Iranian Social Security Organization Research Articles

Design and Implementation of a Web-Based Self-Care Application for Patients with Kidney Stone Treated with Extracorporeal Shock Wave Lithotripsy

Background: The prevalence of kidney stones reduces the patients’ quality of life and imposes high costs on patients and health care system. Extracorporeal shock wave lithotripsy is a safe procedure to treat urinary stones. Appropriate strategies such as self-care programs can effectively reduce the prevalence and recurrence of this disease, and increase quality of life, save costs, and prevent diseases by increasing patient participation. The aim of this study is to design and implement a web-based self-care application for patients with kidney stones undergoing extracorporeal shock wave lithotripsy. Methods: This paper is an applied study and was performed in Sabalan Hospital in Ardabil affiliated to the Social Security Organization of Iran in three stages including needs assessment, design and evaluation. For needs assessment and application design, a questionnaire was designed by searching library resources. The questionnaire was completed by clinical specialists and specialists in health information management and information technology. Then, based on the approved information elements and capabilities, a web-based self-care application was designed. The usability of the designed program was evaluated with the participation of 20 users. Results: The results of the survey showed that the experts confirmed all the identified items and components, and considered them necessary. Users rated the usability of the self-care program at a good level with an average score of 7.9 out of 9. Conclusion: The usability of the self-care application was satisfactory to users in various areas of overall application performance, screen, terminology and information, learning and general impressions.

Evaluating the Impacts of Retirement Age Reform on Financial Status of the Iranian Social Security Organization Using a Dynamic Microsimulation Model

Evaluating the Impacts of Retirement Age Reform on Financial Status of the Iranian Social Security Organization Using a Dynamic Microsimulation Model

Information Requirements of a Self-Care Application for Patients with Kidney Stones Undergoing Extracorporeal Shock Wave Lithotripsy

Introduction: Kidney stones and its treatment, control of possible complications after lithotripsy and prevention of kidney stones recurrence, are the most substantial concerns of patients and physicians. Nowadays, the high capabilities of mobile technologies have become especially important for the prevention and control of diseases and patients' self-care. Use of mobile technologies, applications and smart tools can be a good way to prevent and control kidney stones. The present study was designed to identify the data requirements to design a self-care application for patients with kidney stones undergoing extracorporeal lithotripsy.Material and Methods: This paper is a descriptive study and was performed in Sabalan Hospital in Ardabil affiliated to the Social Security Organization of Iran. A needs assessment questionnaire was designed by reviewing the scientific sources, databases, guidelines and medical records of patients. Ten clinical and technical specialists surveyed the questionnaire.Results: Four main characteristics of demographic data, clinical data, disease monitoring and application capabilities were identified. Familiarity with kidney stone disease, familiarity with treatment methods, familiarity with diet, reminders, interaction with the treating physician were the most important capabilities identified for the application.Conclusion: The findings of the survey showed that all identified items and components scored above average. The identified components were approved by experts and considered necessary.

Developing an Internal Control Model for the Social Security Organization of Iran with a Risk Management Approach

Developing an Internal Control Model for the Social Security Organization of Iran with a Risk Management Approach

Designing A National Model of Medical Facilities Fair Distribution for Iranian Social Security Organization

Background: Fair Distribution of Medical Facilities is one of the most critical issues affecting economic and health indicators. Due to the significant role of ISSO in meeting the medical needs and its high coverage (almost 42%) in Iran, we aimed to identify the factors influencing medical facilities' fair distribution in the ISSO. Materials and Methods: This applied study was conducted as a descriptive study in the ISSO in 2018. Variables affecting medical facilities distribution were elicited from the literature review and through an interview with 16 experts who were occupied in the healthcare management field. Then, a Likert scale-based questionnaire with 56 items in 7 sections was developed. Questionnaires were distributed among 456 person received questionnaires, and 415 responded to all questions. All participants were experts in the healthcare section of the ISSO all over the country. Data were analyzed via exploratory and confirmatory factor analysis and structural equations using SPSS 23 and AMOS-24 software. Results: By exploratory and confirmatory factor analysis, seven main factors (demographic factors, geographical factors, functional factors, structural factors, humanistic factors, economic factors, and Contract parties factors) were identified as critical factors affecting medical facilities distribution. Each aspect included many components. AMOS software showed the significance of variables by P-value and critical ratio (CR) indices to analyze the conceptual model of the research. Function factors with standard coefficients of 0.85 had the most, and economic factors with a standard coefficient of 0.53 had a minor effect on the distribution of medical facilities in the ISSO. Conclusion: To have a more efficient medical facilities distribution in the ISSO must consider all identified factors, special attention should be given to the maximum use of available medical facilities. Furthermore, more attention should be paid to distributing human resources, finance, and medical equipment.

