Iranian Policy Makers Research Articles

Coverage Decision-Making for Orthopedics Interventions in the Health Transformation Program in Iran: A Multiple Criteria Decision Analysis (MCDA)

Introduction: All governments, regardless of available resources, should move to establish a balance between the conflict of resource scarcity of health system and health care services required. This study applied a multi criteria decision analysis (MCDA) approach to contribute to priority-setting and the coverage decision-making on including uninsured orthopedics interventions in the healthcare transformation plan’s subsidized in Iran during year 2015. Methods: This study was conducted in four phases: a comprehensive review of studies related to the methods and criteria for prioritizing health services, identifying prioritization criteria, scoring and finalizing them, weighting of the criteria identified, and planning for a prioritized uninsured coverage for orthopedics intervention. Results: After screening the retrieved titles via PRISMA, from 350 papers, 12 studies were included. The main criteria used for the priority step in the health sector were as follows: safety, efficacy, need, existence of alternative procedures, life expectancy impact, cost, cost-effectiveness, catastrophic health expenditure, impact on the budget, acceptance of social/economic and equity in access. According to the viewpoint of the experts, the safety criteria had maximum weight (0.4) and equity in access had the least weight (0.03). Finally, ten uninsured orthopedics services were prioritized with a score of 9.01 to 5.01. Conclusions: This practical and real-life project significantly contributed to rational, apparent, and unbiased priority-setting practice by using the MCDA methodology. Prioritizing and weighting the criteria in this study indicated that the Iranian policymakers should pay more attention to clinical aspects and benefits of the service than financial issues. This could indicate that there are social perspective and health as the public right in the country.

Factors Influencing the Desired Number of Children Among Married Women in the Reproductive Age and its Implications for Policy Making

Background: Desired number of children is one of the main indexes showing the fertility preferences of couples. This issue is currently more important as Iranian policy makers are revising population policies to improve fertility rate. Objectives: As a result, the main goal of this study was to investigate factors influencing the number of desired children among married women in the reproductive age. A theoretical framework was constructed based on demographic transition theory, demand-supply theory and diffusion theory. Methods: This study was a quantitative research and its research technique was survey. The population of the study included all married women at the reproductive age (15-49), who were living in Shiraz County (Shiraz city and surrounding rural areas). Data was collected by interviews with 626 women, who were selected by multi cluster sampling and purposive sampling during year 2014. Data was analyzed by the SPSS (version 22) software. Results: The findings showed that the desired number of children both in Shiraz city and its surrounding rural areas was exactly below the replacement rate. In addition, findings of this study demonstrated that the desired number of children as a dependent variable is affected by a set of socioeconomic and cultural factors. Results have revealed that the main predictors are couple agreement on the number of children, respondents’ income, son preference, respondents’ authority and ethnicity. Conclusions: Overall, the variables considered in the research model explained only 32.7% of change in the dependent variable. This means that 67.3% of change in the number of desired children is related to factors that are not included in the research model. Moreover, most of the women in Shiraz County desired to have a small family size and this fact can result in further decline of fertility rates in the future because couples respect their desires in fertility. As a result, it is recommender for policy makers to pay more attention to factors influencing the desired number of children.

Why Is Iran Experiencing Migration and Brain Drain to Canada?

Determining the driving factors of migration and brain drain helps Iranian policy makers to prevent migration and brain drain. This study considers two models of migration and brain drain from Iran to Canada. Variables include the number of educated and non-educated migrants, real Iranian National Income, the number of university students, the number of newspapers and periodicals, regime changes and war, and the Canadian unemployment rate from 1970 to 2000. The results of applying a Vector Autoregressive approach support the notion that lagged values of brain drain and migration are major driving factors of migration and brain drain from Iran to Canada.

