Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 Development of a Productivity Assessment Tool for Hospital Settings in Iran: A Delphi Study 75 86 EN Somayeh Mahdiyan Deputy Directorate for Development and Resources, Isfahan University of Medical Sciences, Isfahan, Iran s.mahdiyan59@gmail.com N 0000-0003-2030-4960 Mosuod Ferdosi Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran N 0000-0002-0683-2719 Sima Rafiei Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran sima.rafie@gmail.com N 0000-0002-7502-7078 Rooholah Askari Department of Health Care Management, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran r.asqari@gmail.com Y 0000-0003-2239-6344 10.18502/jebhpme.v3i2.1206 Background: Measurement of the organizational performance would be effective and helpful for improvement, in the case that it is based on an appropriate and principled system. Such a system uses specific indicators to measure the productivity and performance of the organizations. In fact, these indicators act as useful tools for strategic planning in managerial levels. Given the importance of the issue, this study aimed to develop the key productivity indicators for hospitals affiliated to Isfahan University of Medical Sciences. These indicators are designed to be applied in evaluation, implementation, and improvement processes of the organizations under study. Methods: This was a qualitative study conducted among the hospitals affiliated to Isfahan University of Medical Sciences in 2015. Purposive sampling method was applied and the study participants were selected through snowballing. Then, the participants were organized in a focus group consisting of 16 experts in the field of hospital performance and efficiency indicators to achieve the research objectives by using indexing matrix method. Finally, validity of the developed indices was confirmed using Delphi method. Results: A total of 42 productivity indicators were formulated. Of these, nine indices were input (structural), which included financial, human resources, and energy consumption indicators. The next 29 indices were output and mainly belonged to the financial, efficiency, and quality area. The final four indices included process indicators and consisted of length of stay in emergency department, waiting time for out of hospital counseling, and waiting time for the presence of resuscitation team at the patient bedside during the cardiopulmonary resuscitation. Conclusion: Development of the indicators in three areas of input, process, and output helped managers and policy makers to access reliable and valid instrument for measuring organizational productivity. Indicator, performance, efficiency, hospital. http://jebhpme.ssu.ac.ir/article-1-241-en.html http://jebhpme.ssu.ac.ir/article-1-241-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 Measuring Equity in Iranian Healthcare System Financing: Experiences of Recent Health Reform Plan 87 95 EN Abdolvahed Khodamoradi Department of Health Policy and Economics, Social Security Research Institute, Tehran, Iran Khodamoradi84@gmail.com N 0000-0001-7823-1755 Shahram Ghaffari Head of Social Security Research Institute, Tehran, Iran ghaffari.sh@ssor.ir N Amir Abbas Fazaeli Department of Health Economics, Social Security Organization, Tehran, Iran amirfazayeli@yahoo.com N Reza Toyserkanmanesh Department of Health Policy and Economics, Social Security Research Institute, Tehran, Iran Reza.tkm@gmail.com N Vahid Rasi Student of Health Services Management, Iran University of Medical Sciences, Tehran, Iran rasivahid_65@yahoo.com N Fariba Bigdeli Department of Hospital Management, Social Security Organization, Tehran, Iran fbegdeli @gmail.com Y 10.18502/jebhpme.v3i2.1215 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. Health Expenditures, Health System Financing, Health Equity, Fair Financial Contribution, Catastrophic Healthcare Expenditures http://jebhpme.ssu.ac.ir/article-1-211-en.html http://jebhpme.ssu.ac.ir/article-1-211-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 The Preferences of General Practitioners Regarding Family Physician Contract in the Underprivileged Areas of Iran in Using Conjoint Analysis 96 104 EN Sima Rafiei Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran sima.rafie@gmail.com N 0000-0002-7502-7078 Rafat Mohebbifar School of Health, Qazvin University of Medical Sciences, Qazvin, Iran sima.rafie@gmail.com N 0000-0001-6243-6502 Mohammad Ranjbar Health Policy Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran sima.rafie@gmail.com N 0000-0001-5660-8048 Fatemeh Akbarirad Student Research Center, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran akbarirad_f@yahoo.com Y 10.18502/jebhpme.v3i2.1216 Background: One of the most important methods for improving the fair access of people to health services is the family physician program, which is facing many challenges. One of these challenges is the lack of policymakers' understanding of physicians' preferences regarding the provisions of the family physician