Designing A National Model of Medical Facilities Fair Distribution for Iranian Social Security Organization: Design National Model of Medical Facilities Fair Distribution in the ISSO.

Background: Fair Distribution of Medical Facilities is one of the most critical issues affecting economic and health indicators. Iranian Social Security Organization (ISSO) is a non-governmental organization responsible for providing medical services to insured individuals in 77 hospitals, 265 polyclinics, and clinics that has faced much demand from the insured to build a new medical center. So, Due to the significant role of ISSO in meeting the medical needs and its high coverage (almost 42%) in Iran, we aimed to identify the factors influencing medical facilities' fair distribution in the ISSO. Materials and Methods: This applied study was conducted as a descriptive study in the ISSO in 2018. Variables affecting medical facilities distribution were elicited from the literature review and through an interview with 16 experts who were occupied in the healthcare management field. Then, a Likert scale-based questionnaire with 56 items in 7 sections was developed. Questionnaires were distributed among 456 person received questionnaires, and 415 responded to all questions. All participants were experts in the healthcare section of the ISSO all over the country. Data were analyzed via exploratory and confirmatory factor analysis and structural equations using SPSS 23 and AMOS-24 software. Results: By exploratory and confirmatory factor analysis, seven main factors (demographic factors, geographical factors, functional factors, structural factors, humanistic factors, economic factors, and Contract parties factors) were identified as critical factors affecting medical facilities distribution. Each aspect included many components. AMOS software showed the significance of variables by P-value and critical ratio (CR) indices to analyze the conceptual model of the research. Function factors with standard coefficients of 0.85 had the most, and economic factors with a standard coefficient of 0.53 had a minor effect on the distribution of medical facilities in the ISSO. Conclusion: To have a more efficient medical facilities distribution in the ISSO must consider all identified factors, special attention should be given to the maximum use of available medical facilities. Furthermore, more attention should be paid to distributing human resources, finance, and medical equipment.

Designing a Model for Providing Virtual Education in the Social Security Organization of Iran Based on Grounded Theory

هدف: با توجه بهشرایط جامعه و شیوع بیماری کرونا، تحول در ارایه آموزش، آگاهی و آشنایی مسئولین با مفاهیم، نگرشها و رویکردهای آموزش‌های مجازی در سازمان برای دستیابی به اهداف، پاسخ گویی به مشکلات و استقرار یک نظام آموزشی مجازی کارآمد ضروری به نظر می‌رسد. هدف اصلی پژوهش، ارائه مدل آموزش‌های مجازی و نتایج آن بر عایدی سازمان و ادبیات این حوزه میباشد.روش:به لحاظ هدف، کاربردی و با استفاده از نظریه داده‌ بنیاد به‌صورت کیفی و نمونه‌گیری به روش نظری و با بهره‌مندی از تکنیک‌های هدفمند و گلولة برفی، که بر مبنای آن تا اشباع نظری داده‌ها، مصاحبه با خبرگان سازمان که در این حوزة، تجربه و تخصص داشتند انجام گرفت.یافته‌ها: نتایج تحلیل داده‌های به‌دست‌آمده از طی فرایند کدگذاری، به ایجاد نظریة داده -‌بنیاد در حوزة آموزش‌های مجازی منجر و مدل طراحی‌شده شامل شرایط علی، زمینه‌ای، واسطه‌ای، عناصر تشکیل ‌دهنده است که پدیدۀ محوری، پیامدها و راهبردهای اجرای خط‌مشی‌ عمومی را نشان می‎دهد.نتیجه‌گیری: نتایج این پژوهش می‌تواند در کارآمدی بیشتر آموزش‌های مجازی در سازمان از سوی کارگزاران مورد بهره برداری قرار گیرد.

