Health Insurance Organization Research Articles

Supporting deprescribing in long-term care: An approach using stakeholder engagement, behavioural science and implementation planning

Approaches for optimizing medication use and enhancing medication experiences, including deprescribing, for older people living in long-term care homes are urgently needed. Through a multiphase initiative involving an environmental scan (2018) and two stakeholder forums (2019, 2020), we created a framework for developing and implementing sustainable deprescribing practices in this sector. Representatives from public advocacy, health care professionals, long-term care, pharmacy service providers, and regional health and public policy organizations in Ontario, Canada were consulted. We used behavioural science and implementation planning strategies to develop four target behaviours and 14 supporting actions; five of these actions were prioritized for further work. Throughout the phases, stakeholders committed to participation at various levels including ongoing implementation teams working to develop resources for the prioritized actions. A key element of success was attracting and sustaining engagement of a wide variety of relevant stakeholders from across the health system by leveraging best practices in stakeholder engagement. The approach used is described in detail so that it can be adapted and applied by others to plan large behaviour change initiatives.

Prevalence of Hypothyroidism in Children and Adolescents of Fars Province (Southern Iran): A Nationwide Prescription Study, 2018-2019.

Hypothyroidism is the most common hormonal deficiency worldwide; however, there is limited data about its prevalence in the children and adolescents of the Middle East. The prevalence of hypothyroidism were calculated by dividing the number of patients purchasing levothyroxine in 1397 Solar-Hijri year (Correlate with March 2018-February 2019) by the population at risk (per 10000 persons). Data were collected from the Iran health insurance organization registration records and family physician databases of health vice-chancellor of Shiraz University of Medical Sciences. The present study shows that the prevalence of levothyroxine treated population aged under 18 years is 13 in 10000 in the Fars province and it is more common in females (17 in 10000 in females versus 9 in 10000 in males). This study also revealed that the prevalence of hypothyroidism was different in various age groups and increased in older children and adolescents after pubertal ages. Also, an increase in the female: male ratio of prevalence was more obvious during and after puberty. Our study showed that the prevalence of congenital hypothyroidism was 3/10000 in southern Iran. Also, the prevalence of hypothyroidism in children and adolescents was totally 13/10000 population, and this prevalence increased in older age and female gender. This prevalence was close to the data from iodine sufficient areas in Europe and the United States.

National geographical pattern of COVID-19 hospitalization, case fatalities, and associated factors in patients covered by Iran Health Insurance Organization

BackgroundUnderstanding the Spatio-temporal distribution and interpersonal comparisons are important tools in etiological studies. This study was conducted to investigate the temporal and geographical distribution of COVID-19 hospitalized patients in the Iran Health Insurance Organization (IHIO) insured population (the second largest social health insurance organization) and the factors affecting their case fatality rate (CFR).MethodsIn this descriptive-analytical cross-sectional study, the demographic and clinical data of all insured of the IHIO who were hospitalized with COVID-19 in hospitals across the country until March 2021 was extracted from the comprehensive system of handling the inpatient documents of this organization. The Excel 2019 and GeoDA software were used for descriptive reporting and geographical distribution of variables. A multiple logistic regression model was used to estimate the Odds Ratio (OR) of death in patients with COVID-19 using STATA 14 software.ResultsDuring the first 14 months of the COVID-19 outbreak in Iran, 0.72% of the IHIO insured (303,887 individuals) were hospitalized with COVID-19. Hospitalization per 100,000 people varied from 192.51 in East Azerbaijan to 1,277.49 in Yazd province. The overall CFR in hospitalized patients was 14%. Tehran and Kohgiluyeh & BoyerAhmad provinces had the highest and lowest CFR with 19.39% and 5.19%, respectively. The highest odds of death were in those over 80 years old people (OR = 9.65), ICU-admitted (OR = 7.49), Hospitalized in governmental hospitals (OR = 2.08), Being a foreign national (OR = 1.45), hospitalized in November (OR = 1.47) and Residence in provinces such as Sistan & Baluchestan (OR = 1.47) and Razavi Khorasan (OR = 1.66) respectively. Furthermore, the odds of death were lower in females (OR = 0.81) than in males.ConclusionsA sound understanding of the primary causes of COVID-19 death and severity in different groups can be the basis for developing programs focused on more vulnerable groups in order to manage the crisis more effectively and benefit from resources more efficiently.