contract. Therefore, this study was aimed to investigate general practitioners' preferences regarding the type of family doctor contract in one of the underprivileged regions of Iran. Methods: An analytical-cross-sectional study was conducted among 150 general practitioners (GPs) who registered in Ministry of Health and Medical Education (MoHME) family physician plan and were working in the health network of deprived regions in Iran. A discrete choice experiment (DCE) questionnaire was developed by the researchers and then distributed to GPs. Results were analyzed using Ordered Logistic Regression. Data were collected using a questionnaire designed by orthogonal method in SPSS 20. Data analysis was performed using logistic regression model in Stata 13 software. Results: Findings revealed that “type of employer” had the most significant effect on GPs’ preferences (OR = 2.5), followed by “allocating quota for admission to medical specialty courses after 5 years” (OR = 2.25), being allowed to give medical services to population without geographical restriction (OR = 2.8), being allowed to provide services out of the defined service packet (OR = 1.4), and “decreased length of contract” (OR = 0.93). Conclusion: The amendment of the provisions of the family physician contract in accordance with physicians' preferences increases the probability of their participation in and compliance with the family physician program. However, the compliance of the provisions of this contract with relevant international standards and upstream laws of the country should be maintained as much as possible. General practitioner, Family Physician, Logistic Model, Conjoint analysis http://jebhpme.ssu.ac.ir/article-1-122-en.html http://jebhpme.ssu.ac.ir/article-1-122-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 The Relationship between the Kind of Delivery and 5 Indexes of Mother and Baby\'s Health Before and After Implementing Health Reform Plan in Selected Hospitals of East Azerbaijan (Iran) 105 111 EN Hossein Jabari Health care management, Tabriz University of medical sciences, Tabriz. Iran. hosinhosinj@yahoo.com N Bayaneh Seyedamini Health care management, Department of nursing. Mahabad Branch. Islamic Azad University, Mahabad. Iran. @yahoo.com N Elahe Navvabi Iranian center of excellence in health management, Qazvin University of medical sciences, Qazvin. Iran. elahe.navvabi@gmail.com N Salah Asadi Iranian center of excellence in health management, Tabriz University of medical sciences, Tabriz. Iran. salah.asadi.4824@gmail.com Y 10.18502/jebhpme.v3i2.1217 Background: To improve the individuals' health, reforms should be made in the health systems. As a result, assessing the impacts of reforms is a way to evaluate the effectiveness of the health system. The aim of this study was to study the relationship between the kind of delivery and the five indexes of mother and baby's health before and after implementing the health reform plan in selected hospitals of East Azerbaijan, Iran. Methods: This descriptive-analytical study was conducted in 2018. The study was conducted among eight educational, medical, and private hospitals. Before and after the program, 800 files were selected using simple random sampling method. The researcher made a check list with confirmed validity to extract the data. The data were analyzed using descriptive statistics and T-tests by SPSS-22. Results: The average age of mothers in the two intervals was 27 years. Most participants did not deliver before and their education was diploma or lower. The rate of natural delivery from 34.5% (before the plan) reached 44.2% (after the plan)(p<0.05). The rate of mothers and babies' mortality reduced from 0.3 and 0.8 to 0 and 0.5, respectively. Mothers and babies' mortality and stillbirth had no significant difference based on the kind of delivery (p>0.05). Conclusion: Findings indicated significant increase of natural delivery after the reform plan in health system. Moreover, the rate of mothers and babies' mortality decreased. These results can guide the policymakers for deciding about the course of plan and its review.       Health reform plan, Health indexes of mother and baby http://jebhpme.ssu.ac.ir/article-1-204-en.html http://jebhpme.ssu.ac.ir/article-1-204-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 Investigation of Informal Healthcare Payments after Health Transformation Plan: A Case Study in the Southeast of Iran 112 120 EN Mehdi Zanganeh Baygi Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran mp.peyvand@yahoo.com N 0000-0001-6291-5140 Moahmmad Khammarnia Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran m_khammar1985@yahoo.com Y 0000-0003-0209-9975 Eshagh Barfar Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. @gmail.com N Fatemeh Setoodehzadeh Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran khammarnia.m@gmail.com N 0000-0003-2749-4947 Moazameh Shah Husseini Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran golman2009@yahoo.com N Mostafa