient hospitalizations and emergency service visits among participants in an Individual Placement and Support (IPS) model program. Ment Health Serv Res. 2004;6(4):227-237.
21
Compton MT, Rudisch BE, Craw J, Thompson T, Owens DA. Predictors of missed first appointments at community mental health centers after psychiatric hospitalization. Psychiatr Serv. 2006;57(4):531-537. doi:10.1176/ps.2006.57.4.531.
22
Chan H, Inoue S, Shimodera S, et al. Residential program for long-term hospitalized persons with mental illness in Japan: Randomized controlled trial. Psychiatry Clin Neurosci. 2007;61(5):515-521. doi:10.1111/j.1440-1819.2007.01701.x.
23
Sevinçok L. Psychosocial Causes of Schizophrenia Etiology. 2000. Schizophrenia Series 15.
24
Yazıcı A. Mental Training in family and group therapy in patients with schizophrenia. Spring Symposium 2008;4:3-20.
25
Salokangas RK, Honkonen T, Stengard E, Koivisto AM. To be or not to be married--that is the question of quality of life in men with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2001;36(8):381-390.
26
Cardoso CS, Caiaffa WT, Bandeira M, Siqueira AL, Abreu MN, Fonseca JO. Factors associated with low quality of life in schizophrenia. Cad Saude Publica. 2005;21(5):1338-1340. doi:10.1590/S0102-311X2005000500005.
27
Usall J, Araya S, Ochoa S, Busquets E, Gost A, Marquez M. Gender differences in a sample of schizophrenic outpatients. Compr Psychiatry. 2001;42(4):301-305.
28
Thorup A, Petersen L, Jeppesen P, et al. Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. J Nerv Ment Dis. 2007;195(5):396-405. doi:10.1097/01.nmd.0000253784.59708.dd.
29
Erol A, Ünal KE, Tunç AE, Mete L. Predictors of social functioning in schizophrenia. Turkish J Psychiatry. 2009;20(4):313-321.
30
Koç A. Compliance to treatment in patients with chronic psychosis and Treatment Compliance with the Associated Factors considered not to be [Thesis]. Ankara: Gazi Hospital; 2006.
31
Rittmannsberger H, Pachinger T, Keppelmuller P, Wancata J. Medication adherence among psychotic patients before admission to inpatient treatment. Psychiatr Serv. 2004;55(2):174-179. doi:10.1176/appi.ps.55.2.174.
32
Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002;63(10):892-909.
33
Belli H, Özçetin A, Ertem Ü, et al. Some socio-demographic characteristics and factors associated with schizophrenia treatment. Anadolu Psikiyatri Derg. 2007;8:102-112
34
Simon AE, Peter M, Hess L, Valterio C. Antipsychotic use in patients with schizophrenia treated in private psychiatry. Swiss Med Wkly. 2005;135(7-8):109-115.
35
Kayahan B, Veznedaroğlu B, Öztürk O, Ersoy AM. Atypical antipsychotic drugs in schizophrenia mini mental state examination (CBE) effect of comparative with typical antipsychotics - natural follow-up study. Anadolu Psikiyatri Derg. 2004;5:206-212.
36
Ascher-Svanum H, Zhu B, Faries DE, Lacro JP, Dolder CR, Peng X. Adherence and persistence to typical and atypical antipsychotics in the naturalistic treatment of patients with schizophrenia. Patient Prefer Adherence. 2008;2:67-77.
37
Diaz E, Neuse E, Sullivan MC, Pearsall HR, Woods SW. Adherence to conventional and atypical antipsychotics after hospital discharge. J Clin Psychiatry. 2004;65(3):354-360.
38
Soykan A. Overview of Atypical Antipsychotic. Clin Psychiatry. 2000;1:13-15.
39
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Bahar A. Evaluation of non-medical help seeking behaviour in psychiatric patients. New Symposium. 2010;48(3):216-222.
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Güleç G, Yenilmez Ç, Ay F. Description search behavior of disease and cure patients presenting to a psychiatric clinic in an Anatolian city. Klinik Psikiyatri. 2011;14:131-142.