Estimation of disease progression for ischemic heart disease using latent Markov with covariates

AbstractContemporaneous monitoring of disease progression, in addition to early diagnosis, is important for the treatment of patients with chronic conditions. Chronic disease‐related factors are not easily tractable, and the existing data sets do not clearly reflect them, making diagnosis difficult. The primary issue is that databases maintained by health care, insurance, or governmental organizations typically do not contain clinical information and instead focus on patient appointments and demographic profiles. Due to the lack of thorough information on potential risk factors for a single patient, investigations on the nature of disease are imprecise. We suggest the use of a latent Markov model with variables in a latent process because it enables the panel analysis of many forms of data. The purpose of this study is to evaluate unobserved factors in ischemic heart disease (IHD) using longitudinal data from electronic health records. Based on the results we designate states as healthy, light, moderate, and severe to represent stages of disease progression. This study demonstrates that gender, patient age, and hospital visit frequency are all significant factors in the development of the disease. Females acquire IHD more rapidly than males, frequently developing from moderate and severe disease. In addition, it demonstrates that individuals under the age of 20 bypass the light state of IHD and proceed directly to the moderate state.

Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives

Background: The health insurance extent of coverage was decided by the Health Insurance Organization in order to manage costs. In this plan, to determine the extent of payment by each medical center, the performance of the year 2017 was considered the base point. Furthermore, it should not cost more than the performance of the year 2017 or 10 % less. This issue had caused challenges in public hospitals; so, the purpose of this study is to explain the challenges of health insurance extent of coverage from the perspectives of the experts from Mashhad University of Medical Sciences and propose solutions.
 Methods: This was a qualitative study conducted through content analysis method in 2022. In-depth and semi-structured interviews were used to collect data. The research population included experts such as staff and hospital managers, Medical group managers, and insurance managers and experts. It was done through purposeful sampling. Data collection continued until the codes were completed, and finally 17 people were interviewed. In each phase, data analysis and data collection were performed simultaneously, using content analysis method and MaxQDA10 software.
 Results: In this study, the 2 main concepts were management challenges (including sub-concepts of motivation, performance evaluation, patient admission, and hospital costs), and planning challenges (including sub-concepts of education, infrastructures, cross-sectional coordination, and foresight).
 Conclusion: Based on the findings of this study and the challenges expressed, Health Insurance Organization can take steps toward upgrading the plan by considering the necessary prerequisites and providing solutions such as performance monitoring evaluation system, cost management, training the target groups, and appropriate clarification and announcements.

Possibility of Applying Data Mining in Health Insurance

In this paper, a great range of possible applications of data mining, data warehousing and knowledge discovery is described. With the increase of costs and complexity of healthcare systems, application of the following techniques and algorithms can help decision makers in health insurance organisations to increase productivity, cut costs and lower the complexity of their daily processes. The application of data mining is described by using CRISP-DM methodology, while example of possible application is given for each type of data mining approach.

Modern approach to automation of internal control of quality and safety of medical care

