Insurance Organizations Research Articles

Abstract No. 492 Uterine artery embolization in the United States, 2012–2015: a population-based analysis of costs based on hospital characteristics

To explore basic characteristics and hospital-based outcomes of subjects receiving uterine artery embolization (UAE) as the principal procedure for an inpatient admission. Data from the National Inpatient Sample 2012–2015 comprising up to 97% of US hospitals was used. Admissions with uterine artery embolization with or without coil as the principal procedure were identified using the ICD-9 procedure codes. Basic demographic and financial variables were extracted. Outcomes were compared based on hospital characteristics. Included patients had an average age of 44.2 (SE: 0.3) and were mostly located in large central metro areas (51.8%). Overall, 45.1% identified as black, 30.5% as white, and 13.6% as Hispanic. The primary payer in the majority of admissions were private insurance and health maintenance organizations (57.8%) compared to 24.5% Medicare and 7.6% Medicaid. Most of the patients were classified in the minor risk group for loss of function (52.1%) and mortality (80.1%). No significant variation in case severity, mortality (1.0% SE 0.3%), length of stay (3.3 days SE 0.1) or routine disposition (92.4% SE 0.8%) was found based on hospital characteristics. However, total charges were significantly higher at private investor-owned hospitals (74,876$ vs 59,047$ at nonprofit and 44,835$ at government-owned hospitals; P<0.05), hospitals that were larger (60,501$ vs 44,261 for small hospitals; P<0.05) and hospitals at West region (69,241$ vs 54,334$ at Northeast; P<0.05). Despite similar outcomes of mortality, length of stay and disposition, significant differences exist in total charges for uterine artery embolization admissions based on hospital ownership (private vs non-profit vs government owned), size (large vs medium and small) and region (west vs northeast).Tabled 1RegionCost USD (SE) NE54,336 (3796) MW56,540 (3531) S57,781 (3536) W69,241 (3475)Bed Size Small44,261 (2963) Medium57,993 (3747) Large60,501 (2469)Ownership Government44,835 (3275) Nonprofit59,047 (2335) Private74,876 (3347) Open table in a new tab

Biochemical Risk Factors for Kidney Stones in Diabetic Patients

Objective: The aim of this study is to investigate the biochemical risk factors of kidney stones in diabetes. This includes the estimation of serum and urinary creatinine (Cr), albumin (Alb), sodium (Na+), potassium (K+), magnesium (Mg++), phosphorous (Po4++), calcium (Ca++), uric Acid (U.A), alkaline phosphatase (ALP), serum parathyroid hormone (PTH), reduced glutathione levels(GSH), urinary Oxalate, as well as citrate and nitric oxide (NO) levels were measured. Subjects and Methods: The clinical study was performed on 100 patients that attended Suez Health Insurance Organization and Ain Elhyah Hospital. Patients were divided into four groups; 25 diabetic patients (D) (mean age 52); 25 renal stone patients (R, S) (mean age 49); 25 diabetic renal stone patients (D R S)(mean age 51) and 25 control subjects (C)((mean age 47) age-matched, randomly selected. Blood and urine 24 hr samples were collected. Results: Serum (Cr) and (Alb) levels showed a non-significant changes in all patients. However, the data showed a significant decrease in (Mg++) level of all patients groups, with a significant level in (D R S) than (D) and (R, S) patients. Moreover, a significant increase in (U.A) levels of all patients groups but higher in (DRS) than (D) and (R, S) patients groups, the data revealed a significant decrease in urinary magnesium level in(DRS) patients group compared to (C), (R, S) and (D) patients groups. Moreover, a significant increase in urinary (U.A) level of all patients was noticed, it was significantly higher level in (DRS) than (R, S) patients groups. Oxalate level in all patients was increased, significantly. Meanwhile, the oxalate level was increased in (DRS) compared to (R, S) and (D) patients groups. The citrate level was decreased significantly in the urine of all patients groups with a significantly lower level of (DRS) than (R, S) and (D) patients groups. On other hand, a significant decrease in blood GSH level of all patients groups was observed where; its level in (DRS) was significantly lower than the (R, S) patients groups. However, data revealed a significant increase in serum (PTH) level of the (R, S) and (D R S) patients groups compared to (C) one. PTH level in (R, S) patients group was significantly higher than (D) and (DRS) patients groups. The data revealed a significant increase in serum ALP level of (D) and (D R S) groups compared to (C) group with a higher significant level in (DRS) than (R,S) patients groups. Moreover, the urinary 24h (NO) level was increased significantly in all patients groups compared to (C) group.

