Evidence Based Health Policy,

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Background: Determining the inequality in health and the gap level among various socio-economic groups and factors affecting it were always concerns of most politicians and social scientists. This study investigated inequality in utilization of health care among Yazd residents in 2014.
Methods: This analytic and cross-sectional study was conducted in 2014. The participants were all households of Yazd. The data were collected through a three-part questionnaire including demographic factors, socio-economic factors, and utilization of health services. The number of samples was estimated to be 1037 households selected by random stratified sampling. After administrating the questionnaire in the form of interview, data were entered into the SPSS software.  Later, factor analysis method was carried out and participants were categorized based on their social and economical status. Afterwards, using the logistic regression method, the correlation among variables was calculated and finally, for measuring the concentration index, the stratified data were fed into Stata₁₁ software version 12/SE and analyzed.
Results: According to the findings, there was no meaningful inequality in the distribution of contagious and non-contagious decreases in the population under study. Inequality in utilization of services for inpatient and outpatients during the past 6 months in the five socio-economic groups was significant (P-value = 0.000). This shows that accumulation of visits occurred in richer groups of society. Also, it can be claimed that self-treatment has greater accumulation in the poorer quintiles (CI = -0.09).
Conclusion: Inequality in benefitting from health services reflects the economical situation of households. As a result, it is expected that by taking steps to improve the living conditions, the equity in service utilization will be increased.
 

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Background: Economic, physical, and human resources capitals played the most important role in the traditional views of management. However, for development in the current era, social capital is required more than economic, physical, and human capitals. Attitudes and performance of social capital in any organization is one of the important prerequisites for the success in that organization. The aim of this study was to investigate the relationship between psychological capital and organizational citizenship behavior among employees of selected hospitals in Tehran.
Methods: This research was an analytical and applied study that was conducted in 2015. Simple stratified random sampling was conducted based on organizational positions (administrative, financial, and para-clinic) among each class to a certain proportion and based on Cochran formula. Data collection tools included two questionnaires of Luthans psychological capital and organizational citizenship behavior of Netmir. Pearson correlation and hierarchical regression tests were used in order to analyze data in the form of Spss₁₈ software at the significant level of 0.05.
Results: Psychological capital and organizational citizenship behavior were desirable among studied hospital staffs. On the other hand, altruism and self-efficacy had the highest mean scores, while chivalry and optimism had the lowest ratings. Hierarchical regression analysis showed that organizational citizenship behavior is able to predict the overall psychological capital (β = 0.285).
Conclusion: Given that citizenship behavior can clearly predict psychological capital in staff, hospital administrators should try to promote organizational citizenship behavior and consequently psychological capital by involving employees in decisions, consult with them, and hold training courses to motivate them.

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Background: Today, peace and stability of health diplomacy in the Eastern Mediterranean region is faced with many challenges. In spite of extensive ignorance on health consequences in other fields and priorities of foreign policy, but foreign policy can be applied to improve health particularly in international health negotiations.
Methods: To conduct this non-systematic review, articles relevant with the topic were selected from published texts and credible databases for investigation. Databases included Medline, web of science, Google scholar, Springer, PubMed, and all news websites.
Results: Since issues of health are getting more political, having political view and mastering negotiation techniques is necessary. One of these conditions is multilateral negotiations, in which non-governmental organizations, advocacy groups, foundations, research centers, and private sectors get together to affect the present representatives of the member countries’ decision making about health topics and also to be part of the negotiation process.On the other hand, the international commitments of the Millennium Development goals, has put the health issue in a special position in international discussions. Further, epidemic growth of emerging diseases (such as AIDS, hepatitis, and influenza), immigration, and the sanctions have their impacts on the health sector, especially medicines and equipment, its serious impact on public health is also considered as an undeniable threat.
Conclusion: In order to have effective application, health policy principles should be coordinated with other forms of diplomacy and also be placed at the top of all key stakeholders’ affairs including the Ministry of Health and other organizations effective on the health. Thus, to achieve the Millennium Development Goals and to escape from the problems based on the objectives of Vision 2025; this approach will solve many problems.