Introduction. Heads of medical organizations operating under the Moscow Healthcare Department are the ones who take care of internal control of quality and safety of medical care [1-7]. However, once the healthcare system in Moscow switched to the Unified Medical Information Analysis System (UMIAS), abandoning all the other automated information systems the city had previously used (such as Medialog, Megaklinika, Asklepios etc.), Moscow’s medical workers found it impossible to automatically unload certain statistical (analytical) reports. They have to use paper medical records and logs to register the results of the medical care quality control [1, 2, 6]. Many engineers and programmers working in Moscow’s medical system organizations attempted uploading the medical record data and create automated logs within the UMIAS system; however, they failed [4, 8, 9, 10]. That is why they started creating intranet web portals, integrating them with various internal Moscow healthcare systems (such as UMIAS etc.) as well as well as external Federal Compulsory Medical Insurance Fund systems (like the PUMP system for personalized medical care records). This allowed logging in the results of internal quality control and automatically creating statistical and analytical reports, as well as monitoring the document exchange between various offices of Moscow healthcare organizations [11-14]. To ensure the efficiency of these intranet web portals, medical workers responsible for quality control develop checklists that feature pre-approved criteria for evaluating the results of treatment for certain diseases (conditions) in accordance with medical care provision standards and clinical recommendations. Moreover, the comprehensive introduction of intranet web portals helped ensure that clinical recommendations are followed in Moscow healthcare organizations. In fact, it allowed conducting an automated medical and economic examination, similar to the ones carried out by health insurance organizations within the framework of the compulsory medical insurance system as part of state oversight. Goal. To identify the main issues in organizing internal control of quality and safety of medical care associated with the introduction of intranet web portals in Moscow healthcare system’s organizations. Materials and methods. We identified the main issues in organizing internal control of quality and safety of medical care associated with the introduction of intranet web portals in Moscow healthcare system’s organizations. Moreover, we also examined the requirements for checklist development, as well as the difficulties that arise when compiling analytical reports on following the expert criteria and standards of medical care provision and clinical recommendations. Findings. The list of the main issues associated with the introduction of an automated system for organizing internal control of quality and safety of medical care via multi-user intranet web portals includes: training heads of structural units responsible for organizing and carrying out the internal control of quality and safety of medical care; developing checklists using the pre-approved criteria, rules and requirements for providing medical care in accordance with standards and clinical recommendations; and developing an activity plan for organizing various checks (audits) and compiling analytical (statistical) reports to assess the activities of the Moscow healthcare organizations’ structural units (or employees). The checklists must feature codes of MES (medical and economic standards), ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) and medical services, as well expert criteria mentioned in acting legal documents. This is complicated by the fact that the codes of medical services in the UMIAS system differ from the codes featured in the approved medical service nomenclature, whereas expert criteria undergo frequent updates. Conclusion. To ensure the successful implementation of management responses, one needs to regularly host internal meetings with heads of structural units as well as employees responsible for organizing and carrying out internal control of quality and safety of medical care, and timely develop checklists in accordance with pre-approved standards, assessment criteria, rules and requirements of enforcement authorities while taking into account the latest clinical recommendations. To ensure proper control over following medical care provision standards in accordance with clinical recommendations and, therefore, avoid deductions and fines issued by oversight bodies, one needs to adopt a comprehensive approach to internal control of quality and safety of medical care at every level (stage), including heads of department, deputy chief doctors, deputy heads for clinical expert work etc.

Comorbidity progression patterns of major chronic diseases: The impact of age, gender and time-window.

The presence of one chronic disease often leads to the development of one or more other chronic diseases. This study examines whether there are significant progressions between chronic diseases and identifies the risk factors that influence them. This study used an administrative healthcare dataset sample from 29,280 hospitalized patients over 24 years (1995 to 2018, inclusive) to explore the progression of common chronic diseases and their major comorbidities. An Australian health insurance organization provided the dataset. We used the t-test to examine the statistical significance of progression between chronic diseases. A network analysis approach is followed to rank different chronic diseases contributing to disease progressions. We found that few chronic diseases (e.g. cardiovascular diseases and diabetes) have a high prevalence in progressing to other chronic diseases, which is statistically significant at p ≤ 0.05. These progression frequencies significantly increase with time and age. We also found that patients' sex differently affects the disease progressions. This study found that some chronic diseases have a high prevalence in comorbidity progressions. In addition, the progression statistics differ with time and age. The results of this study can help researchers, stakeholders, and policymakers gain insights into the disease transitions and act as a guiding tool to assess future disease burden and plan accordingly.

Belgium's Healthcare System: The Way Forward to Address the Challenges of the 21st Century Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

In this paper we have tried, starting from the results of an analysis of the functioning of integrated care in the Belgian Health System by Martens et al, to design a strategy that could contribute to better addressing the challenges of the 21st century in Belgium. We proposed health system changes at the macro-, meso- and micro-level. We focused on health policy development and organization of care, emphasizing the importance of a shift from a hospital-centric towards a primary care based approach. Special attention was paid to the need for institutional reforms, in order to facilitate the further development of interprofessional integrated care, that focuses on the achievement of the life-goals of a person.