Iranian kidney market in limbo: a commentary on “The ambiguous lessons of the Iranian model of paid living kidney donation”

Sigrid Fry-Revere's The Kidney Sellers: A Journey of Discovery in Iran, an allegedly first-hand examination of the Iranian paid kidney donation model, has been criticized by Koplin in an essay formerly published in the Monash Bioethics Review. Koplin especially challenges Fry-Revere's claim that financially compensating kidney vendors might facilitate altruistic kidney donation. The current situation in Iran, according to Koplin, suggests that the market model has undermined altruistic donation. On this point, this commentary tries to show that healthcare policymakers in Iran no longer see the Iranian paid kidney donation model as a sustainable and ethically justifiable status quo. Briefly touching on the criticisms that have been made even by some positive commentators of the Iranian model, this commentary aims to call attention to the fact that the current dynamic within healthcare policymaking in Iran seeks primarily to decrease its reliance on the organ market instead of revising and modifying it. This complicates the plausibility of any kind of extrapolation, replication or extracting empirical support from the Iranian model to create organ markets in other countries, for example, as Fry-Revere suggests to conduct a trial of a financially incentivized kidney donation scheme in the US. The conclusion is that the Iranian healthcare system should tackle the organ shortage through increasing altruistic living and postmortem kidney donations. This might also provide, finally, a space for conducting extensive and long-term follow-up studies on well-being, satisfaction and social integration of Iranian kidney vendors.

Experts against precaution: analyzing the process of biosafety regulation in Iran

The process of preparing and enacting a biosafety law in Iran lasted more than a decade. This paper examines the process of biosafety policy-making in Iran in relation to the Cartagena Protocol on Biosafety (CPB) and to domestic Iranian factors. While some scholars argued that the CPB would be influential in developing countries, our findings indicate that it was not particularly important in Iranian biosafety legislation. This paper outlines the internal Iranian political processes, which initially envisaged a very precautionary approach, but which concluded with a biosafety law designed to promote the adoption of these technologies. Reference will be made to the changing influence of expert biotechnologists on policy-making. The dominance of domestic policy considerations, compared to CPB provisions, implies that signing the CPB does not imply that national regimes will converge on a common model, based on the text of the CPB.

Validity and Reliability of an Information-Motivation-Skill-Behavior Questionnaire: A Gender-Sensitive HIV Survey

Background: Despite the essence of HIV-related surveys, their precision in measurement of intended constructs has been an area of controversy. Considering the increasing trend of sexual transmission of HIV among women, standard gender-sensitive tools can yield pivotal information for researchers and policy-makers in Iran. Aim: To evaluate the reliability and validity of a questionnaire (IMSB) based on the Information-Motivation-Behavior model of HIV-related behavior prediction. Methods: The IMSB survey constituted of five main domains: HIV-related knowledge, attitudes toward people living with HIV, motivation to practice safe-sex, skills to practice safe-sex, and HIV-related behaviors. Completed questionnaires (n = 189) from pilot phases of three projects were accessed. We assessed face and content validity through expert consultation and respondent feed-backs for the primary pool of items. Discriminant validity was measured utilizing non-parametric tests. Cronbach’s alpha was calculated for each domain to assess internal consistency, and paired t-tests were used to measure stability over time. Results: The primary pool of items was reduced in the process of validation. The discriminant validity was appraised to be favorable since the survey can differentiate between age groups, women with different levels of education and marital status. The survey was reliable in 4 domains; but a Cronbach’s alpha of 0.6 was reported for the fifth domain (HIV-related behaviors). Younger women had higher knowledge and motivation scores; single women were more motivated to practice safe-sex and divorced/widowed women had lower motivation and skills scores. Conclusion: This questionnaire can be used as a valid and reliable tool to measure the IMB constructs. The lower reliability of the “behavior” domain is probably rooted in societal norms and cultural definitions. The integration of motivation and skill domains can provide valuable information for clinicians/interventionists to address vulnerabilities experienced by their female clients.

