Evidence Based Health Policy,

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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: One of the main goals of the health system is the fair contribution of people to healthcare financing. Therefore, the current study not only evaluated the status of fair financial contribution, but also investigated the impacts of the health reform plan on the financial pillars of the Iranian healthcare system.
Methods: To conduct this retrospective descriptive study, the data of Income and Expenditure Survey (2011-2015) commissioned by Statistical Center of Iran were used. To measure fairness of financing, four indices were used. Data were analyzed using the Excel and SPSS software.
Results: The results show that although the health reform plan has increased insurance coverage of both rural and urban households, out of pocket, and even its proportion to household capacity to pay continues to rise. Prevalence of catastrophic health expenditures in the baseline year in rural and urban areas was 2.19% and 1.04%, reaching 3.69% and 2.39% at the end of the study, respectively. Accordingly, fair financial contribution in rural and urban areas was obtained 0.830% and 0.850% in the baseline year, reaching 0.823% and 0.850% in the last year of the study, respectively.
Conclusion: Although indices of fair financial contribution during the 5-year period varied, they ultimately showed a worse situation compared to the baseline year. Thus, it is assumed that the health reform plan has not yet been successful in meeting the goal of improving fair financial contribution to the health system.

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Background: The integrated health system (IHS) entitled “SIB” was launched in 2016 aimed to electronic health record (EHR) in the field of health. Given that, in addition to deploying the system, its acceptance criteria by users has a significant effect on its effectiveness and benefits: therefore, the present study was carried out aimed to determine the acceptance rate of IHS technology in health centers.
Methods: This study as a cross-sectional survey and applied research was conducted in Zahedan University of Medical Sciences (ZAUMS) in 2017. The population in the present study consisted of all users of SIB system affiliated ZAUMS. Of these, 285 users were selected (physician, health care provider, Behvarz) in five counties affiliated with ZAUMS using multistage cluster sampling. In this study, standard technology acceptance questionnaire was used for data collection. The data were analyzed by SPSS₂₂ software and analyzed using descriptive statistics, one-way Anova, T test and other related tests.
Results: About 77.9 % of users used the system for several times a day. The SIB system acceptance rate by 49.5 % of users was moderate and 38.9 % of the users had excellent acceptance of this system. There was a significant relationship between the acceptance rate of SIB system among the users with age, gender, city, level of education, type of employment, place of work and organizational position (P < 0.05).
Conclusion: The results of this study show that, most users have accepted and confirmed the SIB system. Modification of the system with regional approach with the opinion and participation of specialists in comprehensive health service centers is suggested. .

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Background: People, as the main recipients of healthcare services, consider themselves entitled to the right to choose in the health system. This study aimed to investigate people’s right to choose and freedom about healthcare services from healthcare managers’ perspective.
Methods: This qualitative study was conducted in 2020. Data were collected through semi-structured interviews with 15 healthcare managers. Then, the snowball sampling method continued until data saturation level was achieved. All interviews were recorded, analyzed, and the main themes were extracted. MAXQDA₁₀ was used for data analysis using content analysis method.
Results: The people’s rights to choose their healthcare services were categorized into five main themes: people’s awareness of their right to choose, freedom of choice regarding receiving or not receiving services, government guidelines and policies, choice of hygienic services and medical services in a special way, and barriers to free access to services.
Conclusion: Recently, more attention is paid to social values in health systems than in the past, and people have more freedom and choices. On the other hand, to strengthen social justice foundations, there is a need for comprehensive policies and planning in various aspects.

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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.

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Background: Performance-based payment refers to an incentive-based payment to employees in terms of and beyond their job requirements at an extremely high quality. Therefore, this study aims to review the challenges of performance-based payment in the healthcare system.
Methods: The study was carried out as a systematic review through searching databases, i.e., PubMed, Web of Science, and Scopus, for articles published without time limitation to September 30, 2020. The research articles regarding Performance-based payment in hospitals (n = 16) were examined.
Results: Generally, challenges of performance-based payment were divided into four main categories and 17 subcategories, including service providers, payment and financing, quality of provided services, and infrastructure. The main themes and sub-themes were related to the lack of financial resources, discrimination between patients, and the designing of a comprehensive information system.
Conclusion: Suitable implementation of performance-based payment methods in the healthcare system will improve quantitative and qualitative indicators of staff performance. Identifying the challenges and obstacles to the proper implementation of this plan will help health managers and policymakers design and implement remedial measures. It is to reduce the barriers and problems.
 

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Background: In the data-rich and data-sensitive environment, health information systems (HIS) have been used for decision-making by providing reliable data. The current study aims to have a holistic view on the logistic role of IS in health sector.
Methods: PubMed, Scopus, and Science Direct were searched by keywords including "information system AND health AND data", "health information system AND challenges AND network", health information system OR clinical information system AND quality of services". 547 scientific studies from 2010 onwards were selected. At first, based on papers' relevance to the aim of this study, titles and abstracts of publications were studied. 259 studies were filtered out. Then, through analyzing the full texts based on inclusion criteria, authors selected 106 papers. Finally, contents were extracted and categorized.
Results: Due to the impact of IS on quality, effectiveness, and efficiency of services, as well as patients' safety, various types of ISs are used at different levels of the health system. They are classified based on different criteria including generality, level of the health system, managerial level, complexity, and integrity. According to IS components, non-standardized data, weak human resources capacity, incompatibility with work procedures, fragmentation of subsystems, cyber security threats, and insufficient informatics infrastructure were the main challenges.
Conclusion: IS in health play a logistic role in systematic data management and circulation of reliable information. A systematic and integrated view is needed to conquer the organizational and systemic challenges.

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Background: Health system policy implementation (HSPI) plays a crucial role in determining the effectiveness of healthcare systems worldwide. Understanding the factors that influence the success of HSPI is essential for policymakers, healthcare professionals, and stakeholders. This research aims to investigate and analyze these influential factors using a combination of thematic analysis and Analytic Hierarchy Process (AHP) methodology.
Methods: The research utilizes a mixed-methods approach, combining thematic analysis and AHP to comprehensively explore the factors influencing the success of HSPI. The present study is a descriptive-survey with an applied nature and a cross-sectional design. Information was collected using the survey method, classifying it as field research. The statistical population consisted of 15 professors from the Faculty of Medicine at Najaf Abad Azad University, selected through purposive sampling. The data collection tool is a pairwise comparison questionnaire. Data analysis was performed using the AHP method and Expert Choice 11 software.
Results: The thematic analysis reveals a range of factors affecting the success of HSPI, including but not limited to stakeholder engagement, resource allocation, political commitment, organizational capacity, public awareness, and socio-cultural factors. These factors are further analyzed and prioritized using the AHP method to determine their relative importance and impact on policy implementation success. The main factors in order of priority are stakeholder engagement (weight = 0.145), resource availability (weight = 0.133) and policy design and planning (weight = 0.124).
Conclusion: The integration of thematic analysis and AHP provides a comprehensive framework for understanding and assessing the factors influencing the success of HSPI. By identifying and prioritizing these factors, policymakers and healthcare stakeholders can develop targeted strategies and interventions to enhance the effectiveness and efficiency of HSPI, ultimately leading to improved health outcomes and healthcare delivery systems.