Telehealth Before and During the COVID-19 Pandemic: Analysis of Health Care Workers' Opinions.

BackgroundThe COVID-19 pandemic and the lockdowns for controlling the spread of infection have led to a surge in telehealth adoption by many health care organizations. It is unclear how this pandemic has impacted health professionals’ view about telehealth. The analysis of textual data, such as comments posted on a discussion forum, can uncover information that may not be captured by a structured survey.ObjectiveThis study aims to examine the opinions of health care workers about telehealth services during the time frame of March 2013-December 2020.MethodsComments about telehealth posted by health care workers from at least 46 countries were collected from an online discussion forum dedicated to health professionals. The analysis included the computation of sentiment scores from the textual data and the use of structural topic modeling to identify the topics of discussions as well as the factors that may be associated with the prevalence of these topics.ResultsThe analysis of the comments revealed positive opinions about the perceived benefits of telehealth services before and during the pandemic, especially the ability to reach patients who cannot come to the health facility for diverse reasons. However, opinions about these benefits were less positive during the pandemic compared to the prepandemic period. Specific issues raised during the pandemic included technical difficulties encountered during telehealth sessions and the inability to perform certain care routines through telehealth platforms. Although comments on the quality of care provided through telehealth were associated with a negative sentiment score overall, the average score was less negative during the pandemic compared to the prepandemic period, signaling a shift in opinion about the quality of telehealth services. In addition, the analysis uncovered obstacles to the adoption of telehealth, including the absence of adequate legal dispositions for telehealth services and issues regarding the payment of these services by health insurance organizations.ConclusionsEnhancing the adoption of telehealth services beyond the pandemic requires addressing issues related to the quality of care, payment of services, and legal dispositions for delivering these services.

Abstract P3-16-02: Enhancing impact and efficiency of financial support for cancer through use of AI: A nascent initiative of Indian cancer society

Abstract Background: Since 2011, Indian Cancer Society-Cancer Cure Fund (ICS-CCF), established through donations of mutual fund dividends, has funded $27 million in treatment costs for 9800 underprivileged patients. For governance, a Due Diligence Team (DDT) of cancer experts from academic tertiary centers reviewed every planned treatment and authorized covering the treatment costs for evidence-based care. Since expert time is scarce, in 2019, ICS-CCF introduced NAVYA AI (AI) system to scale the prior authorization operation. AI is a clinically validated system that matches clinical data with evidence and expert recommended treatment options. The system can adapt to institutional guidelines such as ICS-CCF authorization criteria on published survival rates. In this prospective study, we explore application of AI in prior authorization, by assessing concordance with DDT expert decisions and potential time savings. Methods: Clinical data of beneficiaries were input in AI and if the output treatment options matched the planned treatment, the application was authorized, otherwise rejected. If AI did not output a decision, the application was deferred to DDT. Concordance between AI and DDT decisions, and DDT time spent on deferred applications, weremeasured. Results: From April 22nd, 2020 to June 9th, 2021, 1994 beneficiary applications were simultaneously reviewed by AI and DDT, of which 601 (30%) were breast cancer patients. AI “authorized” (1563/1994) or “rejected” (16/1994), 79.18% (1579/1267) of applications; and “deferred” 20.81% (415/1994) of applications. AI and DDT were 99.37% (1553/1563) concordant to authorize and 100% (16/16) concordant to reject a beneficiary application. DDT spent an average of 3.4 minutes/deferred application. Conclusions: A clinically validated AI system, 99% concordant with cancer experts in authorizing or rejecting 79% of beneficiary applications, promises a fivefold decrease in experts’ time, the scarcest resource for preauthorization. Subsequent to this study, ICS-CCF is awarding financial support directly based on AI authorize decisions. Similarly, health insurance organizations may consider a prospective study of the AI system in raising quality and efficiency of prior authorization thereby saving cost of time, money and expertise. Citation Format: Tushar Vora, Nehal Khanna, Anant Gokarn, Ann Rawat, Naresh Ramarajan, Gitika Srivastava, Usha Thorat. Enhancing impact and efficiency of financial support for cancer through use of AI: A nascent initiative of Indian cancer society [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-16-02.