Evaluating Science Parks Capacity to Create Competitive Advantages: Comparison of Pardis Technology Park and Sheikh Bahaei Science and Technology Park in Iran

Many countries have used science and technology parks to develop high-tech industries. In recent years, Iranian policymakers have been keenly examining this institution. By reviewing papers in this field and considering local dimensions of the issue, we tried to present a framework to evaluate the potential of creating competitive advantages by science and technology parks in Iran. Framework contains “human resources”, “R&D and technology transfer”, “market development” and “facilities” aspects with 12 factors. Use of this evaluation framework will help managers and policymakers of science parks to identify the main requirements of companies and strengths and weaknesses of the parks and the ability to provide more effective services. Finally, by designing the questionnaire and asking the experts (owners and managers of companies located in the Park) the Pardis Technology Park (PTP) and Sheikh Bahaei Science and Technology Park (SBSTP) were evaluated and compared in creating competitive advantages for their firms. The results show that PTP is significantly superior in providing the factors.

Determinants of pharmaceutical expenditures of urban households: A time series study in Kermanshah province (Iran).

IntroductionIn recent decades, the development of medical and pharmaceutical science has led to a heavy financial burden on the government, insurance companies, and the general population. Due to the increasing the cost of pharmaceutical products in the Kermanshah Province, policy makers have tried to identify the factors that resulted in the increases. The aim of this study was to determine the main factors that affect the expenditures for pharmaceutical products by urban households in Kermanshah Province, Iran.MethodsThis analytical-descriptive study was conducted using time series method. The study population was urban households of Kermanshah Province from 1991 to 2013. The explanatory variables of the log-log model were drug price index (LnDPI), the average income of urban households (LnINC), the number of physicians per 1,000 people (LnPH), and the number of hospital beds per 1,000 people (LnBE).The required data were acquired from the Statistical Center of the Ministry of Health and Medical Education. The unit root was evaluated by the Dickey-Fuller test. Stata v.11 software was used for the statistical analysis.ResultsCoefficients of LnDPI and LnPH were 0.97 and 0.77, respectively, and they were statistically significant (p < 0.05). Also, the coefficients of D. LnINC (first difference of LnINC) and LnBE were 0.34 and 1.8, respectively, and both of them were statistically insignificant (p > 0.05).ConclusionThe results showed that drugs are non-elastic and essential for households. It should be noted that the health policy makers in Iran should conduct appropriate planning to ensure both the physical and financial accessibility to drugs by urban households. The development of basic and supplementary health insurance coverage, especially for poor populations and urban areas where there are patients with chronic diseases, can be a suitable solution to reduce barriers to acquiring the required drugs.

Application of the FMEA in insurance of high-risk industries: a case study of Iran's gas refineries

The purpose of this paper is to categorize and analyze various risk factors in Irans gas refineries for insurance purposes. Using the failure modes and effects analysis method as a subset of probability risk assessment technique and gas refineries data for the period March 2011 till March 2012, risk priorities numbers are calculated from the perspectives of both the insured party (gas industries) and the insurer (insurance companies). Our empirical results indicate that various property damage risk factors embodied in gas refineries including fire, explosion, error and omission, and machinery breakdown are insurable risks. Risks of pressurized vessels defects are in safe category and can be tolerated by the industry owner. The policy implication of this paper for Iranian policy makers in the energy sector is that, gas refineries are insurable in the market with reasonable risk premium. Insuring gas refineries will definitely reduce capital losses which can otherwise be enormous for the economy in general and for oil and gas industries in particular.

“Our Defense is a Holy Defense!” - The Iran-Iraq War and its Legacy in Contemporary Iranian Factional Politics

Abstract The Iran-Iraq War is one of the most influential conflicts in the history of the modern Middle East. It is well-known that it has affected the geopolitics and security policies of regional powers such as Iran, Saudi Arabia, and the other Gulf States. However, the role of the war's legacy in domestic politics of these nations is significantly less understood. This paper analyzes public statements and newspaper editorials from prominent Iranian political figures to assess the different ways in which the Iran-Iraq War is understood in the Iranian domestic context, and to determine how it impacts political rhetoric in the Islamic Republic. The argument is made that Iranian policymakers hold similar views towards the war in regards to foreign policy, but differ significantly when discussing economic policy.