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Background: Health care organizations are faced with a new technology called telemedicine which provides a platform for remote cooperation, training, and consulting. Telemedicine is the use of information technology for clinical care of patients. This study aimed to establish the feasibility of telemedicine in two educational hospitals of Yazd.
Methods: This cross - sectional study was conducted in 2014. Census and random sampling were applied to recruit 200 out of 722 clinical and administrative staffs of both hospitals. Data were then collected through a standardized three-part questionnaire entitled "telemedicine measurement tools". The first two parts of the instrument were in the form of checklist that evaluated the infrastructure, administrative culture, and education dimensions. Questionnaires were distributed among hospitals' managers and IT staffs. The third part of the questionnaire was in a five-item Likert questionnaire format that evaluated staff preparation and also any obstacles to the deployment of telemedicine from the employees' perspectives. Data were analyzed through SPSS₁₈ software and by using descriptive statistics, frequency, and percentage.
Results: Providing raining and providing care were selected as the best applications in telemedicine by respectively 82.4% and 76.2% of respondents. Additionally, lack of technical staff and insufficient bandwidth in telemedicine were reported by respectively 85.4% and 77.8% of participants as the biggest barriers for use of telemedicine. Distance learning and remote monitoring were experienced by 14.5% and 10% of employees, respectively. There was no strategic plan and support for the use of telemedicine in the two hospitals. Employees had the necessary knowledge on the benefits of telemedicine, as well as barriers to its deployment. Technical infrastructure required for the deployment of telemedicine at the two hospitals was not available.
Conclusion: For the deployment of telemedicine, the two hospitals should invest in technical infrastructure and administrative culture. Also, the preparation of the two hospitals' staffs is the reliable implementation of this plan.

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Background: The clinic in a hospital is usually the first place to which patients are referred. A long queue, which results in dissatisfaction among patients, is economically costly for managers; medical institutions can, therefore, determine the level of required resources for optimum investment through management tools like queue theory and waiting time caused by it. The current study was conducted to evaluate waiting time at various clinics of Amir Alam Hospital in Tehran.
Methods: The analytical study was conducted in the period from April to August in 2015 on 150 patients who were referred to five clinics of Amir Alam Hospital. The samples were selected through stratified random proportion to sample size and data was collected in a designed frame through SPSS₂₁ and descriptive tests of mean, standard deviation and regression analysis.
Results: The longest waiting time for patients was related to the surgery clinic at 61.05 minutes. Also, the longest time to provide service was related to the surgery unit at 26.84 minutes. Results obtained from univariate logistic regression test indicated that all evaluated variables—including time to receive service, capacity of providing service, order of queues and number of doctors—exert a significant effect on waiting time of patients in the hospital (P-value < 0.05).
Conclusion: Increasing capacities, keeping adequate number of doctors, reforms, removal of unnecessary works and using scientific tools to manage queues can be effective in reducing waiting time for patients. Owing to its importance for patient satisfaction, it is necessary for managers to think of ways to shorten queues in hospitals

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Background: The educational system of any organization is actively and potentially one of the most important aspects of that organization in human resource development. It is necessary for any system to benefit pathology in order to function properly. The goal of this study is to investigate and identify the weaknesses of staff education systems of the country's medical universities based on McKinsey 7S Model.
Methods: This cross-sectional study was conducted in two phases. In the first phase through key criteria, seven elements of the model were extracted using expert ' opinions and selection criteria was converted to measures and distributed in the form of a questionnaire among 113 officials and experts from Medical Sciences universities. Cronbach's alpha questionnaire was 0.931. Data were analyzed by using descriptive statistics for the frequencies of demographic data and means and standard deviation and analysis statistics such as t-test.
Results: The results showed that the state of education in the country's universities is undesirable respectively in dimensions of the structure (P-value = 0.401), management practice (P-value = 0.69) and strategy (P-value = 0.473). However, the average of overall pathology (141.07) was higher than the interested average (138) and showed that there is generally no serious damage in the country's medical universities training.
Conclusion: Managers' support, clarification of educational rules and regulations, determining specific hierarchy in training unit, goal setting and training strategies in a targeted form and by stakeholders' engagement are proper strategies to remove injuries in staff training systems.