Estimation the medical cost of multiple sclerosis in Iran; 2019\u20132020

BackgroundDue to the high and increasing economic burden of chronic diseases, including Multiple sclerosis (MS), we aimed to investigate the medical cost of MS in Iran.MethodsThis is a descriptive cross-sectional study which conducted using comprehensive national prescription data from Iran’s Health Insurance Organization (IHIO) and rehabilitation data from Ministry of Health and Iran Welfare Organization. The time period considered for this study was 2019–2020. In order to calculate the medical cost of MS, the cost-of-illness (COI) method was used based on the prevalence-based approach and the cost of medications, determining and diagnosing the MS risk, follow-up and rehabilitation was estimated.ResultsThe total medical cost of MS in Iran in 2019–2020 was estimated at $238,124,160, which medications and rehabilitation services had the largest share in the medical cost of MS in Iran with 80 and 19%, respectively, and the cost share of determining and diagnosing of the disease risk accounted for about less than 1%. The total medication cost was estimated to be equal to $192,298 thousand. The total cost of determining and diagnosing of the MS risk was estimated at $348,574 and the total cost of rehabilitation services for all MS subgroups in 2019–2020 was estimated at $45,477,205.ConclusionsResults of calculating the medical cost of MS in Iran in 2019–2020 showed a significant burden on the Iranian health care system and society, among which the medication cost had the largest share, which requires serious attention of health system policymakers.

Using blockchain and semantic web technologies for the implementation of smart contracts between individuals and health insurance organizations

Blockchains and smart contracts are gaining momentum as enabling technologies for a wide set of applications where data distribution and sharing among decentralized infrastructures is required. In this work, we present a distributed application developed using blockchain technologies that allows individuals and health insurance organizations to come into agreement during the implementation of the healthcare insurance policies in each contract. For this purpose, health standards and semantic web technologies were used for the formal expression of both the insured individual's data and contract terms. Accordingly, a fine-grained data access policy was applied for evaluating contract terms on the basis of relevant data captured in healthcare settings. A prototype was implemented involving the development of several different smart contracts for the Ethereum platform as well as the necessary visual environment for accessing them. The developed system validates various features related to blockchain and smart contract features that are briefly discussed in this work, part of which can be mitigated or resolved through the use of a private permissioned blockchain. The application of well-established techniques for potential malfunctions of external services could also boost the security of the system and prevent it from potential attacks.

Hospitalization Expenses and Influencing Factors for Inpatients with Ischemic Heart Disease in Iran: A Retrospective Study

Background: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society. Objectives: This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020. Methods: The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software. Results: The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62). Conclusions: According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

Implementation of the Inter-facility Protocol Including a Company, a Health Insurance Organization, and a Health Check-up Facility Could Improve a Completion Rate of Specific Health Guidance, the Dietary and Exercise Educational Program Provided under the Workplace Annual Health Check-up for a High-risk Group of Metabolic Syndrome, to Nearly One Hundred Percent in a Large-scale Group Organization

Implementation of the Inter-facility Protocol Including a Company, a Health Insurance Organization, and a Health Check-up Facility Could Improve a Completion Rate of Specific Health Guidance, the Dietary and Exercise Educational Program Provided under the Workplace Annual Health Check-up for a High-risk Group of Metabolic Syndrome, to Nearly One Hundred Percent in a Large-scale Group Organization

The use and the cost of outpatient diagnostic procedures for cardiovascular diseases in Isfahan province: A utilization study.

BACKGROUND:Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017.MATERIALS AND METHODS:This descriptive study used insurance claim data (time period: 2011–2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts' opinions.RESULTS:The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011–2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost.CONCLUSIONS:The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction.

Incremental Healthcare Resource Utilization and Expenditures Associated with Cardiovascular Diseases in Patients with Diabetes: A Cross-Sectional Study.