Prevalence and Socio-Demographic Characteristics Related to Stress, Anxiety, and Depression among Patients with Major Tha-lassemia in the Kermanshah County

Thalassemia is one of the most common chronic and genetic blood disorders in the world that can followed by several complications, such as mental disorders. The aim of this study was to determine the prevalence and socio-demographic characteristics associated with stress, anxiety and depression among patients with thalassemia major in Kermanshah during 2014. This cross-sectional study done among 64 patients with thalassemia major during 2014; in the participants were randomly selected among patients who referred to Mohammad Kermanshahi hospital in the Kermanshah County to take part in this study. A standard questionnaire (DASS-21) which analyzed stress, anxiety and depression was applied for collecting data and data were analyzed by SPSS version 20 using chi-square statistical tests. The mean age of respondents was 22.31 years [95% CI: 20.42, 24.21], ranged from 14 to 58 years. Findings showed the 60.9%, 59.4 % and 18.8 % of the respondents were suffering from extremely severe anxiety, depression, and stress, respectively. Furthermore, our findings showed marital status and job have significant relationship with anxiety (P<0.05); education level has significant relationship with depression (P<0.05). Our findings indicated high level of prevalence of mental disorder among patients with thalassemia major. These results can be warning to health policy makers in Iran; and should be the focus of special attention.

Diabetes Research in Iran: a Scientometric Analysis of Publications Output.

Introduction:In the developing countries, diabetes mellitus as a chronic diseases, have replaced infectious diseases as the main causes of morbidity and mortality. International Diabetes Federation (IDF) recently estimates 382 million people have diabetes globally and more than 34.6 million people in the Middle East Region and this number will increase to 67.9 million by 2035. The aim of this study was to analyze Iran’s research performance on diabetes in national and international context.Methods:This Scientometric analysis is based on the Iranian publication data in diabetes research retrieved from the Scopus citation database till the end of 2014. The string used to retrieve the data was developed using “diabetes” keyword in title, abstract and keywords, and finally Iran in the affiliation field was our main string.Results:Iran’s cumulative publication output in diabetes research consisted of 4425 papers from 1968 to 2014, with an average number of 96.2 papers per year and an annual average growth rate of 25.5%. Iran ranked 25th place with 4425 papers among top 25 countries with a global share of 0.72 %. Average of Iran’s publication output was 6.19 citations per paper. The average citation per paper for Iranian publications in diabetes research increased from 1.63 during 1968-1999 to 10.42 for 2014.Conclusions:Although diabetic population of Iran is increasing, number of diabetes research is not remarkable. International Diabetes Federation suggested increased funding for research in diabetes in Iran for cost-effective diabetes prevention and treatment. In addition to universal and comprehensive services for diabetes care and treatment provided by Iranian health care system, Iranian policy makers should invest more on diabetes research.

Iran's shift in family planning policies: concerns and challenges.

Iran's significant success in implementing Family Planning (FP) during the past 25 years, has made it a role model in the world. The Total Fertility Rate (TFR) in Iran has dropped from 6.5 in 1960 to 1.6 in 2012, which is well below the targeted value of 2.2 for the country. Iran's success story, however, did not merely root in the implementation of FP programs. In other words, families' strong tendency to limit fertility and delayed marriages had an undeniable role in decreasing the TFR. On the other hand, Iranian policy-makers are very concerned about such a decrease and have recently restricted access to contraception, while outlawing any surgery that reduces fertility. This paper, tries to highlight the pros and cons of such restrictive policies, and argue that the policy-makers might be jeopardizing the success of Iran's FP program by overestimating its role in the TFR reduction rate.

The Drug Reimbursement Decision-Making System in Iran

BackgroundPrevious studies of health policies in Iran have not focused exclusively on the drug reimbursement process. ObjectiveThe aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. MethodsReview of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. ResultsIran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. ConclusionsThe Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries.