Суперечності понятійного апарату в дослідженні системи пенсійного забезпечення

Мета статті. Встановлення елементів системи пенсійного забезпечення, а також логічного зв’язку між основними поняттями в дослідженні даної системи.&#x0D; Наукова новизна. У статті проведена систематизація основних понять системи пенсійного забезпечення, вказані їх відмінності, встановлено елементи зазначеної системи.&#x0D; Висновки. Державна політика є родовим поняттям по відношенню до державної соціальної політики, яка включає в себе політику соціального захисту і політику соціального забезпечення. У свою чергу їх складовими є пенсійна політика і політика пенсійного забезпечення.&#x0D; Підсистемами системи пенсійного забезпечення є солідарна система загальнообов’язкового державного пенсійного страхування; накопичувальна система загальнообов’язкового державного пенсійного страхування та система недержавного пенсійного забезпечення. Ці підсистеми системи пенсійного забезпечення можна розглядати як окремі самостійні системи зі своїми елементами: особами, від імені та на користь яких здійснюється накопичення та інвестування коштів; підприємствами, установами, організаціями та фізичними особами, що здійснюють перерахування внесків до системи накопичувального пенсійного забезпечення; юридичними особами, які здійснюють адміністративне управління пенсійними фондами та управління їх пенсійними активами; зберігачами; страховими організаціями.&#x0D; Термін «пенсійний фонд» має два значення: цільовий фонд, який створюється відповідно до законодавства і акумулює страхові внески застрахованих осіб; центральний орган виконавчої влади, що реалізує державну політику з питань пенсійного забезпечення. Поняття «солідарний рівень» доцільно застосовувати до осіб, які отримують забезпечення на цьому рівні, а солідарну систему слід розглядати як сукупність елементів, що, виконуючи визначені функції, реалізують завдання щодо забезпечення пенсіонерів саме на цьому рівні.

HUBUNGAN PERCEIVED QUALITY DENGAN KEPUASAN FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP) DI WILAYAH SURABAYA TIMUR PADA PELAYANAN BPJS KESEHATAN

Primary health cares facility called as FKTP as partners of social health insurance organization called BPJS Kesehatan to provided basic health services. It is important to paid attention for FKTP satisfaction toward BPJS Kesehatan to optimized health services that gave to public. One of the factors that influence satisfaction is perceived quality, which is perception of services. The main purposed of this research is to analyze the correlation between satisfaction and perceived quality included professionalism and skills, attitude and behavior, accessibility and flexibility, reliability and truthworthiness, recovery, reputation and credibility. This research is an observational research with cross sectional design. Sample was determined by using the total population method involving 35 FKTP in East Surabaya area consisting of puskesmas and primary health clinic. This research used the primary data obtained from the questionnaire. The results of research shows that most FKTP is satisfied. The result of the correlation between variable reliability and trustworthiness; reputation and credibility with satisfaction is strong, attitudes and behavior; recovery with satisfaction is quite strong, and professionalism and skill; accessibility and flexibility with satisfaction is low. Needs improvement for recovery aspects about the existence of a fast and responsive complaint handling system with assignation BPJS Kesehatan employee in every FKTP for direct complaints handling that related to JKN-KIS program.

The Comparison of Direct Health Expenditures of Selected Insurance Organizations of Isfahan Province and Isfahan University of Medical Sciences, Iran, before and after Health Care Reform in Years 2013 and 2015

The Comparison of Direct Health Expenditures of Selected Insurance Organizations of Isfahan Province and Isfahan University of Medical Sciences, Iran, before and after Health Care Reform in Years 2013 and 2015

ROS1 mutation non-small cell lung cancer-access to optimal treatment and outcomes.