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Background: Providing healthcare services of the highest quality and quantity, based on the results of scientific research, is one of the main tasks of nurses. The aim of this study is to evaluate nurses’ perception of evidence-based knowledge, attitude and practice in selected hospitals of Iran.
Methods: This study was a descriptive cross-sectional analysis that was conducted to investigate nurses’ perception of evidence-based practice (EBP). Two hundred-and-sixty nurses were selected randomly from six hospitals in Qazvin city in Iran to participate in the study. An evidence-based practice questionnaire was used to assess the dimensions of EBP. Descriptive and inferential statistics using frequency tables, t-student statistics, Pearson correlation coefficient and ANOVA were used for data analysis.
Results: According to this study, nurses’ perception of EBP was generally above average (3.91 out of 7) and average of Practice, attitude and knowledge/skills were 4.14, 3.78 and 3.74 respectively. There was no statistically significant relationship among EBP dimensions and gender, age and job tenure (P-value > 0.05). There was a statistically significant relation between attitude of nurses and type of employment (P-value < 0.05).
Conclusion: In this study, the mean of evidence-based practice among nurses was at a level higher than the average. The attitude of the nurses who were studied was moderate, but thanks to the low level of their knowledge about EBP, training programs based on needs assessments resulting from the findings of this study were suggested that could improve nurses’ knowledge of EBP.

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Background: Hospitals are the largest and most costly operating units of health systems, and their share of current government expenditures in the healthcare sector is between 50 and 80 percent. The hospital efficiency is more indicative of the proper function of the resources devoted to it. The aim of this study was to evaluate the efficiency of hospitals in Tabriz by using the Pabon Lasso model.
Methods: This is a descriptive study that investigated the efficiency of Tabriz hospitals during 2009-2013. All hospitals of Tabriz were entered by census. Data (bed occupancy rate, bed turnover and patient length of stay) were collected in summer 2014 and charts were plotted using SPSS₁₉ software.
Results: The mean of Pabon Lasso's three indices of efficiency in 5 years (excluding psychiatric beds) was 67.6% for bed occupancy rate, 104.3 times bed turnover, and 2.48 days average patient length of stay. The coefficient of bed occupancy increased by 3% over 5 years, the bed turnover index increased by 8 times and the average length of stay decreased by 0.17 day. On average, 25.2% of hospitals were in Region 1, 23.5% in Region 2, 26.1% in Region 3 and 25.2% in Region 4 of Pabon Lasso Diagram.
Conclusion: The presence of 26% of hospitals in the region of Pabon Lasso Diagram shows the effective efficiency of hospitals which is not an acceptable statistics for hospitals and requires the intervention of health practitioners and policymakers.

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Background: Since disabled persons and their families are those who refer to wellbeing organization, staff of such organization requires special education to provide essential capabilities in them. On the other hand, such educations should increase job satisfaction of staff leading to the increasing commitment. The current research aims to find the relation between organizational learning and organizational commitment of staff in wellbeing organization of Yazd province.
Methods: This is an analytical-descriptive research and the statistical population is all staff of wellbeing organization of Yazd province (74 persons). Sampling was done by census in 2015. To gather information, Nifa organizational learning questionnaire and Allen & Mayer's organizational commitment questionnaire were used and each includes 24 items. Data were analyzed using SPSS₁₈ software, t-test, ANOVA, Pearson correlation and linear regression tests in significance level of P-value < 0.05.
Results: Participants were 34 men (46%) and 40 women (54%). 66% of respondents had bachelor and 35.1% had work experience between 11 and 15 years. There was no significant difference between organizational commitment, organizational learning and gender. There was no significant relation between age and other research variables except for normative commitment. There was a linear significant relation and positive and direct correlation between components of organizational commitment including affective commitment, continuous commitment and normative commitment (P-value < 0.01).
Conclusion: there was a positive and direct relation between organizational learning and organizational commitment of staff. Organizational commitment and organizational learning were averagely low in the organization. Therefore, managers of wellbeing organization should identify educational requirements of staff and offer opportunities to meet such needs and to promote abilities, skills, loyalty and commitment of staff to the organization.

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Background: Insurance industry is recognized as a major economic entity. Development of insurance, and particularly life insurance, is among the necessities of industrial societies as this plays a substantial role in reinforcement of the society’s economic power and, thus, establishes security and confidence. Aimed at analyzing the economic-social factors affecting insurance demand, the present study deals with estimation of life insurance demand function using panel data from 2006 up to 2014 in Iran.
Methods: The present research is a descriptive-analytical study of the retrospective cohort applied type. Information registered in Iran’s Statistics Center encompassing the interval from 2006 to 2014 was analyzed. Benefitting from economic evaluation mechanism and macro-scale economic and social variables affecting life insurance demand were investigated in 30 provinces of Iran. Finally, the country’s demand function of life insurance was estimated using Stata₁₂ and Eviewes8 software packages with panel data method.
Results: Life expectancy rate has the largest impact on life insurance demand among the variables analyzed. In addition, urban settlement rate leaves the smallest effect on life insurance demand.
Conclusion: Results of the study indicate that increase and rise of variables such as life expectancy rate, dependency rate, urban settlement rate, literacy rate, likelihood of family head’s death, population, and average net annual expenditures of urban family lead to increased tendency of individuals to life insurance. Furthermore, increase of other parameters like inflation rate and interest rate result in reduction of people’s tendency toward life insurance.