Health transition in Iran toward chronic diseases based on results of Global Burden of Disease 2010.

Drawing on the results of the country-level Global Burden of Diseases, Injuries, and Risk Factors 2010 Study, we attempted to investigate the drivers of change in the healthcare system in terms of mortality and morbidity due to diseases, injuries, and risk factors for the two decades from 1990 to 2010. We decomposed trends in mortality, cause of death, years of life lost due to disability, disability-adjusted life years (DALYs), life expectancy, health-adjusted life expectancy, and risk factors into the contribution of total increase in population size, aging of the population, and changes in age-specific and sex-specific rates. We observed a decrease in age-specific mortality rate for both sexes, with a higher rate for women. The ranking of causes of death and their corresponding number of years of life lost remained unchanged between 1990 and 2010. However, the percentages of change indicate patterns of reduction for most causes, such as ischemic and hemorrhagic stroke, hypertensive heart disease, stomach cancer, lower respiratory infections, and congenital anomalies. The number of years lost due to disability caused by diabetes and drug use disorders has significantly increased in the last two decades. Major causes of DALYs, such as injuries, interpersonal violence, and suicide, showed increasing trends, while rates of communicable diseases, neonatal disorders, and nutritional deficiencies have declined significantly. Life expectancy and health-adjusted life expectancy increased for both sexes by approximately 7 years, with the highest rate of increase pertaining to females over the age 30. Time trend information presented in this paper can be used to evaluate problems and policies specific to medical conditions or risk factors. Despite recent improvements, implementing policies to reduce the number of deaths and years of life lost due to road traffic injury remains the highest priority for Iranian policymakers. Immediate action by Iranian researchers is required to match Iran's decreasing mortality rate due to liver and stomach cancers to a rate comparable to the global level. Prevention and treatment plans for mental disorders, such as major depressive disorder, anxiety disorder, and particularly drug use disorders, should be considered in reforms of the health, education, and judiciary systems in Iran.

Iran’s Policy towards Afghanistan

The fall of the Taliban in 2001 presented Iran with a complex strategic situation. On the one hand, the removal of the Taliban promised to open up new opportunities for Iran to expand its influence, based on historical and cultural ties between Iran and Afghanistan. On the other hand, the 2001 operation brought the United States (US) to the region. The large scale entrenchment of US troops on the eastern borders of Iran presented tangible security risks, dominating Iran’s strategic outlook. The closure of the US base in Uzbekistan and the planned withdrawal of US troops from Afghanistan have offered an opportunity to policy makers in Iran to recalibrate bilateral relations with Afghanistan. But the Iranian leadership appears too slow in readjusting its strategic outlook, keeping Iran’s policy towards Afghanistan hostage to its hostility towards the US.

Family physician program in Iran, patients satisfaction in a multicenter study.

Patient satisfaction is an integral component of service quality and obtaining feedback from patients about quality of primary healthcare is a powerful way to develop more patient-centered approaches to healthcare delivery. The aim of this study was to measure patients' satisfaction with family physician program in central provinces of Iran in the fall of 2010. A cross sectional survey was conducted at 60 medical centers with family physician services at central provinces of Iran. Patient satisfaction was measured by a standardized questionnaire with eight domains: personnel manner, time consumption, guidance and training, cost of services, service adequacy, capability and skills of personnel, adequacy of equipment and amenities. Student t test, Analysis of Variance (AVOVA) and Kruskal-Wallis test were used in data analysis. Overall, 76.03% of the respondents were satisfied with the whole performance of family physician program, 76.41% of the respondents were satisfied with the family physicians. The strongest domains of client satisfaction were the manner of staffs and adequacy of equipments. It was shown that high patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the program. A considerable proportion of patients are unsatisfied with guidance and training and adequacy of program services. Iranian policymakers can develop better programs based on comments from service recipients and promoting the project and some program processes.

