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Showing 32 results for Policymaker

Sara Mortaz Hejri, Mohammad Jalili,
Volume 28, Issue 1 (1-2014)

  The process of determining the minimum pass level to separate the competent students from those who do not perform well enough is called standard setting. A large number of methods are widely used to set cut-scores for both written and clinical examinations. There are some challenging issues pertaining to any standard setting procedure. Ignoring these concerns would result in a large dispute regarding the credibility and defensibility of the method. The goal of this review is to provide a basic understanding of the key concepts and challenges in standard setting and to suggest some recommendations to overcome the challenging issues for educators and policymakers who are dealing with decision-making in this field.


Sara Razmjou, Hamid Reza Baradaran, Jalil Kouhpayehzadeh, Kamran Soltani-Arabshahi,
Volume 29, Issue 1 (1-2015)

Background: Clinical supervision is an important factor in the development of competency in residency program. Attending physicians play a key role in supervision of residents. However little is known about how attending physicians and residents perceive the quality of clinical supervision. The aim of this study was to explore the differences between perceived qualities of supervision in these two groups in different wards in teaching hospitals in Tehran, Iran.

  Methods: A valid questionnaire were completed by 219 attending physicians  and residents from surgery, psychiatry, gynecology, pediatrics, internal medicine, orthopedics and radiology wards in two teaching hospital affiliated to Iran University of Medical Sciences. This questionnaire contained 15 items in regards to supervisory roles, rated on a five point Likert scale (1=never, 2=seldom, 3=sometimes, 4=often, 5=always).

  Results: Out of 219 participants, 90 (41%) were attending physicians and 129 (59%) were residents. The overall mean±SD scores of perceived clinical supervision achieved by attending physicians and residents were respectively, 4.20±0.5 and 3.00±0.7 which was statistically significant (p<0.05). Attending physicians and residents acquired minimum scores (mean=4.06 and 2.7, respectively) regarding expectation from their supervisor to know and do during training period of residency.

  Conclusion: It seems that the clinical supervisory does not have an efficient performance in teaching hospitals which needs to be more assessed and improved. Therefore it is suggested that policymakers in medical education system pay more attention to this important issue and enhance some faculty development programs for clinical educators in Iran
Abdolhalim Rajabi, Najmeh Maharlouei, Abbas Rezaianzadeh, Abdolreza Rajaeefard, Ali Gholami,
Volume 29, Issue 1 (1-2015)

Background: Iran has a high C-section rate (40.6% in 2005). The objective of this study was to assess the associations and population-attributable risks (PAR) of risk factors combinations and C-section in the Southwest Iran.

Methods: We performed a population-based cohort study using the reports provided by Shiraz University of Medical Sciences. The cohort included pregnant women within September 2012 and February 2013 (n=4229), with follow-up until delivery. Then, the actual delivery was recorded i.e., C-section delivery, vaginal delivery, and miscarriage. A multiple logistic regression model was used to estimate the point and the interval probability. The adjusted population attributable risks (aPARs) were calculated through adjusted odds ratio from the final multiple logistic regression models for each variable.

Results: Of 4,217 deliveries, 2,624 ones were C-section (62.2%). The rate of C-section was significantly higher in healthcare departments of private clinics compared to governmental clinics. The rate increased steadily with the mother’s age, marriage age, family income and education. The multiple logistic regression analysis showed that local healthcare, supplementary insurance, maternal age, age of marriage, place of birth, family income, maternal education, education of husband and occupation were the key contributing factors to choose the mode of delivery. The multiple logistic regression analysis for reproductive factors showed that parity, previous abortion and stillbirth, previous infertility, birth weight (g) and number of live births were selected risk factors for C-section. Among the exposures, family income, location of healthcare and place of birth showed the highest population attributable risks: 43.86%, 19.2% and 18.53% respectively.

Conclusion: In this survey, a relatively large contribution of non-medical factors was identified against the background of C-section. All of these factors influence the knowledge, attitudes and norms of the society. Thus, the attention of policymakers should be drawn to the factors associated with this mode of delivery.

Reza Tabrizi, Farzaneh Zolala, Maryam Nasirian, Mohammad Reza Baneshi, Abbas Etminan, Eghbal Sekhavati, Mahmoud Khodadost, Ali Akbar Haghdoost,
Volume 30, Issue 1 (1-2016)

Background: Chronic kidney disease is asymptomatic until its last stages and though it is increasing globally, we are faced with paucity of a population-based model to assess this disease, particularly in developing countries. Therefore, the aim of this study was to estimate the prevalence and trends of CKD according to a new estimation method.