Factors Affecting Hospital Network Management in the Social Security Organization of Iran

Background: Hospitals are considered the most important consumer units in the health system. Based on the effect of the hospital network in optimal and efficient hospital management, this study aimed to identify and explain the role of factors influencing hospital network management in the Iranian Social Security Organization (ISSO). Methods: This study was conducted by a mixed method in 2018. First, variables and factors affecting the management of hospital networks were extracted from the literature review and through interviews with 15 experts, and a questionnaire with 40 questions was developed. Then, it was distributed among 448 experts in the healthcare section of the ISSO all over the country, and 405 questionnaires were completed and collected. Data were analyzed via exploratory and confirmatory factor analysis and structural equations using SPSS23 software and AMOS24 software. The validity of the questionnaire was determined via expert judgment (CVRs = 0.40) and reliability was estimated by Cronbach's alpha coefficient (α = 0.87). Results: Based on the confirmatory factor analysis, financing, monitoring and evaluation, accountability, strategic planning, and decision rights were identified as key factors affecting hospital network management. Financing with standard coefficients of 0.83 had the highest and decision rights with standard coefficients of 0.44 had the lowest effect on hospital network management of the ISSO. Conclusion: To efficient hospital network management of the ISSO, while emphasizing all identified factors, special attention should be paid to financing and modifying the method of budgeting and using suitable monitoring and evaluation mechanisms.

Managmante Of Compilation and Explanation of The Strategic Sports Plan of The Social Security Organization of Iran

Managmante Of Compilation and Explanation of The Strategic Sports Plan of The Social Security Organization of Iran

Identifying and Prioritizing Strategies for Developing Medical Tourism in the Social Security Organization of Iran: A SWOT-AHP Hybrid Approach.

Background:The present study aimed to identify and prioritize strategies for medical tourism improvement in the Social Security Organization (SSO) of Iran.Methods:Using Delphi method in the first step, we identify strengths, weaknesses, opportunities and threats that Social Security Organization of Iran faces in medical tourism during 2017–2018. In the second step we interviewed 100 medical and tourism experts to identify proper strategies using SWOT method and finally priori-tize strategies through the Analytic Hierarchy Process (AHP) by using Expert Choice software.Results:The application of SWOT technique indicated that the dominant strategy for the Iranian SSO should be conservative. It should overcome its internal weaknesses and exploit its external opportunities. The Iranian Social Security Organization should arrange appropriate marketing in target countries, invest in international medical/hospital standards, boost the communicative competence of personnel in SSO hospitals and create multilingual web-based information to introduce the capabilities and costs of the hospitals.Conclusion:Since the SSO’s weaknesses are more prominent than its strengths, thus SSO should plan to reduce its weaknesses to boost medical tourism. For this purpose, SSO should design coherent plans for attract medical tourists to the organization’s hospitals, attempt to upgrade hospital and medical centers standards, train the medical staff regarding linguistic and communicative skills, and run a user-friendly website to introduce its medical capabilities.

Demographic Characteristics, Clinical Symptoms, and Radiological Features in Patients With COVID-19 in Iran