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Tatlıdil E. The Effect of Social Functioning of Symptomatology in Schizophrenic Patients [Thesis]. Ankara: Ankara University; 2008.
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Glass RM. Mental disorders quality of life: inequality of insurance coverage. JAMA. 1995;274:1557.
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Aker T, Üstünsoy S, Kuğu N, Yazıcı A. Psychotic disorder rating scale mismatch and drug therapy compliance in patients. 36th National Psychiatry Congress; 2000; Antalya.
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Hofer A, Kemmler G, Eder U, Edlinger M, Hummer M, Fleischhacker WW. Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects. J Clin Psychiatry. 2004;65(7):932-939.
46
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47
Gürhan N. Schizophrenic patients, social support, disease, and evaluation of coping with stress [PhD Thesis]. Ankara: Ankara Hacettepe University; 1995.
48
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49
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50
ORIGINAL_ARTICLE
Effects of Patient Education Program on the Quality of Nursing Care and Inpatient Satisfaction in Surgical Wards of Selected Hospitals in Isfahan, Iran
Background: The implementation of patient education within a hospital is a difficult task that plays a key role in improving and controlling diseases and providing quality healthcare services. Objective: The current study evaluated the effect of patient education on the quality of nursing care and inpatient satisfaction in surgical wards of selected hospitals in Isfahan, Iran. Methods: This quasi-experimental study was conducted in 2014. The sample group consisted of 64 patients admitted to the surgical wards of select hospitals in Isfahan and selected using the voluntary sampling method. Participants were randomly divided into experimental (n=32) and control (n=32) groups. A patient education program was implemented for each subject in the experimental group (during hospitalization and after discharge), but no intervention was conducted for the control group. Data was collected from both groups before and after the educational intervention using the standard questionnaire SERVQUAL to measure expectations (with a reliability of 87%), perceptions (with a reliability of 85%), and inpatient satisfaction (with a reliability of 83%). Data was analyzed using descriptive statistics, univariate and multivariate analysis of covariance, Kolmogorov-Smirnov, Chi-square, and t-tests in SPSS software (ver. 20). Results: The results of covariance analysis showed that the patient education program significantly increased the mean scores of the quality of nursing services and inpatient satisfaction in the experimental group compared with the control group (p<0.01). Conclusion: A patient education program is an important pillar for improving public health. It is also a low-cost intervention to increase a patient's hope in living a good quality life.
https://www.jhpr.ir/article_40686_9499b265113c9ac113ab046df22b4fb9.pdf
2016-11-01
129
134
10.21859/hpr-0104129
patient education
Quality of nursing care
Patient Satisfaction
Surgical wards
Shahnaz
Keifi
1
Imam Khomeini Falavarjan Hospital, Isfahan, Iran
AUTHOR
Mohsen
Shahriari
2
Nursing and Midwifery school, Isfahan University of Medical Sciences, Iran
AUTHOR
Zahra
Baghersad
3
Nursing and Midwifery school, Isfahan University of Medical Sciences, Iran
AUTHOR
Donya
Sheibani-Tehrani
abi_6891@yahoo.com
4
Shahid Beheshti University, Tehran, Iran
AUTHOR
Farzaneh
Rejalian
f_rejalian@yahoo.com
5
Department of Health Services Management, Yazd University of Medical Science, Yazd, Iran
LEAD_AUTHOR
Walling AM, Maliski S, Bogorad A, Litwin MS. Assessment of content completeness and accuracy of prostate cancer patient education material. Patient Educ Couns. 2004;54(3):337-343. doi:10.1016/j.pec.2003.10.005.
1
Tolooee M, Dehghan Nayery N, Faghihzadeh S, Sadooqi‐Asl A. Motivational factors for nurses with patient education. Hayat. 2006;2(12):43-45. [Persian].
2
Purraberi M, Jamshidi N, Soltani Nejad A, Sabzevari S. The impact of nursing on patient satisfaction and patient education on knowledge, attitude and practice of cardiac intensive care unit nurse. Journal of Health and Care. 2011;13(1):30-36. [Persian].