IntroductionROS1 oncogenic fusion, which was first identified by Rikova et al, is reported to be present in 1%–2% of non-small cell lung cancers (NSCLCs) and is defined as a distinct molecular sub-group. Crizotinib is very effective in ROS1-positive patients and is now Food and Drug Administration (FDA) approved for the treatment of patients with advanced ROS1-positive NSCLC. We report our experience in a tertiary cancer care hospital in India in ROS-1 positive patients.Materials and methodThe present series is a retrospective analysis of 22 patients from the prospectively maintained lung cancer audit. Demographic data were collected which included age, performance status, gender, stage, co-morbidities, sites of metastasis and smoking history. Data were also collected regarding the source of financing for crizotinib whether self-financed, through insurance or Non-Governmental Organisation (NGO) sponsored. Patients who had tested negative for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) and were subsequently found to be ROS1-mutation negative by fluorescence in situ hybridization (FISH) were evaluated on similar lines. All the data were entered and statistical analyses were performed using the SPSS software version 22.0. Response evaluation was done by RECIST 1.1 criteria.ResultsBetween January 2015 and December 2017, there were 22 patients who were ROS1 positive from a total of 535 patients in whom ROS1 testing was performed. A total of 16 patients could receive crizotinib and 6 patients were never exposed to crizotinib. Among the 16 patients who received crizotinib, 2 (12.5%) achieved complete response (CR) as their best response and continue to remain in CR at follow-up. 13 (81%) had a partial response as best response and of which on follow-up 5 (38%) have progressed, while 8 (62%) continue to maintain response. The patients who were on crizotinib had good tolerance with none experiencing any grade 3/4 toxicity. The median follow-up of the entire cohort was 15.2 months in ROS1-positive cohort and 11.4 months in ROS1-negative cohort. In ROS1-positive cohort median, progression-free survival (PFS) was not reached and the estimated 2-year PFS was 54% and in ROS1-negative cohort, it was 5.1 months. The median overall survival of the entire ROS1-positive cohort was not reached and the estimated 1- and 2-year overall survival (OS) was 72% and 54%, respectively, and was 8.8 months in ROS1-negative cohort.ConclusionROS1 rearrangement with an incidence of 4% of lung adenocarcinoma which is EGFR and ALK negative represents an important targetable driver mutation in the Indian population. Crizotinib also represents an effective treatment option with outcomes similar to those reported. Access to treatment remains an important roadblock to improve outcomes but innovative methods may improve access to these drugs.

Оцінка платоспроможності страхових організацій Республіки Білорусь.

Sustainable development of insurance organizations aimed at ensuring their solvency in order to protect the interests of policyholders is the main priority of the insurance market of the Republic of Belarus. The most important indicator characterizing the reliability and stability of the insurance market is the solvency of the insurance company. The subject of the study is the process of assessing the solvency of insurance organizations. The goal is to analyze the current practice of assessing the solvency of insurance organizations in the Republic of Belarus. The tools to maintain solvency of insurance companies of the Republic of Belarus are insurance rates, insurance reserves, investments and reinsurance. The practical application of these tools in the activities of insurance organizations of the Republic of Belarus is considered. In accordance with the Instruction on the criteria and procedure for assessing the solvency of insurance organizations, the solvency of an insurance company is the estimated value, within which the insurer, based on the specifics of the concluded contracts and the volume of insurance obligations assumed, should have its own capital free from any future obligations, with the exception of rights of claim of property owners. Solvency assessment involves a comparison of the actual and standard sizes of the solvency margin, which are based on the financial statements of the insurance organization. The process of assessing the solvency of insurance organizations of the Republic of Belarus also includes the calculation and monitoring of compliance with safe functioning standards. It is concluded that the Republic of Belarus uses a combined approach to assessing the solvency of insurance organizations, which provides for two areas: a comparison of the actual and standard sizes of the solvency margin and an assessment of the implementation of safe functioning standards. The solvency assessment process should take into account all aspects of the insurance organization and allow the analysis of factors affecting its solvency. Factors should take into account both the conditions typical for all participants in the insurance market and the particularities of a particular insurance organization.

Leader member exchange leading service employee desired job outcomes and performance: an Indian evidence

Leader member exchange theory, being an emergent theory in leadership literature, has been associated with several desired job outcomes in past. However, least research is conducted regarding job outcomes like service employee satisfaction, trust and service performance particularly in an Asian context. To plug the gap, the current study examines leader member exchange in relationship with desired employee job outcomes like employee satisfaction and trust and its influence on service performance. The current study is also an endeavour to be first research study examining the relationship in Indian service industry with integration of insurance, banking and postal service organizations. The study is conducted in Kashmir region, the northern most part of India that offers valuable findings, implications and suggestions regarding betterment of leader member exchange quality, desired job outcomes and employee service performance.