Background: Considering the new Coronavirus outbreak and limited data about this pandemic in Iran, this study aimed at assessing the demographic characteristics, clinical symptoms, paraclinical findings, and radiological features of hospitalized patients with COVID-19 according to their hospital records. Methods: In this descriptive-cross-sectional study, the required data were collected from the Health Information System (HIS) and the records of the patients who had been hospitalized following positive COVID-19 Polymerase Chain Reaction (PCR) and lung Computed Tomography (CT) scans, in some hospitals of Markazi Province, Iran from February 20, 2020, to April 20, 2020. The selected hospitals were affiliated with the Iranian Social Security Organization. Clinical follow-up was continued until April 26, 2020. During this period, 260 records were assessed. The collected data included demographic characteristics, clinical symptoms, as well as the paraclinical findings and radiological features of the patients. The obtained data were analyzed by SPSS. Results: Among 260 confirmed cases of COVID-19, 161 (61.9%) cases were men and 99 (38.1%) were women. The Mean±SD age of the explored patients was 58.78±16.44 years. Besides, 221 (85%) patients were hospitalized in the general ward and 39 (15%) cases in the Intensive Care Unit (ICU). Hypertension and diabetes were the most prevalent medical histories (comorbidities). Fever, fatigue, cough, anorexia, myalgia, dyspnea, oliguria, taste impairment, and smell deficiency were the most frequent clinical symptoms. Neutrophilia, lymphopenia, low blood glucose level, and increased BUN, ALP, CRP, and ESR were among the critical laboratory findings. Almost 30% of the studied patients presented acidosis in arterial blood gases analysis and 55% had normal blood gasses. Decreased PaO2 was observed in 80% of the investigated patients. Most of the patients had received oxygen therapy, lopinavir, and hydroxychloroquine. Additionally, 11.2% of the patients were under invasive mechanical ventilators. Concerning the lung CT scan, 42.7% of the patients had ≥5 involved lobes. In terms of density, 51.9% of the subjects had mixed opacity. Most lung damages (41.5%) were in the central part of the lungs. In 55.8% of cases, these damages were patchy lesions, and 40% had an air-bronchogram. According to the Chi-squared test data, there was a significant relationship between the location of the lesions and the patient’s need for suction (P<0.001). Besides, patients with central lung lesions required the highest percentage of suction (26%). In this study, 15% of the explored patients were hospitalized in the ICU, 84% were discharged by April 26, and 8.07% died. Conclusion: The current research results provide the health team with beneficial information about the assessment and care of patients with COVID-19 and the prediction of treatment outcomes.

Conceptualization of a multi-level social responsibility model in the public sector

PurposeThe term “social responsibility” bears different meanings among nations. Most studies on corporate social responsibility are conducted in Western countries, and literature shows a dearth of scientific research on the subject in developing countries. Meanwhile, the public sector, with its essential role in national development and social welfare, has been the focus of limited studies on social responsibility. In Iran, as a developing country, the concept of social responsibility has not yet found its rightful place inside organizations and companies. Therefore, the purpose of this paper is to design a multi-level social responsibility model in the Iranian Social Security Organization (SSO), the largest public organization in the country.Design/methodology/approachIn this paper, the thematic analysis was used along with interpretive structural modeling (ISM) to design a multi-level social responsibility model in a specific context. It was a field survey with 20 open interviews. The direct relationships between variables of different levels, identified via thematic analysis and ISM, were investigated in a study population of 510 SSO stakeholders using structural equation modeling (SEM).FindingsIn the designed model, service improvement and optional and voluntary activities variables were identified in the first level; economic and financial activities in the second level; political activities and education and research variables in the third level; and finally, laws and regulations, organizational components and organizational culture variables were identified in the fourth level. The results of SEM revealed the direct influence of all lower-level variables on their higher level counterparts, except the influence of laws and regulations on political activities. Based on the results, organizational components had direct effects on education and research (ß = 0.630), and political activities (ß = 0.341), the variable of organizational culture affected education and research (ß = 0.176) and political activities (ß = 0.613), the variable of political activities affected economic and financial activities (ß = 0.633), the variable of education and research affected economic and financial activities (ß = 0.381), the variable of economic and financial activities affected service improvement (ß = 0.925) and optional and voluntarily activities (ß = 0.877) and the variable of laws and regulations affected education and research (ß = 0.151).Practical implicationsThe research results showed that social responsibility was a dynamic and context-based phenomenon, which should be used in accordance with the Iranian organizations and national conditions. According to the results, a qualitative research plan can give new insights into social responsibility through the phenomenological constructivism approach. Policymakers could perceive the subject better and take more effective actions by identifying the activities of social responsibility at the Iranian SSO from the perspective of key stakeholders and analyzing the interplay between them.Originality/valueThis model is the first designed and developed at the Iranian SSO by considering the expectations of major stakeholders affecting the SSO. Another advantage of this model is the use of qualitative approaches in model development, which increased integrity of the proposed model. Dimensions of the model showed the main bottlenecks hindering the realization of SSO responsibilities. Finally, this study recommends to the empirical researchers of social responsibility to consider the institutionalized conditions of every society in their work.