peyvand Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran mp.peyvand@gmail.com N 10.18502/jebhpme.v3i2.1218 Background: Informal payment in many developing countries is a serious obstacle towards to improving healthcare system and has negative effects on the function of healthcare system. In order to reduce the informal payments and direct payments from patient's pocket, the Health Transformation Plan (HTP) executed. This study was conducted to assess the informal payments in the hospital related to government. Methods: This study was a survey based on descriptive analytic method in Zahedan, the capital of Sistan-Baluchistan Province, in 2017. The study population included all patients discharged from all wards of the two general hospitals affiliated with Zahedan University of Medical Science (ZaUMS) in a one-month period (from September 23 to October 22), in which 500 patients were selected by multistage cluster sampling. Data collection tool was a standard questionnaire that was conducted by interview method. The data were analyzed using by SPSS v22 and descriptive statistics. Results: In this study 98% of patients were male, 484 (96.8%) lived in the urban area, and about 2% had informal payment. The average amount of informal payments was 51.48 $. The highest number of informal payment was in the maternity ward (n:5, 50%). The doctors didn't have any informal payment, and all of the participants disagreed this type of payments. Conclusion: The rate of informal payments in the hospitals affiliated with ZaUMS in Southeast of Iran after execution of HTP is minimal. Poor economic status of the patients and well executed HTP are the possible explanations for minimal informal payments. Solutions including constant supervision on employees and realization of the medical services tariffs and strengthening insurance companies are effective steps towards elimination of informal payments. Health transformation plan, Informal payments, Hospitals http://jebhpme.ssu.ac.ir/article-1-177-en.html http://jebhpme.ssu.ac.ir/article-1-177-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 Identifying Executive Challenges of Performance-Based Payment from Medical and Educational Hospitals Administrators’ Perspective and Offering Solutions in Isfahan (2018) 121 130 EN Alireza Jabbari Health Management and Economics Research Center, Faculty of Management and Medical Informative, Isfahan University of Medical Sciences. Isfahan. Iran behrooz.madahian@yahoo.com N 0000-0001-6849-0075 Nasrin Shaarbafchi Zadeh Health Management and Economics Research Center, Faculty of Management and Medical Informative, Isfahan University of Medical Sciences. Isfahan. Iran behrooz.madahian@yahoo.com N 0000-0001-7104-2214 Behrooz Maddahian Faculty of Management and Medical Informative. Isfahan University of Medical sciences. Isfahan, Iran behrooz.madahian@yahoo.com Y 0000-0002-4465-3172 10.18502/jebhpme.v3i2.1223 Background: Performance-based payment is a payment model that attempts to reward the measured dimensions of performance and encourages health service providers to achieve predetermined goals by financial incentives. This study aimed to identify executive challenges of performance-based payment from medical and educational hospitals administrators’ perspective and offering solutions in Isfahan 2018. Methods: This study was a qualitative study. Semi structured interviews were used to collect data. The research population was 11 people (the administrators of educational and medical hospitals in Isfahan) who were selected purposefully. All interviews were recorded and then written on a paper. The duration of the interviews varied between 45 to 60 minutes. The data were analyzed using MAXQDA12 software and based on thematic analysis. Results: In this study, , regarding executive challenges, seven themes and fifteen sub-themes were obtained, including the weakness of the performance-based payment project, weakness in education and educational support, low employee participation, weakness of information and communication technology, weakness of laws and regulations, unfavorable economic conditions of the public sector, and special conditions governing public hospitals. Conclusion: performance-based payment, if implemented correctly, can lead to the improvement of quantitative and qualitative indicators related to employees’ performance. Correct implementation requires identifying challenges and obstacles and then corrective actions. This study was able to identify and present some of the operational challenges of the performance-based payment from the viewpoint of hospital administrators. Challenge, Performance-Based Payment, Medical and Educational Hospitals, Payment System, Iran http://jebhpme.ssu.ac.ir/article-1-245-en.html http://jebhpme.ssu.ac.ir/article-1-245-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 Job Satisfaction and its Related Factors in Health Care Providers and Health Workers in Esfarayen, Iran 131 138 EN Ahmad Sadeghi Department of Public Health, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran ahmadsadeghi1363@gmail.com N 0000-0003-3713-9519 Hasan Jafari Health Policy and Management Research Center, Department of Health Care Management, School of Public Health, Jafary_h@yahoo.com N 0000-0002-6569-4942 Hossein Rouhani Student Research Committee, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran @gmail.com Y 0000-0002-2589-099X Akram Zhianifard Department of Public Health, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran N 0000-0003-3285-1443 Maryam Siavashi Student Research Committee, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran N 10.18502/jebhpme.v3i2.1221 Background: Job Satisfaction in Health care organizations is one of the important pillars of health promotion, due to the role they play in the prevention, care and treatment. The aim of this study was to determine the job satisfaction and its related factors in health workers in Esfarayen. Methods: This descriptive-analytical study was carried out on 140 health care workers in Esfarayen in 2018. Data was collected using Herzberg job satisfaction questionnaire, and data were analyzed using ANOVA and t-test in SPSS21 software. Results: The mean age of participant was 37 ± 8.34. Most of them were female (70%) and married (85.5%). The average of job satisfaction was 61.45 ± 7.65 (out of 100). The highest job satisfaction score was work ability (73.54 ± 1.08) and the lowest score belonged to supervision (49.15 ± 5.73). Among the demographic variables, Job satisfaction was significantly associated with Employment Status (P<0.05.) Conclusion: Despite employees have job satisfaction, factors that increase job satisfaction of employees should be considered by the relevant authorities. Establishing suitable job standards, fair and reasonable salary, and the creation of facilities in the workplace can lead to improved employee satisfaction and, consequently, improved service quality. Job Satisfaction, Health Workers, Herzberg Model http://jebhpme.ssu.ac.ir/article-1-181-en.html http://jebhpme.ssu.ac.ir/article-1-181-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 3 2 2019 7 1 Identification of the Main Elements of Single Payer System; A Comparative Study 139 153 EN Ali Aboutorabi School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran a.abutorabi@yahoo.com N Saman Ghasempour Health Management and Economics Research centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran tanhasa76@yahoo.com Y Behzad Najafi School of Health Management and Information Sciences, Tabriz University of Medical Sciences, Tehran, Iran bnadjafi59@gmail.com N 0000-0001-9479-3774 Sirous Panahi School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran siruspanahi@gmail.com N 0000-0001-7610-906X 10.18502/jebhpme.v3i2.1225 Background: Progress towards universal coverage requires adequate capital in health sector. Investing and optimal allocation of resources in this sector will contribute to the development and reduction of poverty in countries in order to achieve the goals of health system. Therefore, the more people contribute to risk sharing, we have lower financial risks in facing the issue. The single payer system as a public health coverage model seeks to expand the insurance coverage scope at community level. The present study aimed to identify the main elements of S-PS to conduct a comparative study. Methods: A comparative study was conducted to describe the fundamental of financing and the provision of services in selected countries - Germany, Thailand, Turkey, and Colombia, as well as to achieve the main elements of S-PS. In addition, the health system of Iran has been studied. The basis for selection of countries was health system Garden typology. The main criteria for selection or rejection of studies were the separation of health services provider from financial functions; has allowed a single department to purchasing process. Results: single payer system in two functions of health system, namely, financing and providing health care; consolidation resources (reducing fragmentation by creating a single pooled fund and achieve massive purchase of health care through the insurance agent as single purchaser) and ensuring community health (delivery of services by the network of providers represented by Health Promotion Organization) represents 12 main organizational elements. Conclusion: the multiple insurers and payers of health care in Iran are both inequity and ineffective. And its integration is not a simple task. Iranian financing policies should aimed to achieving universal health coverage by creating greater risk pooling and becoming aware of the important tasks of insurance system; take advantage of the strength in numbers, setting the principles of cross-subsidy and preventing adverse reaction. It is important not to put together a long-term, coherent plan to reach the S-PS. consolidation, Health Insurance funds, health care reform, multiple pools, Single Payer System http://jebhpme.ssu.ac.ir/article-1-83-en.html http://jebhpme.ssu.ac.ir/article-1-83-en.pdf