  Methods: Using multiplier method, we estimated the numbers of different stages of CKD based on the number of patients with end stage renal failure from 2006 to 2016. The required multipliers were extracted from a simulation of the disease in Kerman following a dynamic model. The 95% uncertainty interval was computed using Monte-Carlo technique with 10,000 iterations.

  Results: The prevalence of CKDA (GFR<=90mL/min/1.73m2) and CKDB (GFR less than 60mL/min/1.73m2) patients were estimated to be 7.6% (95% uncertainty interval (UI), 5.7-9.1%) and 1.1% (95% UI, 0.8-1.3%), respectively in 2011. The method revealed that the prevalence may rise up to 25.7% (95% UI, 18.2-32.5%) and 3.7% (95% UI, 2.7-4.5%) for CKDA and CKDB, respectively in 2016, indicating approximately 3.3 times increase for both figures.

  Conclusion: This study predicted an increase in the prevalence of CKD in the future. This may be due to the increasing life expectancy of the population, the increase in the prevalence of non- communicable diseases such as hypertension and diabetes, or patients’ survival due to receiving better support. Therefore, the policymakers should be concerned and well informed about this increase. 

Farideh Mohtasham, Bahareh Yazdizadeh, Zahra Zali, Reza Majdzadeh, Sima Nedjat,
Volume 30, Issue 1 (1-2016)

Background: Health technology assessment (HTA) is a tool utilized for efficient dissemination of technology. For the purpose of encouraging decision-makers to utilize this tool, at first, we need to identify the obstacles in the processes of preparation, utilization, and implementation of HTAs. This study aims to define these barriers and offer solutions for effective utilization of HTA reports produced in Iran.

  Methods: This qualitative content analysis determines the various beneficiaries of HTA, and utilizes a semi-structured interview with the participants who are all involved in the HTA.

  Results: Nine out of ten people invited for the interviews accepted the researchers’ invitation. An analysis of barriers and solutions for improving the utilization of HTA reports was conducted in three levels of policy makers (policy level), specialists in healthcare (professional level), and ordinary people (public level). The barriers in the policy level include unsuitability of reports for their audience, incompatible views toward the definition and necessity of health technology assessment, lack of financial resources for report preparation, and limitations in large-scale policymaking in Ministry of Health. Barriers in the professional level include lack of knowledge on HTA among service-providers. Barriers in the public level consist of information asymmetry.

  Conclusion: There are various barriers toward accurate utilization of HTAs in Iran. Thus, a systematic approach which involves people, brings about culture, improves infrastructures, and boosts supervision on the performance is recommended.

Koorosh Etemad, Parvin Ebrahimi, Hassan Azimi, Mansoureh Lotfi, Marzieh Nojomi,
Volume 30, Issue 1 (1-2016)

Background: Media advertisements especially radio and TV are one of the most important and effective ways for health promotion and consumption of healthy productions worldwide. Ministry of Health and some other ministries in Iran agreed to control and restrict the advertising of unhealthy products and services. Therefore, adequate supervision and monitoring should be done in this field.  A content analysis of Health-related Advertisements was done in Islamic Republic of Iran Broadcasting (IRIB)

  Methods: This study was a cross-sectional research and collecting of data was carried out in 2012. Ten selected TV and radio channels were recorded from 6 a.m. to 12 p.m. for two successive months in the special weekdays. Broadcasted advertisements data were extracted by the trained observers according to a checklist and analyzed using SPSS 18 software and described with descriptive statistics.

  Results: The percentage of different types of advertising were including 73.9% unrelated to health, 21.9% harmless health related, 2.9% less healthy, 1.3% harmful or harmful with a probability of abuse. Non-harmful to health advertisements included 95.86% of total advertisements out of ten TV and radio channels; and the remained advertisements (4.14%) were related to the harmful, less healthy foodstuff and detrimental services and products. Also, 0.8% of the advertisements were shown during children programs.

  Conclusion: The main findings of the current study revealed that majority of the advertisements of Islamic Republic Broadcasting were unrelated to health. It seems advertising of harmful for health in IRIB was less than 5%, and the levels of these type ads were less than the other countries. Even so, the policymakers need to pass and enforce some executive and governing law for the prevention of broadcasting unhealthy advertisements to increase the society health level and prevent the diseases resulted from unhealthy products causing the considerable damages in a long time.