3
Mobaraki A, Karimi Z. Importance of patient education from the perspective of nursing students. Dena.2006;3(1):61-68. [Persian]
4
Salehi A. A survey of educational needs in health-therapeutic centers of Isfahan in 2005. Regional Seminar on New Methods of Patients Care and Education. Ahvaz: Islamic Azad University. Ahvaz Branch; 2005. [Persian].
5
Rankin SH, Stallings KD, London F, eds. Patient Education in Health and Illness. Philadelphia, PA: Lippincott Williams and Wilkins; 2005.
6
Berwick D. Postgraduate education of physicians: professional self-regulation and external accountability. JAMA. 2015; 313(18):1803-4. doi:10.1001/jama.2015.4048.
7
Bastable SB, Gramet P, Jacobs K, Sopczyk D. Health Professional as Educator: Principles of Teaching and Learning. UK: Jones & Bartlett learning; 2011.
8
Cardiovascular disease statistics. American Heart Association website. http://www.americanheart.org/downloadable/heart/1105390918119HDSStats.
9
Lewis SL, Bucher L, Dirksen SR, Heitkemper MM. Medical Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier; 2011:49-50.
10
Arian M. The effect of designed walking program with holistic nursing approach on serum ferritin and heart problems of thalassemia major patients [Thesis]. Tehran: Tarbiat Modares University; 2013. [Persian].
11
Emami Razavi H, Mohaghegh MR, Razavi S. Accreditation standards for hospitals in Iran. Tehran: Sound Publishing Center; 2010:73-80. [Persian].
12
Hakari D, Mohamadzadeh R. Survey the status of patient education in nursing students and nurses and its effective factors in Tabriz hospitals in 86-87. Medical Science Journal of Islamic Azad University. 2010;20(1):58-63. [Persian]
13
Bahrampour A, Zolala F. Patient satisfaction and related factors in Kerman hospitals. East Mediterr Health J. 2005;11:905-912. [Persian].
14
Nouhi AS, Pooraboly B. Educational requirements of the discharged patients and their satisfaction about nursing educational performance, Kerman, Iran. Hormozgan Med J 2009;13(3):206-212. [Persian].
15
Taylor N. A Patient education program supported by staff training can reduce the rate of falls for older patients during inpatient rehabilitation. J Physiother. 2015;61(4):224. doi:10.1016/j.jphys.2015.07.016.
16
Zimmer A, Blauer C, Coslvosky M, Kappos L, Derfuss T. Optimizing treatment initiation: effects of a patient education program about fingolimod treatment on knowledge, selfefficacy and patient satisfaction. Mult Scler Relate Disord. 2015;4(5):444-450. doi:10.1016/j.msard.2015.06.010.
17
Du S, Hu L, Dong J, Xu G, Jin S, Zhang H, Yin H. Patient education programs for cancer – related fatigue: a systematic review. Patient Educ Couns. 2015;98(11):1308-1319. doi:10.1016/j.pec.2015.05.003.
18
Coates VE. Education for Patient and Client. London: Routledge; 1999.
19
Redman BK. The Practice of Patient Education. 8th ed. New York: Mosby; 2001.
20
Krupat E, Fancey M, Cleary PD. Information and its impact on satisfaction among surgical patients. Soc Sci Med. 2000; 51(12):1817-25. doi:10.1016/s0277-9536(00)00113-1.
21
Bastable SB, ed. Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. Boston: Jones and Bartlett; 2003.
22
Mehdipour R, Jamshidi N, Soltani Nejad A, Sabzevari S. Effects of nurse education on both patients’ satisfaction of teaching patients, and nurses’ knowledge, attitude and performance in intensive care units of teaching hospitals. Journal of Health and Care. 2011;13(1):29-36. [Persian].
23
Shojaee A, Tahrir B, Naderi N, Zareian A. Effect of patient education and telephone follow up by the nurse on the level of hope in patients suffering from heart failure. JNE. 2013;2(1):16-26. [Persian].