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Background: One approach to improve efficiency in health care is to identify patients with high risks of readmission so that resources should be distributed in a way they would benefit targeted care. A model named LACE (length of stay, acuity of admission, Charlson comorbidity index (CCI(, and number of emergency department visits in preceding 6 months) has been proposed to predict patient readmission which is widely used due to its simplicity to rank factors’ risks. The aim of this study is to determine if LACE Index could be used to predict Iranian hospital readmission.
Methods: This was a prospective cohort study in which the prediction of readmission for patients admitted to the cardiac intensive care of Shahid Beheshti Hospital of Qom during April to June 2012 within one month after the discharge was evaluated based on 4 items of LACE index. Following-up readmission states by making calls within a month after discharge. Purposive sampling was used to select the sample, patients having four most prevalent chronic heart diseases in the CCU of the hospital were selected and at last sample size was 109 patients. We used logistic regression, the phi and Spearman correlation coefficient to analyze data using SPSS₁₈. the significance level was considered as 5% in all tests. 
Results: Among the items of LACE model, 48.6% of patients stayed at the hospital for 4 to 6 days. Only 11 patients (10.09%) referred to the hospital after a month. None of the components of the LACE index could enter the stepwise logistic regression model.
Conclusions: Considering that LACE model with its four items is a weak in predicting readmission, in order to improve the model in predicting the readmission of cardiac patients, it is recommended that individual variables and factors associated with the service providers be added to it.

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Background: The identification of strengths and weaknesses of services provided is the first step for the improvement of the quality of services. In hospitals, patients are the most important groups for the evaluation of the quality of healthcare services. Thus, this systematic review and meta-analysis aims to evaluate hospital service quality from patients’ perspective in Iran using Servqual model.
Methods: A systematic review and meta-analysis of studies evaluating patients’ perspective about hospital services quality was conducted. Required data were collected through searching following key words: Servqual, services quality, gap, hospital, patients, Iran, using the database sources including PubMed, Scopus, Google Scholar, MagIran, SID and IranMedex. Comprehensive meta-analysis (CMA) software, Version 2 was used to estimate the total mean score of patients’ perception and expectation of services quality and the gap between them.
Results: Totally, 11 eligible studies were entered into the systematic review. Based on the random effect model, the total mean score of patients’ perception, patients’ expectation and the gap between them were estimated 3.66 (95% CI, lowest = 3.40, highest = 3.92), 4.62 (95% CI, lowest = 4.42, highest = 4.82) and 0.94 (95% CI, lowest = 0.78, highest = 1.10), respectively. The mean score of the gap between perception and expectation was 0.95 and the biggest gap was related to the responsiveness dimension.
Conclusion: Responsiveness is related to the areas, such as providing appropriate and timely services, the reliability of providers, good communication between staff or physicians and patients. The importance of these areas signifies the necessity of taking actions in order to provide more appropriate and higher quality services.

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Background: High hospital costs on one hand, and limited resources and facilities on the other hand, have led hospital managers to reduce costs and increase efficiency. Performance measurement is one of methods for assessing efficiency of hospital .in terms of resource utilization. Therefore, the present study was conducted with the aim of evaluating the efficiency of hospitals affiliated with Bushehr University of Medical Sciences before and after the implementation of the Health development Plan.
Methods: This study is descriptive-analytic. The research population of this study was all hospitals affiliated with Bushehr University of Medical Sciences whose performance was evaluated in two years of 2013 and 2014. To measure the efficiency of these hospitals, data frontier analysis was used. The criteria of the total number of employees, the total number of physicians, the number of nurses and active beds were studied as input variables, and the percentages of cesarean section in total deliveries, number of surgeries, average residence. The data were collected in collaboration with the University's Center of Statistics as well as referring to the hospitals and analyzed using DEA software.
Results: The mean technical efficiency, managerial and scale of performance before the implementation of health system development plan were reported 0.934 ± 0.116, 1.00 ± 0.0 and 0.934 ± 0.116, respectively. Furthermore, six out of the eight hospitals studied were technically and scale-oriented efficient, and all eight hospitals were efficient regarding management. Only two hospitals had a surplus and two hospitals were inadequate. The mean efficiency after the implementation of the development plan was 0.9504 ± 0.131, 0.977 ± 0.059 and 0.966 ± 0.088, respectively. Conclusion: According to the findings of this study, the health system development plan has had a positive effect on the efficiency of hospitals, Although the efficiency of hospitals is desirable, it is essential that managers and policymakers of the health sector take measures to improve the efficacy and increase the use of resources.