Enayatollah Homaie Rad, Zahra Kavosi, Masoud Arefnezhad,
Volume 30, Issue 1 (1-2016)

Background: Health utilization inequality is a major concern for health policymakers. Equality in utilization of services is very important for having a healthy society. The aim of this study was to describe inequality in dental care utilization in Iran, Therefore, concentration index, its curve, and the predictors of inequality in utilization of dental services and their spending were calculated.

  Methods: Data of a health utilization survey which previously had been gathered in Shiraz, Iran were used for this study. Tobit and Poisson estimators were used to estimate utilization and out of pocket models. Furthermore, concentration index and curve was calculated to show inequality in dental care utilization.

  Results: High inequalities was found in dental care utilization in Iran (concentration index=0.19). In the utilization model, the relationship between income and utilization was positive. People with higher income could utilize more services. Being covered by insurance increased the probability of dental care utilizations too.

  Conclusion: Policy makers must find solutions like increase the coverage of dental insurances to decrease inequality in dental care utilization.

Akram Hashemi, Azim Mirzazadeh, Mandana Shirazi, Fariba Asghari,
Volume 30, Issue 1 (1-2016)

Background: Professionalism is a core competency of physicians. This study was conducted to design a model for formative assessment of professional commitment in medical students according to stages of change theory.

  Methods: In this qualitative study, data were collected through literature review & focus group interviews in the Tehran University of Medical Sciences in 2013 and analyzed using content analysis approach.

  Results: Review of the literature and results of focus group interviews led to design a formative assessment model of professional commitment in three phases, including pre-contemplation, contemplation, and readiness for behavior change that each one has interventional and assessment components. In the second phase of the study, experts’ opinion collected in two main categories: the educational environment (factors related to students, students’ assessment and educational program); and administrative problems (factors related to subcultures, policymakers or managers and budget). Moreover, there was a section of recommendations for each category related to curriculum, professors, students, assessments, making culture, the staff and reinforcing administrative factors.  

  Conclusion: This type of framework analysis made it possible to develop a conceptual model that could be effective on forming the professional commitment and behavioral change in medical students.

Salime Goharinezhad, Mohammadreza Maleki, Hamid Reza Baradaran, Hamid Ravaghi,
Volume 30, Issue 1 (1-2016)

Background: The number of people aged 60 and older is increasing faster than other age groups worldwide. Iran will experience a sharp aging population increase in the next decades, and this will pose new challenges to the healthcare system. Since providing high quality aged-care services would be the major concern of the policymakers, this question arises that what types of aged care services should be organized in the coming 10 years? This protocol has been designed to develop a set of scenarios for the future of elderly care in Iran.

  Methods: In this study, intuitive logics approach and Global Business Network (GBN) model were used to develop scenarios for elderly care in Iran. In terms of perspective, the scenarios in this approach are normative, qualitative with respect to methodology and deductive in constructing the process of scenarios. The three phases of GBN model are as follows: 1) Orientation: Identifying strategic levels, stakeholders, participants and time horizon; 2) Exploration: Identifying the driving forces and key uncertainties; 3) Synthesis: Defining the scenario logics and constructing scenario storyline.

  Results:  Presently, two phases are completed and the results will be published in mid-2016.

  Conclusion: This study delivers a comprehensive framework for taking appropriate actions in providing care for the elderly in the future. Moreover, policy makers should specify and provide the full range of services for the elderly, and in doing so, the scenarios and key findings of this study could be of valuable help.

Khosro Keshavarz, Behzad Najafi, Yaghob Andayesh, Aziz Rezapour, Masoud Abolhallaj, Ali Sarabi Asiabar, Amir Hashemi Meshkini, Ehsan Sanati, Iman Mirian, Shekoofeh Nikfar, Farhad Lotfi,
Volume 31, Issue 1 (1-2017)

Background: Socioeconomic indicators are the main factors that affect health outcome. Health price index (HPI) and households living costs (HLC) are affected by economic reform. This study aimed at examining the effect of subsidy targeting plan (STP) on HPI and HLC.
   Methods: The social accounting matrix was used to study the direct and indirect effects of STP. We chose 11 health related goods and services including insurance, compulsory social security services, hospital services, medical and dental services, other human health services, veterinary services, social services, environmental health services, laundry& cleaning and dyeing services, cosmetic and physical health services, and pharmaceutical products in the social accounting matrix to examine the health price index. Data were analyzed by the I-O&SAM software.
   Results: Due to the subsidy release on energy, water, and bread prices, we found that (i) health related goods and services groups’ price index rose between 33.43% and 77.3%, (ii) the living cost index of urban households increased between 48.75% and 58.21%, and (iii) the living cost index of rural households grew between 53.51% and 68.23%. The results demonstrated that the elimination of subsidy would have negative effects on health subdivision and households’ costs such that subsidy elimination increased the health prices index and the household living costs, especially among low-income families. The STP had considerable effects on health subdivision price index.
   Conclusion: The elimination or reduction of energy carriers and basic commodities subsidies have changed health price and households living cost index. Therefore, the policymakers should consider controlling the price of health sectors, price fluctuations and shocks.