24
ORIGINAL_ARTICLE
Do Hospitals Affiliated With the Kurdistan University of Medical Sciences Perform Efficiently? Non-parametric Data Envelopment Analysis
Background: One way to improve the performance of hospitals, the largest resource-consuming units in the healthcare sector, is to continuously evaluate their performance.Objective: The current study assessed the performance of hospitals affiliated with the Kurdistan University of Medical Sciences using data envelopment analysis (DEA).Methods: This retrospective descriptive-analytic study used DEA to assess efficiency types (technical, managerial, and scale) in hospitals of the Kurdistan University of Medical Sciences (n = 12) in the years 2007 to 2011. The number of active beds, nurses, physicians (general and specialist), and other staff were inputs; inpatient admission and occupied bed days were outputs. Stata version 12 was used for data analysis.Results: The mean technical, scale, and managerial efficiency values were 0.85, 0.89, and 0.95, respectively. The highest and lowest slack inputs were nurses and active beds, respectively.Conclusion: The findings indicate that Kurdistan hospitals were less than appropriately efficient during the studied period. They also suggest that there is a capacity of about 15% for enhancing output in hospitals (compared with the most efficient studied hospitals) without increasing costs or inputs.
https://www.jhpr.ir/article_34218_1ffd922c7cc1f128421de0227753312e.pdf
2016-11-01
135
140
10.21859/hpr-0104135
Data Envelopment Analysis
Efficiency
Hospitals performance
Satar
Rezaei
1
Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
AUTHOR
Nooredin
Dopeykar
2
Najmiyeh Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Mohsen
Barouni
3
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Mohammad
Jafari
4
Iranian Health Insurance, Kerman, Iran
AUTHOR
Fardin
Gharibi
fardin.gharibi@muk.ac.ir
5
Vice Chancellor for Research Affairs, Kurdistan University of Medical Sciences, Sanandaj, Iran
LEAD_AUTHOR
Hajialiafzali H, Moss J, Mahmood M. Efficiency measurement for hospitals owned by the Iranian social security organisation. J Med Syst. 2007;31(3):166-172. doi:10.1007/s10916-007-9051-6.
1
Kiadaliri AA, Jafari M, Gerdtham U-G. Frontier-based techniques in measuring hospital efficiency in Iran: a systematic review and meta-regression analysis. BMC Health Serv Res. 2013;13(1):312. doi:10.1186/1472-6963-13-312.
2
Yaisawarng S. Performance measurement and resource allocation. Efficiency in the Public Sector. Springer; 2002:61-81. doi:10.1186/1472-6963-13-312.
3
Kuntz L, Scholtes S, Vera A. Incorporating efficiency in hospital-capacity planning in Germany. Eur J Health Econ. 2007;8(3):213-223. doi:10.1007/s10198-006-0021-6.
4
Tandon A, Lauer JA, Evans DB, Murray CJ. Murray CJL, Evans DB, eds. Health system efficiency: concepts. In: Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva: WHO; 2003:683-691.
5
Goudarzi R, RjabiGilan N, Ghasemi SR, Reshadat S, Askari R, Ahmadian M. Efficiency measurement using econometric stochastic frontier analysis (SFA) method, Case study: hospitals of Kermanshah University of Medical Sciences. J Kermanshah Univ Med Sci. 2014;17(10):666-672.
6
Kirigia JM, Emrouznejad A, Sambo LG. Measurement of technical efficiency of public hospitals in Kenya: using data envelopment analysis. J Med Syst. 2002;26(1):39-45. doi:10.1023/b:joms.0000023298.31972.c9.
7
Jacobs R. Alternative methods to examine hospital efficiency: data envelopment analysis and stochastic frontier analysis. Health Care Manag Sci. 2001;4(2):103-115.
8
Karimi S, Bidram R. Efficiency Estimation in General Hospitals of Isfahan University of Medical Sciences during 2005-2006 by Data Envelopment Analysis. Journal of Health Administration. 2009;12(36):39-46.
9
Zere E. Hospital efficiency in sub-Saharan Africa. Evidence from South Africa. Helsinki: UNU/WIDER; 2000.