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Background: In recent years, the tendency of women to have C-section has increased, without enough knowledge about it and its side-effects. Vaginal birth promotion program is one of programs included in the health care reform plan which is an important step in promoting the awareness of vaginal birth. The aim of this study is to investigate the impact of the health care reform plan on C-section rates in one of educational hospitals in Tehran University of Medical Science.
Methods: The present study was descriptive-analytic which was conducted in longitudinal and retrospective manner. Data were collected from 8510 deliveries through the patients' medical records in the span of three consecutive years, one year before implementing the health care reform plan and two years after its implementation. Calculations were done via Excel and SPSS ₂₀ soft wares.
Results: From the total of 2309 deliveries in 2013, (before implementing the plan), 69 percent of them had C-section and 31 percent had vaginal delivery. In the first year of the plan, from a total of 2989 deliveries, 70.8 percent had C-section and 29.2 percent had vaginal delivery and in the second year, from a total of 3212 deliveries, 71.3 percent had C-section and 28.6percent had vaginal delivery. The rate of avoidable C-sections in 2013, was 21.6 %, in 2014, 14.8 % and in 2014, 15 % .The execution of health care reform plan led to a 6.7 % decline rate in avoidable C-sections such as elective caesarians.(p = 0.001). Among the reasons for non-avoidable caesarians are, repeated caesarian, failure in delivery, and preeclampsia, respectively.
Conclusion: Although this hospital did not succeed in reducing the rate of C-section, considering the causes for C-section, it could reduce avoidable caesarians like elective deliveries. Given that this hospital has a large number of critically ill patients referred from other centers for C-section, it has a high rate of C-section. Two important factors contributing to the execution of this program are, making the delivery room's space pleasant according to the birth center standards, and increasing human resources and professional and friendly obstetricians. Therefore, in order to promote vaginal birth a comprehensive planning is needed.

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Background: Medical diagnostic laboratories and accuracy and precision of laboratory test results play a decisive role in improving services delivery to patients. Therefore, special attention to the quality of medical health services activities appears to be essential. This study aimed to evaluate the performance of laboratory of Isa ibn Maryam hospital of Esfahan due to the concept of quality management and carried out by using a 360 degree feedback approach.
Methods: The current paper is a cross-sectional study which was conducted in Isa ibn Maryam hospital in Isfahan University of Medical Sciences. Simple random sampling is used and totally 42 patients and hospital staff (laboratory customers) were selected. The data collection tool was a self-made questionnaire and data were analyzed using Microsoft Excell 2010.
Results: Based on the findings, the highest mean score of evaluating performance was related to pediatric department with a score of 5/50 and the lowest mean was related to hygiene and the infection control unit was with a score of 5/42.
Conclusion: The most important flaws in each performance evaluation system are personal taste orientation and applying personal views. Thus, it may be possible to minimize the deployment of personal opinion in evaluations by using a 360 degree feedback approach.

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Background: Considering the importance of organizational learning and its impact on health accreditation, the present study investigates the level of learning and its relationship with accreditation and its promotion strategies in medical sciences universities as the core of the health sector.
Methods: In this descriptive-analytic study, data was gathered from 176 nurses working in four teaching hospitals in Ardabil. The standard organizational learning questionnaire and the accreditation rating checklist (second generation) were used as well. Data were analyzed by ANOVA, SPSS₂₂, follow-up tests and correlation coefficient.
Results: The results showed that there was no significant difference in the total score of accreditation between teaching hospitals (P-value = 0.320, F = 1.178), but there was a significant difference in organizational learning (P-value > 0.001, F = 146.9) due to the very low rating of one of the centers. The results also showed a positive, significant and strong relationship between the organizational learning score and the total score of accreditation in 4 teaching hospitals in Ardabil (r = 0.319, P-value < 0.001).
Conclusion: Based on the results there is a positive and significant relationship between the organizational learning and the accreditation scores. By increasing personnel organizational learning, the accreditation score has also significantly increased. Therefore, with proper policy on organizational learning, educational centers can have a higher level of accreditation in order to provide decent services.
 