Mehrsadat Mahdizadeh, Mahnaz Solhi, Farbod Ebadifard Azar, Ali Taghipour, Aliasghar Asgharnejad Farid,
Volume 31, Issue 1 (1-2017)

Background: Social networking has a dramatically increasing trend among adolescents. By creating novel models of content production, distribution, and reception, this space has introduced opportunities and threats for adolescents, which must be understood in relation with their health status. This study was conducted with the aim of describing the psychosocial experiences of Iranian adolescents in the Internet's virtual space.
Methods: The present qualitative formal content analysis was conducted in Mashhad a city Iran. The participants included 32 adolescents of 13-18 years of age. Data were collected through 32 semi-structured individual and group interviews with maximum variation. The data were recorded, transcribed, and then analyzed via MAXQ 10 software. 
Results: In this study, 2 main themes of “moving towards constructiveness” and “perceiving social and psychological tensions” were formed. Accordingly, 9 subcategories were formulated including: increasing the social capital, a good feeling in life, escaping loneliness, being seen in the social network, intelligent selection of content, perceived threats, temptation, decline of behavioral values and principles, and emotional and social helplessness.
Conclusion: Adolescents’ positive and negative experiences in the Internet form based on personal and environmental factors. These experiences affect the mental and social dimensions of their health. These factors call for the attention of scholars and policymakers for developing enabling strategies for adolescents, and their families and for experts for promoting adolescents’ health. 

Amin Doosti-Irani, Hossein Moameri Hossein Moameri, Hasan Ahmadi-Gharaei, Kourosh Holakouie-Naieni,
Volume 31, Issue 1 (1-2017)

Background: Depression is the most common mental disorder in individuals with HIV and AIDS (PLWHA), and comorbidity with depression exacerbates the disease. Several studies have estimated the prevalence of depression in HIV and AIDS patients so far, but there is no consensus about the prevalence of depression among these patients. Thus, we aimed at estimating the overall prevalence of depression among Iranian PLWHA.
   Methods: The international and national databases including Web of Science, Scopus, Medline, Science Direct, MagIran, Scientific Information Database (SID), IranMedex, and Medlib were searched until June 2016. The quality of included studies was assessed using Newcastle-Ottawa Scale.
   Results: Out of 591 references, 9 cross-sectional studies met the eligibility criteria and were included in the review. The lowest and highest reported prevalence of depression among people with HIV was 22% (95% CI: (11, 33)) and 76% (95% CI: (71, 81)), respectively. Prevalence of depression in people with HIV in the north, west, and south of Iran was 45% (95% CI: (23, 67)), 30% (95% CI: (15, 45)), and 56% (95% CI: (35, 77)), respectively. Prevalence of depression among addict and non-addict patients was 25% (95% CI: (21, 30)) and 58% (95% CI: (40, 77)), respectively.
   Conclusion: According to the results of this systematic review, the prevalence of depression is considerable among Iranian PLWHA. Prevalence in the southern regions of Iran is more than the western and northern regions of Iran. This evidence may be useful for Iranian health policymakers to design suitable preventive and therapeutic interventions in PLWHA to prevent and control depression among these people in Iran.

Farhad Habibi Nodeh, Ibrahim Jafari Pooyan, Iraj Harirchi, Mohamad Arab,
Volume 31, Issue 1 (1-2017)

Background: Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran’s health system.
   Methods: Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and English-language databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts.
   Results: Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran’s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural).
   Conclusion: The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.