10
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11
Kheirollahi H, Matin BK, Mahboubi M, Alavijeh MM. Chance constrained input relaxation to congestion in stochastic DEA. An application to Iranian hospitals. Glob J Health Sci. 2015;7(4):151. doi:10.5539/gjhs.v7n4p151.
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Kirigia JM, Emrouznejad A, Cassoma B, Asbu EZ, Barry S. A performance assessment method for hospitals: the case of municipal hospitals in Angola. J Med Syst. 2008;32(6):509-19. doi:10.1007/s10916-008-9157-5.
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Akazili J, Adjuik M, Jehu-Appiah C, Zere E. Using data envelopment analysis to measure the extent of technical efficiency of public health centres in Ghana. BMC Int Health Hum Rights. 2008;8:11. doi:10.1186/1472-698X-8-11.
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Marschall P, Flessa S. Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis. Health Econ Rev. 2011;1(1):1-15. doi:10.1186/2191-1991-1-5.
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Barouni M, Rahbar A, Abrazeh A, Parsa H. The estimation of technical efficiency of public hospitals in Qom using data envelopment analysis approach. Q J Sabzevar Univ Med Sci. 2015;22(2):238-244. [Persian].
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Ghaderi H, Goudarzi R, Gohari M. Determination technical efficiency of hospitals affiliated with Iran University of Medical Science by data envelopment analysis (2000-2004). J Health Adm. 2007;9(26):39-44. [Persian].
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27
ORIGINAL_ARTICLE
Drug Supply Chain Management and Implementation of Health Reform Plan in Teaching Hospital Pharmacies of Ahvaz, Iran
Background: Drugs play a strategic role as a health commodity. Thus, the supply chain management of drugs is an important issue to reducing costs and thereby improving patient health. Objective: This study evaluated the status of drug supply chain management and health reform in the pharmaceutical sector of teaching hospitals in Ahvaz, Iran. Methods: This cross-sectional study was carried out in pharmacies of teaching hospitals in Ahwaz, Iran in 2015. Data was collected through a checklist extracted from the Evaluation Checklist of the Food and Drug Deputy and related articles. The study checklist examined six dimensions of the Evaluation Checklist, including drug storage, administrative regulations, preparation of medicines, drug distribution, taking medication, and implementation of health reforms in the pharmaceutical sector. The content validity of the checklist was confirmed by experts and pharmaceutical specialists. Data was analyzed for descriptive characteristics such as frequency and percentage using EXCEL version 2010 software. Results: The findings show that hospitals met standards for administrative regulations with 78.5% and preparation of medicines with 77.25%. The dimensions of drug storage with 74.75%, taking medication with 74.25%, implementation of health reforms with 71.5%, and drug distribution with 62.5% were in a near-standard state. Conclusion: Supply chain management systems of medicines in teaching hospitals are near-standard. To improve hospitals, offering proper training to employees, using the fixed-rate shopping system, and providing facilities to patients are recommended.
https://www.jhpr.ir/article_34222_02672d69e4ac4622272e6e251891a3d2.pdf
2016-11-01
141
145
10.21859/hpr-0104141
Pharmacy
Organization and administration
Hospitals
Health reform
Effat
Jahanbani
1
Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
Reza
Shakoori
rezashakouri94@gmail.com
2
Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
Masoume
Bagheri-Kahkesh
masume.bagheri@yahoo.com
3
Department of Management Development and Resources, Alborz University of Medical Sciences, Karaj, Iran
LEAD_AUTHOR
Rahimikalamrudi H. Reviews the drug system of health center of Guilan and providing ways to it’s improve [Thesis]. Tehran: Tehran University of Medical Sciences; 1997. [Persian].
1
Fattahzadeh A. Health System Reform. 2nd ed. Tehran: Cultural Institute of Ibne Sina; 2006.
2
World Health Organization, The Nigerian Federal Ministry of Health. Baseline Assessment of The Nigerian Pharmaceutical Sector. http://apps.who.int/iris/bitstream/10665/69108/1/a87426_eng.pdf. Published 2002.