Main areas of auditing insurance companies’ financial statements

This article formulates and analyzes the main areas of audits of financial reporting of insurance organizations and audit procedures, as well as auditor's programs in this area. At the same time, proposals and recommendations on auditing the financial statements of insurance companies have been prepared. In order to confirm the financial stability and solvency of the insurance organization, the task of determining compliance of the financial and operating operations with the current legislation, the reliability and the validity of the financial results of the insurance companies in accounting and reporting, audit was organized. It is evident that as there appear legal relationship and the mutual interest on the basis of a contractual arrangement, it is required that the control system be improved. According to the AXS 200, Conducting general objectives of the independent auditor and auditing in accordance with international auditing standards and AHS 250, Consideration of laws and regulations in the audit of financial statements, the purpose of the audit is to ensure the reliability and accounting of financial (accounting) the implementation of the procedure according to the legal and regulatory requirements. Thus, the origin of the audit of the financial statements of insurance organizations is primarily incompatible with the interests of reporters (managers of the entities) and interests of users (owners of subjects of the subject), necessity of reliable information for economic decision making, the material required for evaluation appears as they are commercial secrets.

Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece.

Background and Aims:Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges.Methods:One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization.Results:The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment.Conclusion:Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.

Components Affecting Pharmaceutical Strategic Purchasing: A Scoping Review.

Pharmaceutical strategic purchasing is considered as a key to improve access to medicines especially for developing countries. The aim of this scoping review is to determine the most important components affecting pharmaceutical strategic purchasing. Here, we employed a comprehensive search strategy across PubMed, ProQuest, EBSCO, ISI Web of Science, Scopus, ScienceDirect, and Google Scholar for the terms related to medicines strategic purchasing. Among 13 included studies, 7 (53.85%) and 6 (46.15%) studies belonged to the developing and developed countries, respectively. Six main variables were emphasized as the effective variables on medicines strategic purchasing, including purchasing interventions, target group and service users, providers and suppliers of interventions, methods and motivations, price, and finally structure and organization. It seems that the insurance organizations of developing countries can achieve strategic purchasing only through the modification of the pharmaceutical pricing system and payment systems. Furthermore, they should pay attention to the real needs of target groups (demand) and modify the structure and organization as well as purchasing the most effective medicines from the best pharmaceutical providers.

Analysis of competitiveness of insurance organizations of the republic of Kazakhstan .

Analysis of competitiveness of insurance organizations of the republic of Kazakhstan .

PROBLEMS OF IMPLEMENTATION OF PROVISIONS OF ARTICLE 41 OF THE CONSTITUTION OF THE RUSSIAN FEDERATION CONCERNING RENDERING MEDICAL SERVICE

The implementation of the constitutional rights of citizens declared by Article 41, rests on the problems associated with the judicial proceedings on the provision of medical services. In 2007, the report on the grant of the American Association of Justice has already given arguments for and against, inflamed discussions, which then cover Europe and other states. However, in the domestic literature we find only comments and research on this issue. It is necessary to create mechanisms that are not burdened with contradictions between law and bioethics, in the process of protecting medical organizations and doctors in conflicts with insurance organizations and patients about the provision of medical services. The article analyzes the provisions of international law and practical experience; the provisions of the current Russian legislation on mediation and arbitration; the experience of the NMP. The authors propose an algorithm that allows to discuss, propose and resolve complex conflicts from the point of view of medical law and under the condition of bioethical approach. It should be emphasized that there is a need for discussion on the consideration of disputes between patients and doctors about the provision of medical services in specialized medical courts.