Haidar Nadrian, Towhid Babazadeh, Nadia Nadrian, Hassan Mahmoodi, Anvar Khosravi,
Volume 32, Issue 1 (2-2018)

Background: As a primary phase of a Health Impact Assessment (HIA) on the Iranian Targeted Subsidy Plan (TSP), this study was conducted to assess the psychometric properties of a newly developed quantitative Health Policy Impact Assessment Tool (HEPIAT).
   Methods: In 2014, multistage cluster sampling was employed to recruit 509 key informants in Sanandaj, Iran, to participate in this cross-sectional study. A comprehensive literature review was conducted to develop the initial draft of HEPIAT. Content validity was determined by a consensus panel of experts, and construct validity and factor structure of the HEPIAT were assessed using Exploratory Factor Analysis (EFA). Reliability was assessed utilizing the Cronbach’s alpha coefficient and the test– retest reliability coefficient.
   Results: Applying EFA, the optimal solution including 35 items and 6 factors was emerged, which accounted for 64.94% of the total variance. The mean items’ relevancy, clarity, simplicity, and their total mean±SD score were 88.3±0.2, 90.1±0.5, 86.1±0.7, and 89.6±0.4, respectively. The scores of intra-class correlation coefficients (ICC) and internal consistency reliability for all the factors were ranged from 0.67 to 0.89. HEPIAT demonstrated an appropriate validity, reliability, functionality, and simplicity.
   Conclusion: Although further works in different settings are warranted, HEPIAT may be a practical and useful quantitative instrument in socioeconomic-related HIAs aimed to inform policymakers and stakeholders on the health impacts of their decisions and plans.

Ali Kazemi Karyani, Arash Rashidian, Ali Akbari Sari, Sara Emamgholipour Sefiddashti,
Volume 32, Issue 1 (2-2018)

Background: Nonmarket stated preferences valuation, especially discrete choice experiments (DCEs), is one of the commonly used techniques in the health sector. The primary purpose of this approach is to help select attributes and attributes-levels that are able to properly describe health care products or services. This study aimed at developing attributes and attributes-levels for basic health insurance system in Iran.
   Methods: This study was conducted in 3 phases. First, narrative review was performed to identify related attributes. Also, 9 experts were interviewed to identify relevant attributes of health insurance in context. Other 36 experts rated the attributes and levels. Then, the research team decided on the inclusion of attributes and levels in the final design. The design was constructed using generic and D-efficient method with SAS 9.1. The design was divided into 3 blocks, each having 8 choice sets. Finally, the choice set was piloted with 45 participants.
   Results: Public hospitals, and private hospitals benefits, dental insurance coverage, inpatient benefits, rehabilitation therapy, and paraclinical benefits, long-term care,  medical devices benefits (Ortez, Protez, etc.), and monthly premium were identified and included in the final attribute design (D-efficiency = 98.16). The pilot study revealed that participants could easily understand and answer all the choice sets.
   Conclusion: The results of our study indicated that health insurance service benefit packages and premium were among the most important attributes that need to be included in the final attribute design for Iranians. The policymakers and health insurance organizations should emphasize these attributes in the benefit packages to make improvements. The emphasis on these attributes can help elicit people’s preferences and willingness to pay for attributes.

Ehsan Zarei, Adeleh Nikkhah, Behrouz Pouragha,
Volume 32, Issue 1 (2-2018)

Background: Physiotherapy services constitute a principle part of health care systems, and interest in their use has increased in the recent decades.  This study was conducted to investigate the utilization and OOP payment for physiotherapy services in public hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran.
   Methods: This cross-sectional study was conducted using the data of physiotherapy department of three public hospitals. The study sample included 6528 patients who had received 7257 episodes of care. Data were extracted through hospital information systems and analyzed using multivariate regression analysis by SPSS17. ‎‎‎‎‎‎
   Results: The average episode per patient was 1.11 and 12.6 session per episode.‎ The average cost of each episode and treatment session was 1 784 660 IRR (USD 59) and 142 023 IRR (USD 4.7), respectively. The OOP payment share for physiotherapy was 31%. Age, OOP amount, having insurance coverage, insurance type, and service type significantly affected physiotherapy utilization. Number of treatment sessions, having insurance coverage, type of insurance coverage, and gender were related to OOP payment.
   Conclusion: There is a large variety in utilization and OOP payment in the insurance funds, which could restrict the accessibility and utilization of services by patients, leading to inequalities in utilization. Therefore, policymakers should conduct an overall review on the tariffs and service packages of insurer organizations to provide better conditions for the elderly, unhealthy, and vulnerable population to mitigate inequality in service utilization and decrease OOP payment.