Designing an E-Health Management Framework for Social Security Organization of Iran

Introduction: In Iran, almost half of the population receive health benefits from social security organization (SSO) that reveals the necessity of proper planning and management. As a relatively recent practice, e-health is widely using to facilitate achieving the managerial goals of healthcare organizations. The current study aimed to design an e-health management framework for SSO of the I.R. Iran. Method: This is an applied study that was carried out using descriptive-analytical methods. Based on the results of recent studies and available reports (both national and international), a conceptual model and a researcher-made questionnaire were developed. After confirming the reliability and validity of the questionnaire, it was filled out by 557 of high and medium level managers of the SSO. Simultaneously, e-health strategies of the following countries were comparatively evaluated: Turkey, India, the UK, Estonia, Sweden, and Pakistan. Exploratory and confirmatory factor analyses were used to analyze the data. Results: The Kaiser-Meyer-Elkin and Bartlett tests indicated the sufficiency of the sample size and correlation between items of the questionnaire. Varimax Rotation showed that for five factors the special value was higher than one (indicates items of this instrument are loaded on these five factors). 23% of the variance was accounted for in the first principal component, 15% on the second, 14% on the third, 11% on the forth, 9% on the fifth (72.47% of the variance in total). Comparative indexes and the Tucker-Lewis index are accepted in the range greater than 0.9. The root-mean-square deviation and residual of mean-square error should be less than 0.80. These conditions were true in the present study, but RMSD was higher at about 0.009. Besides, the lower the Akaike the better the fitness of the model. Which the model with five factors had the lowest Akaike. The final model consisted of 20 (out of 22) items. Conclusion: Based on the results and included items, 20 items had a significant association with related factors. Therefore, the developed framework can be used for the SSO. Future studies are needed to evaluate and monitor this framework.

Presenting a Desirable Model of Social Security Organization Management in Light of Its Administrative and Financial Independence in Iran

The Social Security Organization of Iran is the country's largest social insurance fund. It has been discussed from the beginning by examining the issue of social security, the way in which the social security is run, the assignment of the principal trustee and its administrative and financial independence. Therefore, one of the main objectives of the present study is how to manage a social security organization, providing a desirable model of social security organization. In addition, while investigating the nature of social security institutions and the need for administrative and financial independence of the social security organization, we present the characteristics of a desirable social security model. The research technique or method of collecting information in this research is libraries (both documents and books) meaning that the information required for this research is collected from books, articles and documents available in reputable libraries and sites. (External sources are also used, apart from existing sources) and then the information has been processed and analyzed in a descriptive-analytical manner. The results of the study show that The Social security in the legal form of nongovernmental organization and as the representative of the government is a trustee to manage the social security affairs. One of the features of this legal framework is that it is one of the public law entities on the one hand and has administrative-financial independence and legal personality independent of the government. And on the basis of its financial administrative autonomy, the Council must lay down rules on how to administer and perform the duties of the within the framework of the law. And sovereignty requires oversight by the government (the triple powers) of this entity. Regarding the privatization of social security, it must be acknowledged that despite the general policies of the Islamic Republic of Iran on privatization and with considering the many benefits that come with this discussion, it seems that regarding the identity of Social Security as a nongovernmental organization and its financial administrative independence, and by maintaining the organization's true position and assisting the private sector in its executive functions, one can expect to fulfill this task of government sovereignty with greater quality and quantity; today, Iran's social security system has entered the stage of organizational evolution and moving towards improving its current status and achieving administrative and financial independence, but this system, like all human-designed systems, has some shortcomings that need to be addressed

The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian social security organization.

The present study was conducted to determine the relation between nurses’ moral distress and the ethical climate in selected hospitals of the Iranian Social Security Organization (ISSO). This descriptive-analytical correlational study was conducted in 6 hospitals under the coverage of the Iranian Social Security Organization in 2016. Three hundred nurses were selected by convenience sampling method. Data were gathered using Corley’s Standard Moral Distress and Olson’s Hospital Ethical Climate Scales. Data were analyzed using SPSS software version 19.The mean score of the nurses’ moral distress was 1.94 ± 0.66, which is considered moderate. The mean score of ethical climate was 88.97, indicating desirable ethical climate in these hospitals. The frequency score of moral distress had a unilateral reverse correlation with the total score of ethical climate as well as its dimensions, including colleagues, patients, hospitals and physicians. The score of the intensity of nurses’ moral distress also had a unilateral reverse correlation with the total score of ethical climate and the scores of the hospital and physicians dimensions.These results emphasized the importance of creating a positive ethical climate to decrease moral distress as well as the need for professional interventions to increase support in moral issues.