Signals of support: flexible work for mutual gain

Even where organizational policy provides for flexible work arrangements (FWAs), uptake of FWAs depends on employee perceptions of supervisor and organizational support for flexible work. Supervisor support has previously been identified as having significant influence on employee uptake of FWAs as supervisors can encourage or discourage FWA use. Supervisors work within an organizational context, so understanding how that organizational context shapes supervisor support is critical to improving FWA implementation. Incorporating both signaling theory and HR process theory, this case study of an Australian insurance organization examines the signals of support for FWAs that exist within an organization, and the influence of these signals, both explicit and implicit, on supervisor implementation of FWAs. The findings demonstrate how organizational statements, infrastructure investment, senior manager behavior, and organizational discourse shape supervisor support for FWAs. Theoretically, the study demonstrates that signals are an important feature of a strong HR system and can lead to a discourse of mutual gains which ultimately limits the use of particular FWAs, despite policy ostensibly supporting them. More broadly, the study contributes to a deeper understanding of how the implementation of HR policy can differ from HR policy intent.

Designing a pragmatic model for strategic purchasing of health services in health insurance companies

PurposeThe purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an applicable model for other similar organizations in developing countries.Design/methodology/approachThe present qualitative study was conducted in 2017 to identify the factors affecting the implementation of strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an indigenous and practical model through two phases: semi-structured interview followed by a Delphi process.FindingsAccording to the findings of this study, Ministry of Welfare, Labor and Social Security plays a central role in the strategic purchasing. In addition, this was also approved by the representatives of citizens in communities concerning professional associations, insurance agencies and representative of the Council of Ministers. Model development explored 9 themes and 54 sub-themes.Research limitations/implicationsBased on the model, most attention has been paid to consumer role and inter-sector leadership of the company with other relevant organizations and systems including other insurance organizations and the welfare ministry. More importantly, the health insurance company should be able to communicate with providers and to choose the best providers, receiving price information through competition in the most appropriate mechanism. Guided by this model, it can strategically buy the best and the most effective services for its insured population.Social implicationsIt might help developing societies to promote their health systems based on targeting the health budgeting and financial constraints so that it is prioritized according to the strategic purchasing criteria and consequently, economic evaluation.Originality/valueThe linchpins of the present study are as follow: first, the pragmatic model presented in the paper could help developing health systems to overcome the impediment in the implementation progress of strategic purchasing. Second, the model satisfies the need of enough knowledge to apply strategic purchasing in the health system. Third, the indigents have long been given special protection and consideration in the model that has continued to capture the attention of every policy-maker, in particular, developing countries, the portion of which is significant. Fourth, based on this model, attention has been paid to consumer role and inter-sector leadership of organization with other relevant organizations and systems. Fifth, this model could be correspondent for every insurance company in countries with similar developing conditions.

Regional Aspect of the Russian Insurance Market

Regional disproportions of the Russian insurance market have a considerable impact on insurance coverage of regional needs. The development of insurance relationship results from high-quality and structural changes in insurance interests both in corporate and in retail insurance, in voluntary and mandatory forms. Regional conditions define the quality and dynamics of insurance offer. At the same time, organizational, legal, financial requirements to insurance companies do not consider their specificity. Therefore, regional organizations are driven out from the market. Moreover, an insurer, especially in personal insurance and property and casualty insurance, remains with representative offices of the federal companies offering the uniform customs and not assuming individual approach. The results of the study have proved that during the development of Russian insurance based on market principles, territorial disproportions had a significant impact on the satisfaction of insurance interests. Currently, the situation has been aggravated due to increased insurance supervision, increased requirements for the authorized capital of insurance organizations, asset quality, significant additional costs for the transition to a new chart of accounts, XBRL data formats at the request of the Central Bank of Russia, the development of insolvency, temporary administration, bankruptcy. Additional diversion of resources to counter «insurance lawyers», the settlement of problems with the Federal Anti-Monopoly Service (FAS) significantly affects the financial condition of insurance organizations, which are not in the list of the top 50 insurers. However, the access to the insurance services is not equal. Thus, in any region and locality in the country, consumers can not obtain insurance products of the required quality, even in the case of MPTL insurance for car owners. The conditions are unequal even for the settlement of claims in the area of insurance risks. We have considered the characteristics of the regional development of the insurance market and proposed additional criteria for their evaluation. We have identified the main problems of regional development, proposed a number of organizational and regulatory innovations to optimize the structure of the market. On the basis of the system comparative analysis of the regional insurance markets of Russia, we have concluded that there is a need for different approaches to determining the directions and key indicators for the development of regional insurance markets. The state of regional insurance is compared with the specificity of the regional economy, which is the basis for the development of insurance. We propose different requirements for the federal and regional insurance organizations. We have suggested new approaches to the regulation of regional insurance companies, which will allow to equalize supply and to improve the quality of insurance services in regional insurance markets.