Behzad Damari, Hossein Almadani, Mahin Ahmadi Pishkuhi,
Volume 32, Issue 1 (2-2018)

    Background: Addiction is a serious concern in workplaces, as it can lead to accidents, absenteeism, and loss of productivity, neglect, delay, arguing, unhappiness, production cuts, and irregular working pattern. This national survey was conducted to assess the prevalence and pattern of drug use among employees of industrial environments in Iran.
   Methods: In this cross sectional study, the sample size was determined to be 13489 using multistage cluster sampling method during November 2013 and November 2014. Data were collected by trained interviewers using a structured questionnaire developed by the research team. Urine drug test was done for participants using laboratory rapid kits. A total of 13 286 questionnaires were completed with remarkable responsiveness such that only 1.2% of them were excluded due to defects in urine drug tests, and the rest were analyzed after the review.
   Results: The response rate to the questionnaires was 98.4% and 13 128 individuals took the urinary drug test. Many participants who had positive urine test did not express drug use and positive tests were more than self-reported cases. Compared to information about the pattern of drug use, data on the estimated prevalence of drug use was more reliable.
   Conclusion: This study presents the protocol of a well-designed national survey, including sampling procedure, appropriate instrument and test, field work, and discussion on the strengths and limitations of the study, and thus its results can be used effectively by policymakers.

Pouran Raeesi, Touraj Harati-Khalilabad, Aziz Rezapour, Samad Azari, Javad Javan-Noughabi,
Volume 32, Issue 1 (2-2018)

Background: In the recent decades, most studies have paid more attention to community expenditures in health sector and health outcomes. This study provides econometric evidence linking countries’ health expenditures to 3 health outcomes: (1) infant mortality, (2) under 5 mortality and (3) life expectancy within 4 different health care systems.
   Methods: In this study, we used the econometric method to estimate the effect of health expenditure on health status. Panel data were collected and grouped for 25 countries according to the health care system over 15 years (2000-2015). The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of different factors on the 3 mentioned health outcomes.
   Results: A significant relationship was found between health expenditures and health indicators. The effect of private health expenditures on health outcomes in countries with mixed health financing system and traditional sickness fund insurance was higher than public expenditures.  Also, after comparing the results between different health care systems, we found that the effect of health expenditure on the health outcome in countries with national health system (NHS) was more than other health care systems.
   Conclusion: To improve health status, health policymakers should focus on the factors that lie inside the health care system. Therefore, since private and public health expenditures have different effects on health outcomes in each health care system, countries should choose an optimal combination of private and public health expenditures.

Jalal Arabloo, Sogand Tourani, Hamid Ravaghi,
Volume 32, Issue 1 (2-2018)

    Background: Tobacco consumption is still considered as the first preventable cause of death in the world. In order to influence tobacco policy process, researchers and policymakers must use frameworks of policy-making to understand the process to provide them insights for influence the process. This systematic review aims to review the application of policy analysis frameworks in the field of tobacco control.
   Methods: A systematic search for articles was performed using four databases (Ovid Medline, Scopus, Cochrane Library, and PubMed) up to December 19, 2016. The articles were selected based on inclusion and exclusion criteria. All research studies focusing on tobacco policy and on one or more specified frameworks of policy analysis included in this study. Finally, thematic analysis was used to synthesize the findings.
   Results: 17 studies based on eligibility criteria were included in this study. The findings of this study showed that most of the studies were in North America, published in the Health journals, conducted to analyze the national and state policies, focused on analyzing agenda-setting phase. Multiple streams model was the most widely used framework within the literature. Few studies had used advocacy coalition framework. From the three agenda setting frameworks and theories (MSF, PEF, ACF), the ACF framework is the most detailed framework in terms of elements and factors affecting the dynamics of political sub-system the reasons for models selection and suitability for the study was noted only in a small number of studies. The results of this study showed underuse and the incomplete or improper use of policy analysis models and frameworks in the field of tobacco research.
   Conclusion: The study showed that a number of theories and frameworks have been used but their use was limited and have significant methodological weaknesses.
Alireza Olyaeemanesh, Masoud Behzadifar, Nasrin Mousavinejhad, Meysam Behzadifar, Sanaz Heydarvand, Samad Azari, Mariano Martini, Ahad Bakhtiari, Nicola Luigi Bragazzi,
Volume 32, Issue 1 (2-2018)

Background: Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani’s government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the “Health System Transformation Plan” (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran.
   Methods: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts – policy- and decision-makers, professors and academicians, health department workers, health activists, journalists.
   Results: Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran’s HSTP was revised, finalized and then performed.
   Conclusion: HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved.

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