Commitment to care: a qualitative study of intensive care nurses' perspectives of end‐of‐life care in an Islamic context

Currently, end-of-life care is a significant issue and a topic of debate in intensive care settings but understanding of nurses' perspectives about this within an Islamic context is surprisingly lacking. The purpose of this study was to explore intensive care nurses' perspectives of the end-of-life care in South-east of Iran. A descriptive qualitative research approach was used to engage 12 intensive care nurses from three intensive care units of teaching hospitals affiliated to Kerman University of Medical Science in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. Four major categories emerged from analysis of the interviews: commitment to care, awareness of dying patients, caring relationships, and dealing with barriers and ethical issues. The first category was emphasized and appeared dominant in all interviews. Because of specific socio-cultural and environmental factors, the findings of this study may not be applicable in other contexts, but enhance our knowledge about the topic in an Islamic context. This study emphasizes the importance of looking at the end-of-life care for critical terminally ill patients within the context of spiritual milieu associated with commitment to a compassionate care until the last moment of their life. Intensive nurses, faced with various barriers and ethical issues, instead were focused on physical and spiritual care and believed that it should fulfil their role in the challenging process. These findings indicate that there is a need for policies that help increase the quality of life of dying patients. It is imperative that nursing managers and policy makers in Iran consider these findings to improve end-of-life care in intensive setting. More training programmes, further education and research on the topic, should be implemented.

Social exchange outcomes of transformational leadership

PurposeThe purpose of this study is to investigate gender differences in transformational leadership and social exchange outcomes in public primary schools in Tehran, Iran.Design/methodology/approachA total number of 400 teachers and 77 principals completed questionnaires. Multivariate analysis of variance was performed to determine gender differences in transformational leadership dimensions including idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration. Also, multiple regression was used to identify the impact of dimensions on three social exchange outcomes including procedural justice, trust in principal, and organizational citizenship behaviors of teachers.FindingsResults showed that female principals as compared to male principals obtained significantly higher scores on transformational leadership dimensions and the greater amount of transformational behaviors displayed by them has accompanied with the greater prediction of social exchange outcomes.Research limitations/implicationsThis study suggests that there are some benefits associated with having female principals and schools could particularly benefit from developing principal training programs that focus on developing female principals qualities. Some following limitations could be avoided in future research: only relying on teacher rating of principal, possible effect of the teacher's gender on the relationship of transformational leadership with social exchange outcomes, and principal‐teacher gender mach limitation in rating principals.Originality/valueGiven the limited studies conducted on gender differences in transformational leadership and social exchange outcomes in schools and in Iran, this study provides empirical insights and extends this line of inquiry in public schools. This study confirms the results of previous studies which they have found females as more transformational than male counterparts and also provides new finding surrounding social exchange outcomes. These results could be influential in encouraging Iranian policy makers to further acknowledge women administration in public schools.

Oil and Methanol Price volatility

Crude oil as one of the main sources of energy is also the main source of income for members of OPEC. So, the volatility of crude oil price is one of the main economic variables in the world and analysis of the effect of its changes on key economic factors has been always considered as significant. The reason might be the high sensitivity of oil price to political, economic and cultural issues worldwide and consequently its volatility on the one hand, and the high influence of the volatile prices on macroeconomic variables. On the other hand, for different reasons such as oil price volatilities and income from oil export, economic planners and policy makers in Iran have been mainly focused on the promotion of non-oil exports especially during the last few decades. Therefore, methanol as one of the most commonly used petrochemical products has a high potential for production and export of non-oil products in Iran. For this reason, in the present study there was an attempt to examine the relationship between the prices of Iran’s crude oil and methanol using FIGARCH model and based on the weekly time series data related to the research variables. The results of the study showed that the long memory parameter is equal to 0.32 which is meaning the shocks caused by volatility of methanol market and crude oil price to the methanol price were lasting and meaningful and were revealed in the long term.