Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 Designing a Financial Resource Allocation Model Using Goal Programming Approach: A Case Study of a Hospital in Iran 70 79 EN Marzieh Lashkari Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran N Vahid Yazdi-Feyzabadi Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran N Mohsen Mohammadi Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran N Hossein Saberi Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran N Mohammad Hossein Mehrolhassani Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Y Background: Prioritization and resource allocation are the most important processes in managing and developing each organization. Given the high turnover and cost of hospitals in health system, this study aimed to provide a model for financial resource allocation with the Goal Programming (GP) in Afzalipour teaching medical center in Kerman. Methods: This mixed method and case-study study was conducted in Afzalipour teaching medical center located in Kerman, south-eastern of Iran. Participating key informants and operation research experts, twelve focus group discussions (FGDs) were developed to extract a goal programming model. Then, the hospital accounting data were collected from 2010- 2013 according to the extracted model. The WinQSB software was used for running the model. Results: The findings of this study showed that the share of personnel costs of this hospital was 72% which 28% was devoted to fee-for-service (FFS) and contractual services, current and other costs were 6%, 2%, and 12%, respectively. However, the findings of goal programming model showed that the optimum and satisfactory amount of personnel costs must be 66%, 14% of which were allocated to the FFS cost. The share of contractual services, current and other costs must be 15%, 2%, and 17%, respectively. Conclusion: The results showed that resource allocation in the hospital follow merely the accounting perspective rather than optimum and satisfactory ones. It is suggested in order to achieve the optimum values, the board of trustees should be institutionalized in practice; moreover, the outsourcing services should be addressed more. Therefore, personal costs which include a large part of costs can be reduced. Resource Allocation, Financial Resources, Goal Programming, Hospital, Iran http://jebhpme.ssu.ac.ir/article-1-143-en.html http://jebhpme.ssu.ac.ir/article-1-143-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 The Effect of Social and Economic Factors on Maternal Mortality in Provinces of Iran within 2009-2013 80 90 EN Hanie Gholampoor Department of Management and Health Economic, School of public Health, Tehran university of medical sciences, Tehran, Iran Y Abolghasem Pourreza Department of Management and Health Economic, School of public Health, Tehran university of medical sciences, Tehran, Iran N Hasan Heydari Department of Management and Economic, School of Economics, Tarbiat Modares University, Tehran, Iran N Background: The mothers' role in health of family members is very important, and her death has uncompensable losses for the family and society. With regard to the importance of maternal mortal ratio in development indicators of the United Nations (UN) this study is conducted to investigate the impact of socioeconomic factors on maternal mortality ratio Methods: In the current study the role of socioeconomic factors on maternal mortal ratio was investigated by panel regression. Data include number of maternal mortality, total fertility, number of hospital beds, number of midwifes, number of physicians and urbanization in the period between 2008 and 2012. Since the dependent variable was in count form, Poisson estimator, Hausman test, and Breusch-pagan test were used. Results: Based on the findings, household’s income and fertility rate had direct and inverse association with maternal mortality, respectively. Investigating the association between midwifes and maternal mortality showed that increasing the number of midwifes decrease it, but no significant association was found between the number of physicians and maternal mortality. Number of hospital beds also showed a direct association (significant at 10%). Conclusion: All of the variables to somehow are related with the level of development. In developed regions, per capita income, access to health resource and urbanization is higher and there is more equity in distribution of health resources. It could be concluded from the findings that by increasing the level of development, maternal mortality would decrease. Maternal Mortality, Iran, Poisson Regression, Panel Data http://jebhpme.ssu.ac.ir/article-1-144-en.html http://jebhpme.ssu.ac.ir/article-1-144-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 Organizational Determinants of Mental Health among Hospital Clinicians 91 99 FA Razieh Montazeralfaraj Department of Healthcare Management, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2 Hospital Management Research Renter, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N Zahra Mahmoodian Department of Healthcare Management, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N Hossein Fallahzadeh Biostatistics and Epidemiology Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N Mohammad Amin Bahrami Department of Healthcare Management, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2 Hospital Management Research Renter, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Y Background: Bringing the psychologically unhealthy personnel is one of the organizational damages and is considerable for organizations like the hospitals which deal with life and health of the people. This study was aimed to investigate the relationships of perceived organizational justice and quality of working life with mental health among hospital clinicians. Methods: This is an analytical and cross-sectional study done in 2015-2017.  A total of 423 clinical personnel of the chosen hospitals of Yazd province, Iran were selected via stratified sampling and participated in the study. Required data were gathered using Nihoff and Mormen (1993), Walton (1973) and Goldberg and Hiller (1979) questionnaires and were analyzed using the AMUS and SPSS22 and via structural equations method (SEM). Results: The results show that the perceived organizational justice affects mental health and quality of working life. Also the quality of working life affects the mental health. Conclusion: Findings show that organizations paying attention to the quality of working life and improving the fair behaviors enjoy psychologically healthier employees. Perceived Organizational Justice, Quality of Working Life, Mental Health, Hospital Clinicians http://jebhpme.ssu.ac.ir/article-1-145-en.html http://jebhpme.ssu.ac.ir/article-1-145-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 Correlation between Organizational Learning and Accreditation of Educational Care Centers: A Case Study in Ardabil 100 108 EN Hamed Zandian Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran N Yalda Chamanian Medical Education Development Center, Ardabil University of Medical Sciences, Ardabil, Iran N Telma Zahirian Moghadam Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran N Esmaeil Farzaneh Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran Y 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.   