Occupational Accidents in Iran: Risk Factors and Long Term Trend (2007-2016).

Although much is known about the distribution of occupational accidents in the world, less is known about occupational injuries in developing countries. Therefore, the aim of this study was to investigate the trend of occupational accidents during 10 years (2007-2016) and to find factors affecting the accident outcome. A cross-sectional study. This study was done based on the data gathered by the Iranian Social Security Organization (ISSO), including demographic data (age, sex, marital status) and occupational accident characteristics (accident sector, cause, type, body part, location, time, month, and incident outcome). A decreasing pattern of occupational accidents was found from 2.95 per 1000 workers in 2007 to 1.46 per 1000 workers in 2016. The mean age of injured workers was 32.97 years. The most common cause and type of accidents were incaution and lack of attention and collision, and trapping, respectively. Limbs were the most affected body parts, and less than 1% of occupational accidents resulted in death. The highest incident was seen in the industrial sector during all years. More severe accident outcomes were seen at older ages and in the male gender, married subjects, winter season, agriculture sector, and outside of work place. These results provide a basis for further investigations regarding data collection and accident causes. Modification of some associated factors and implementation of safety prevention programs would be useful in reducing occupational accidents in Iran.

Effect of Saffron with or Without Date Sugar on Intensity of Pain and Anxiety During Labor in Primiparous Females: A Randomized, Controlled Trial

Background: Reduction of pain and anxiety during labor is necessary to prevent some of the maternal and fetal complications, as well as request for cesarean section. There is limited evidence assessing the effects of saffron and dates on intensity of pain and anxiety. Objectives: The current study aimed at examining the effect of saffron with or without dates on the intensity of pain and anxiety during transitional and active phases of labor in primiparous females. Methods: In the current superiority trial, 96 primiparous females admitted to a hospital covered by the iranian social security organization in Tabriz, Iran, at the onset of active phase of labor were recruited using convenience sampling method from 10 January to 21 October 2016. They were randomly divided into three equal groups using block randomization; receiving 80 mL oral syrup of saffron (250 mg) plus date juice (65 g), saffron (250 mg) plus artificial sugar (165 mg sodium saccharin and 420 mg sodium carboxymethyl cellulose), or placebo every two hours for maximum three doses (240 mL). Intensity of pain and anxiety were assessed using 0-10 visual analogue scale every one hour. Results: Compared with the placebo, mean scores of both pain and anxiety were lower in the intervention groups. The differences were statistically significant at the saffron plus date juice group (adjusted mean difference: -0.8 (95% confidence interval (CI): -1.5 to 0.0), P = 0.022 and -1.3 (95% CI: -2.4 to -0.2), P = 0.012, respectively), but were not significant at the saffron plus artificial sugar group (-0.5 (95% CI: -1.2 to 0.2), P = 0.322 and -1.1 (95% CI: -2.2 to 0.0), P = 0.058, respectively). The differences between the two intervention groups were not statistically significant (-0.3 (95% CI: -1.0 to 0.4), P = 0.557 and -0.2 (95% CI: -1.3 to 0.8), P = 0.927, respectively). One woman from saffron plus date juice, three from saffron plus artificial sugar, and four from the placebo groups had emergency cesarean section. Conclusions: The current study results show that the oral syrup of saffron plus date juice could be used to reduce the intensity of pain and anxiety during labor in primiparous females. However, the results are inconclusive for the effects of saffron plus artificial sugar.

Epidemiology of work-related injuries among insured construction workers in Iran.

Background and aimWork-related injuries are among the most important health problems in developing countries, such as Iran. The purpose of this study was to determine the epidemiology of work-related injuries among construction workers who had been insured by the Iranian Social Security Organization (ISSO).MethodsThis is a cross-sectional study. The population included all construction workers who had a work- related accident during 2012 in Iran, which were recorded in the ISSO database after inspection. The effects of independent variables on injuries were estimated by logistic regression. SPSS software version 18 was used for analyzing the data.ResultsOverall, 5352 work-related injuries were investigated. The incidence rate of fatal and nonfatal injuries was 0.07 in 1000 and 11.18 in 1000 workers, respectively. More than half of these accidents were due to careless activities. A younger age at the time of the accident (OR=0.98, CI: 0.97–0.99, p=0.001), being married (OR=1.37, CI: 1.04–1.79, p=0.02), place of accident (OR=1.86, CI: 1.18–2.92, p=0.007), lack of information (OR=5.28, CI: 1.57–17.75, p=0.007), disrespect of safety regulations (OR=3.11, CI: 1.87–5.17, p=0.001), non-use of protective equipment (OR=2.98, CI: 1.62–5.50, p=0.001), and defective equipment (OR=2.22, CI: 1.18–4.20, p=0.01) had a significant effect on the incidence of work-related injury.ConclusionsThe pattern of work-related injury in Iran was almost similar in regard to age, gender, cause and type of the accident, with other parts of the world.