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Background: specifying the determinants of healthcare expenditure is one of the most important challenges in the health sector. The current study was aimed to assess factors affecting government health care expenditure in Iran.
Methods: to identify short-term and long-term determinants of healthcare expenditure in Iran during 1971-2007, Auto Regressive Distributive Lag (ARDL) bound testing approach to co integration was used. The explanatory variables were defined into economic, demographic and supply side categories. The data were collected from the official websites of the Iranian Statistics Centre, Central Bank of Iran, and the Ministry of Health.
Results: we found health care expenditures as necessary goods in both short-term and long-term. In long-term, per capita income (β = 0.815, P-value = 0.033), elderly population (β = - 1.790, P-value < 0.001), and physician density (β = 3.204, P-value = 0.004) had effect on health care expenditure. In short-term per capita income (β = 0.577, P-value = 0.026) was the only factor that significantly affected health care expenditure.
Conclusion: Government health expenditure is necessary goods in both short and long run. Thus governmental health care expenditure does should grow proportional to increase in national income. This could result to decrease in out of pocket payment.

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Background: Several explicit approaches are used to make decision on health services coverage and to develop the basic health package. In this study, first the approaches used to prioritize health services were introduced, and then the limitations of each method were reported.
Methods: We critically reviewed market literature regarding explicit priority setting approaches. The current literature focusing on explicit priority setting approaches in health care system was reviewed.
Results: Eight explicit approaches for prioritizing health care were identified: CEA, CEA / BOD, PBMA, HTA, MCDA, A4R, the Value Assessment Framework, and combinational approaches such as MCDA-A4R and PBMA-A4R. Developing the value framework for making a decision, not just informing a decision was needed to be investigated.
Conclusion: This study addressed the explicit health services prioritization methods. The results showed that a value framework approach as one of the innovative approaches that has become increasingly widespread in recent years can help to achieve goals of the health system.

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Background: Medical tourism represents the travel of individuals to receive health care and treatment to another country. One of the important factors in the marketing of medical tourism is promotion. The purpose of this study is to investigate the importance of promoting factor in the proposed marketing pattern of medical tourism services.
Methods: This study is a Descriptive-Correlational research method and an applied research in terms of purpose conducted in2017. The statistical population of the study consisted of all staff of medical centers and active units in the medical tourism area of the medical Science Universities in Iran and 630 of them were selected as a statistical sample by using simple sampling method. The data collection tool was a questionnaire with 63 questions related to tourism marketing components with scoring based on Likert scale. The validity of the questionnaire was evaluated by experts' judgment and reliability was measured by using Cronbach's alpha coefficient (0.82) and Test re Test (0.92) in SPSS₂₂.
Results: According to the standard estimates of path coefficients, the promotion factor with score of 0.98 consisted of 8 components ranked first among others was determined. 
Conclusion: Considering the importance of the promotion component, Policy makers in the field of medical tourism services should pay special attention to promotion and related issues in order to properly identify the Capacities and capabilities of active centers globally.
 

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Background: Global surgeries include ninety operations in the common surgical procedures, with the annual fixed fees; which the insurance companies pay hospitals accordingly. The aim of this study was to compare the global fees to these surgeries’ real costs and to investigate the affecting factors in two teaching hospitals affiliated to Tehran University of Medical Sciences.

Methods: This longitudinal retrospective descriptive-analytic study was conducted on all hospital records with global surgeries in three months in 2012 to 2013 in two educational hospitals affiliated to Tehran University of Medical Sciences.Data were collected using the researcher’s –made checklist and extracted from the HIS (Hospital Information System). SPSS₂₀, EXCEL, and STATA software were used to analyze the data and to obtain the difference between the recorded costs and global fees.
Results: The global fees were less than the recorded costs in both hospitals. The recorded costs in hospital B were much less than hospital A for the same surgeries. In hospital B, costs have been reduced for some surgeries in 2013comparedto 2012 by reducing the patients’ length of stay and time management.
Conclusion: Fees in the referral hospitals of Tehran University, which usually involve complicated patients, should be determined more accurately. However, this study suggested that hospitals can greatly reduce the cost of global surgeries throughclinical and cost management.