3
Colella SJ, Lawrence SM, Widenhofer GJ, inventors; Pyxis Corporation, assignee. System of drug distribution to health care providers. United States patent US 6 003 006. 1999 Dec 14.
4
Jahangiri K. Principles of Disaster Management. Tehran: Tehran University of Medical Science; 2010.
5
Berdot S, Sabatier B, Gillaizeau F, Caruba T, Prognon P, Durieux P. Evaluation of drug administration errors in a teaching hospital. BMC Health Servs Res. 2012;12:60.
6
World Health Organization. Handbook for Drug Supply Management at the First-Level Health Facility. Geneva: WHO; 2006.
7
World Health Organization. Management of Drugs at Health Center Level. Geneva: WHO; 2004. http://apps.who.int/medicinedocs/pdf/s7919e/s7919e.pdf.
8
Dinarvand R. Evaluation and the model presentation of regional distribution of drugs in Iran. Journal of Medical Council of Iran. 2005.
9
Barnett JW. Supply of Medicines Text Book of Hospital Pharmacy. London: Blackwell; 1980.
10
Bagheri Kahkesh M, Jahangiri K, Hajinabi K. Situational analysis of drug chain management in rural health houses at Masjed Soleiman district and effect of an educational intervention on process improvement. Journal of Healthcare Management. 2011;3(1-2):25-33.
11
Chandani Y, Felling B, Allers C, Alt D, Noguera M. Supply chain management of antiretroviral drugs: considerations for initiating and expanding national supply chains. Arlington, Va: DELIVER, for the U.S. Agency for International Development; 2006.
12
ORIGINAL_ARTICLE
The Need for Complementary Health Insurance in Iran and Suggestions for Its Development
International experience has shown that the increasing diversity in healthcare services precludes the integration of all services under a government health insurance plan in terms of performance and economy; no institution receiving a fixed amount of money per capita is able to provide all services. Supplementary insurance is used in many countries.1 In Iran, comprehensive coverage of medical costs through a basic government medical insurance program is not possible because of the rising costs of diagnosis, use of more up-to-date and expensive medical technologies, and the development of new treatment methods. The number of people deprived of the right to healthcare is increasing daily. The structure of complementary insurance is based on participation and provides three types of coverage: completion of services, completion of costs, and integration of costs and services. In many leading countries, insurance is provided to a group with the participation of the insured and the insured’s employer who pays the employee’s premiums.
https://www.jhpr.ir/article_40714_fd729f2cdb77107710813ace976b87fd.pdf
2016-11-01
146
146
10.21859/hpr-0104146
Health Insurance
Healthcare
Iran
Seyed Morteza
Adyani
1
Atiyeh Sazane Hafez, Treatment Supplement Insurance, Tehran, Iran
AUTHOR
Ezzatollah
Gol-Alizadeh
dr.golalizadeh@gmail.com
2
Support Deputy of Islamic Republic of Iran’s Medical Council, Tehran, Iran
LEAD_AUTHOR
Nosratnejad S, Rashidian A, Mehrara M, Jafari N, Moeeni M, Babamohamadi H. Factors influencing basic and complementary health insurance purchasing decisions in iran: analysis of data from a national survey. World Med Health Policy. 2016;8(2):179–196. doi:10.1002/wmh3.187.
1
Kiil A, Arendt JN. The effect of complementary private health insurance on the use of health care services. Int J Health Econ Manag. 2016. doi:10.1007/s10754-016-9195-3.
2
Mackintosh M, Channon A, Karan A, Selvaraj S, Cavagnero E, Zhao H. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. Lancet. 2016;388(10044):596-605. doi:10.1016/S0140-6736(16)00342-1.
3
Choi Y, Kim JH, Yoo KB, et al. The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008–2012). BMC Health Serv Res. 2015;15:489. doi:10.1186/s12913-015-1153-0.
4
Franc C, Pierre A. Compulsory private complementary health insurance offered by employers in France: implications and current debate. Health Policy. 2015;119(2):111-116. doi:10.1016/j.healthpol.2014.12.014.
5