Empirical Bayesian Geographical Mapping of Occupational Accidents among Iranian Workers.

Work-related accidents are believed to be a serious preventable cause of mortality and disability worldwide. This study aimed to provide Bayesian geographical maps of occupational injury rates among workers insured by the Iranian Social Security Organization. The participants included all insured workers in the Iranian Social Security Organization database in 2012. One of the applications of the Bayesian approach called the Poisson-Gamma model was applied to estimate the relative risk of occupational accidents. Data analysis and mapping were performed using R 3.0.3, Open-Bugs 3.2.3 rev 1012 and ArcMap9.3. The majority of all 21,484 investigated occupational injury victims were male (98.3%) including 16,443 (76.5%) single workers aged 20 - 29 years. The accidents were more frequent in basic metal, electric, and non-electric machining jobs. About 0.4% (96) of work-related accidents led to death, 2.2% (457) led to disability (partial and total), 4.6% (980) led to fixed compensation, and 92.8% (19,951) of the injured victims recovered completely. The geographical maps of estimated relative risk of occupational accidents were also provided. The results showed that the highest estimations pertained to provinces which were mostly located along mountain chains, some of which are categorized as deprived provinces in Iran. The study revealed the need for further investigation of the role of economic and climatic factors in high risk areas. The application of geographical mapping together with statistical approaches can provide more accurate tools for policy makers to make better decisions in order to prevent and reduce the risks and adverse outcomes of work-related accidents.

Estimation of Production Function of Direct Health Care Services Delivered by Iranian Social Security Organization

Background and Objectives: Social Security Organization (SSO) is the second largest organization to the Ministry of Health and Medical Education (MOHME) in providing health care services in Iran. In recent years the gap between the SSO’s resources and expenditures has shown an unprecedented growing trend due to the rapidly increasing demand. Continuation of this trend may lead to financial imbalance in the following years, which would negatively impact access of public to health care services. This study, thus, seeks to explore factors affecting the efficiency of SSO’s health care services in quest for solutions to alleviate the potentially critical situation ahead. Methods: A microeconomic analysis was carried out by Panel SFA method. Cobb-Douglas production function was estimated based on Maximum Likelihood Estimation (MLE), using seven-year panel data derived from the yearbooks of SSO (2008-2015). The annual admission rate was selected as the output variable and it was assumed to be a function the number of physicians, nurses, active beds, paraclinical and other staff, and the bed restoration interval. Calculation was carried out using Frontier Version 4.1 Software. Findings: Significant elasticity coefficient of 0.835, 0.073, 0.0273, -0.199 was obtained for active beds, physicians, nurses, and bed restoration interval respectively. The marginal production of inputs was calculated to be 79.14, 9.48, and 1.73 for active beds, physicians and nurses, respectively. The marginal rate of technical substitution (MRTS) was identified to be 0.18 for nurse-physician, 0.02 for nurse-bed, and 0.12 for physician-bed substitution. The η and were calculated to be 0.015 and 0.581, respectively. Conclusions: Our results clearly shows that the production (annual patient admission rate) in SSO’s hospital is capital intensive being highly dependent on number of active beds with increasing return to scale. The inefficiency has only marginally decreased over time, yet there is room to improve production by increasing efficiency. The MRTS for nurse-physician substitution suggests that the escalating burden of physicians’ wage may be reduced by employing nurses in the services they can deliver instead of physicians. The negative contribution of bed restoration interval to production highlights the challenging nature of quality improvement by increased ALS, which is currently low in SSO’s hospitals. The problem of inconsistency between quality services and high production, thus, persists pointing to the need for in-depth reform in the structure of health care delivery.