http://jebhpme.ssu.ac.ir/article-1-146-en.html http://jebhpme.ssu.ac.ir/article-1-146-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 The Relationship between the Distribution of General Practitioners and the Mortality Rate of Children Based on the Gini Coefficient and Lorenz Curve 109 114 EN Majid Hajimaghsoudi Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N Najmeh Baghian Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran , Iran N Mehdi Raadabadi Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Y Background: Equity is one of the most important issues in the distribution of resources and access to health services. Although it is very challenging to address health equity issues, it deeply affects policy making, resource allocation, and generally the legal principles of government and society. This study aimed to determine the inequality of distribution of general practitioner in Tehran province. Methods: This was an applied study that by ecological descriptive method investigated the relationship between the distribution of general practitioners and the mortality rate of children in the cities of Tehran province in 2012-2015. The data collection tool was a researcher-made form including the name of the city, the number of general practitioners, the mortality rate for children under five years old, and the population of each city. The STATA software with the DASP21 version 2.1 was used to draw the Lorenz curve. The SPSS19 software and Pearson correlation coefficient (P-value < 0.05) were utilized for analyzing data. Results: Based on the results the Gini coefficient for general practitioners was not significantly changed and was in a relatively equitable position, the Gini coefficient varied from 0.269 to 0.299. The results of the study did not show a significant relationship between the distribution of general practitioners and the mortality rate of children, although, with an increase in the ratio of general practitioners, the mortality rate of children decreased (P-value ≤ 0.05). Conclusion: The results of the study indicate that the distribution of general practitioners was relatively inequitable. Therefore, it is essential for the Ministry of Health to establish the balance in the distribution of the human resources General Practitioner, Gini Coefficient, Inequality http://jebhpme.ssu.ac.ir/article-1-148-en.html http://jebhpme.ssu.ac.ir/article-1-148-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 Time Series Analysis of Determinants of Health Care Expenditure in Iran: A Bound Test Cointegration Approach 115 124 EN Mohsen Bayati 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. N Mohammad Hossein Ziloochi Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran N Somayeh Delavari Department of Medical Education, School of Medical and Center for Educational Research in Medical Sciences(CERMS), Iran University of Medical Sciences, Tehran, Iran N Sajad Delavari Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Y 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. http://jebhpme.ssu.ac.ir/article-1-149-en.html http://jebhpme.ssu.ac.ir/article-1-149-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 Explicit Priority Setting Approaches in Health Care Coverage Policies: A Critical Review and Implications for Further Research 125 132 EN Mojtaba Nouhi Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran Y Mahdi Naderi Expert in Financial and Payment System, Office of Technology Assessment, Standardization and Health Tariffs, Deputy of Treatment, Ministry of Health and Medical Education, Tehran, Iran N Zahra Goudarzi Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran N Seyed Masood Mousavi Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran N Alireza Olyaeemanesh National Institute for Health Research, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran N 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. Coverage Decision Making, Critical Review, Evidence-Informed Deliberative Process, Priority Setting, Value Framework http://jebhpme.ssu.ac.ir/article-1-150-en.html http://jebhpme.ssu.ac.ir/article-1-150-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 2 2018 6 1 A New Costing System in Hospital Management: Time-Driven Activity Based Costing: A Narrative Review 133 140 EN Sina Etemadi Department of Health Services Management, School of Health, Bam University of Medical Sciences, Bam, Iran N Behzad Mohammadi Department of Health Services Management, School of Health, Bam University of Medical Sciences, Bam, Iran N Mohammad Javad Akbarian Bafghi Department of Health Services Management, School of Health, Bam University of Medical Sciences, Bam, Iran Y Marjan Hedayati Poor Department of Health Services Management, School of Health, Bam University of Medical Sciences, Bam, Iran N Mohammad Tasavon Gholamhoseini Department of Health Services Management, School of Management and Medical science, Kerman University of Medical Sciences, Kerman, Iran N Background: Changes in the hospital environment, technology, and service delivery as well as the increased share of overhead costs have motivated hospital managers to look for useful means of calculating costs. A key element of the health system success is the accurate computation of costs. Determining the exact costs enables managers and policymakers to make proper decisions with regard to optimal allocation of resources. This study explores the results of the activity-based costing model (ABC) and time-driven activity-based costing model (TDABC) in calculating the cost of diagnostic departments in hospitals. Methods: This was a narrative literature review paper. The data was gathered from the earliest documented scientific English and Persian articles, up to 2016, as well as relevant books based on keywords such as Activity Based Costing, Time-Driven Activity Based Costing and hospitals. Finally, a total of 543 studies were obtained after searching, then, to collect the relevant articles, the researchers considered a clear explanation of each part of articles about costing. Results: The results showed that the ABC system was unable to account for new issues, which is the reason researchers presented the new TDABC method. Some advantages of this system are its simple and updatable system, its usability in large and small companies for both simple and complex processes, economic evaluation of activities and performance assessment. Conclusion: The successful implementation of the TDABC model would provide an accurate cost report for goods and services, helping managers to evaluate the performance of diagnostic departments. Activity Based Costing, Costs, Hospital, Time-Driven Activity Based Costing http://jebhpme.ssu.ac.ir/article-1-151-en.html http://jebhpme.ssu.ac.ir/article-1-151-en.pdf