Trust in times of health reform

Trust is seen as an important condition for the smooth functioning of institutions, such as the health care system. In this article we describe the trust relationships between the three main actors in the Dutch health care system: patients/insured, healthcare providers and insurers. We used data from different surveys between 2006 and 2016. 2006 was the year of the introduction of an insurance reform in the Netherlands towards regulated competition.In the triangle of trust relationships between the three actors we found strong and mutual trust relationships between patients and healthcare providers and weak trust relationships between healthcare providers and insurers as well as between insured and insurance organisations. This hampers the intended role of insurers as selective purchasers of health care on the basis of quality and price.

Financial sustainability management of the insurance company: case of Ukraine

In the current conditions of the Ukrainian economy, which is characterized by crisis phenomena and frequent changes in legislation, the insurance organizations are facing a number of difficulties in maintaining their financial sustainability. Moreover, these processes take place under the increased requirements for solvency of insurers. However, a significant part of domestic insurance companies is financially unstable, which is conditioned not only by the lack of funds, but also by the low level of management. This situation hinders the further development of the insurance market in Ukraine and has a negative impact on all areas of the domestic financial system and prevents it from successful integration into the European financial field. In order to address this problem, it is necessary to distinguish the key groups of risks that affect the financial sustainability of insurance organizations, among which there are the following: insurance, strategic, market risk, risk of inefficient capital structure, risk of limiting the insurance company’s liquidity, tax risk, investment risk, operational risk, the risk of ineffective organizational structure of the enterprise, and information risk. It should be noted that under conditions of changing environment, the impact of these risks only increases, and therefore the task of minimizing the impact of these risks on the activities of insurance companies is highly important. Accordingly, the authors of the article proposed a four-stage strategy to manage the financial sustainability of the insurance company, the purpose of which is to identify the risks of limiting the insurer’s financial sustainability, their qualitative and quantitative assessment, as well as the development and implementation of appropriate measures to minimize and eliminate unacceptable consequences.

Challenges of implementation: Strategic purchasing in Iran Health Insurance Organization.

Strategic purchasing has been introduced as a key strategy for solving the problems faced by insurance companies. In Iran, the government has mandated the Iran Health Insurance Organization (IHIO) to implement this strategy. However, there are serious challenges to achieving that. The present study aims to identify these challenges. In this qualitative study, a semi-structured interview was conducted on 27 health managers and experts at the national level. The dimensions of the A. Preker model were used to analyze the data. Challenges of strategic purchasing in the IHIO were categorized into five concepts-political economy, policy design, organizational structure, organizational environment, and management capacity; within these concepts, 22 challenges were identified. Improving strategic purchasing in Iran requires adopting a coherent approach and taking into account all the affecting factors. By revising some policies, and modifying and defining the rules needed to solve the infrastructural problems, the success of strategic purchasing can be obtained.

Mohammad Reza Shah Pahlavi’s Autocracy: Governmental Constraints, 1960s–1970s

Even when Mohammad Reza Shah became an autocrat by the early 1960s, systemic constraints on his power persisted. One was government officials. They certainly accepted the shah’s governmental centrality. But in parallel they inventively created more elbowroom for themselves than they are normally credited for, shaping everyday administration and co-shaping policies. The article substantiates this argument in two steps. First, it looks at Iran’s Sāzmān-e bimeh-hā-ye ejtemāʿi-ye kārgarān (Workers Social Insurance Organization [SBIK]), drawing principally on French-language International Labor Organization (ILO) archival files. Although the shah had a well-publicized stake in social insurance expansion, the SBIK influenced policy strategy, sometimes against his explicit wishes; also, it handled routine operations and relations with the ILO independently from him. Second, the article zooms out to analyze Persian-language Harvard University Iranian Oral History Project interviews with high-ranking officials, alongside other published and unpublished sources, to show how government officials maintained some autonomy vis-à-vis the shah. Their strategies included self-effacement, the agreement on a unified cabinet policy position before a royal audience, resignation threats, open pushback, and gifts, including favors, to third parties.