Background: Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients.Methods: In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively.Results: A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001).Conclusion: CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.

Preferences of people in choosing a family physician in rural areas: a qualitative inquiry from Iran.

Creating a stable and long-term relationship called 'longitudinality' between the population and general practitioners is crucial for the family physician program. The constant change of family physicians (FPs) can deteriorate longitudinality. This study aims to reveal what factors people usually consider when choosing a new FP or changing their current FP. A qualitative study with a thematic analysis approach was carried out in Ilam province, Iran, in 2019. Purposeful sampling with a maximum variation strategy was followed to select the key informants. We did 34 interviews with following groups: patients (rural residents); FPs; and experts from Iran Health Insurance Organization, Ilam University of Medical Sciences, and Health Network Development Center. Data were analyzed using a thematic analysis to identify and contextualize the preferences of people in choosing a FP in rural areas. All the processes related to data coding and emerging themes were carried out using MAXQDA 2012 software. The content of the interviews was categorized into 2 main themes, 6 sub-themes, and 39 codes. The first theme was 'family physician characteristics' including four sub-themes: general behaviors, social and physical characteristics, professional expertise, and pharmaceutical prescriptions. The second theme was 'health center' consisting of two sub-themes including location and physical features and properties of the health center. Some of the factors extracted from the interviews may have a different effect on the choice of people with different demographics. For instance, patients may have different ideas about the age, gender, years of medical practice, and finally, language and origin of the birthplace of FPs. Quantitative studies are needed to rank the factors identified in this study according to their significance for choosing FP and reveal patients' preferences for each factor.

The Effect of Health Transformation Plan on Out-of-Pocket Payments of the Hospitalized Patients in Hamedan, Iran

Background: Out-of-Pocket (OOP) payment is categorized among the critical indicators of health system financing. Given the high hospitalization costs of the hospitals, the ministry of health has attempted to implement Health Transformation Plan (HTP) in Iran to reduce OOP. The purpose of this paper is to show the effects of HTP on OOP payments of the hospitalized patients in Hamedan, Iran. Methods: This descriptive-analytical study was carried out on 587 patients in the educational hospitals of Hamedan. The data obtained before and after implementing the HTP was from 2013 to 2015. Data analysis was performed using SPSS16. Results: In this study, each patient's expenditures increased by 32.2 % in 2015, compared to before the implementation of the HTP. Therefore, the health insurance organization's coverage of OOP payments decreased to 8.3 % of the total costs by a 20.2 % reduction in 2015, compared to before the implementation of the plan. Conclusion: According to the study, HTP and government health subsidies were adequate, but the total hospitalization costs had an upward trend in all funds.

JOB SATISFACTION AMONG DENTISTS OF THE MINISRTY OF HEALTH IN ALEXANDRIA

Introduction: High prevalence of work-related physical and psychological disorders among dentists has been reported. Only one study explored job satisfaction among Health Insurance Organization dentists, in Alexandria. However, job satisfaction among Ministry of Health and Population (MOHP) dentists has not been examined.Objectives: The objective of this study was to measure the level of job satisfaction among MOHP dentists, in Alexandria and to assess the association of work environment factors as well as personal and practice-related factors to job satisfaction.Material and Methods: This study was a cross sectional analytical survey conducted among dentists working in MOHP facilities, in Alexandria during a six month period from October 2019 to March 2020. A validated questionnaire modified from the Dentists Satisfaction Survey that was previously tested in Saudi Arabia was adopted. The first section was concerned with demographic and practice related data whereas the second section explored work environment factors. Multivariate stepwise linear regression analysis was performed to examine the association between total mean job satisfaction with personal/ practice related characteristics and work environment factors.RESULTS: The level of job satisfaction was neutral (2.91±0.41). Overall job satisfaction (Beta=0.437), monetary satisfaction (Beta=0.328) and personal time (Beta=0.265) reported the most significant associations with job satisfaction according to the multivariate linear regression analysis.CONCLUSIONS: This study revealed that overall job satisfaction, perception of income and personal time showed a significant impact on job satisfaction. The findings of this study would help policy makers to design plans to increase level of job satisfaction among dentists.