Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Have Health Human Resources Become More Equal Between Rural and Urban Areas after the New Reform?359360292810.15171/ijhpm.2014.129ENQianYangCenter for Health Policy Studies, Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou,
Zhejiang, ChinaHengjinDongCenter for Health Policy Studies, Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou,
Zhejiang, China0000-0002-5064-7297Journal Article20141103The lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before.https://www.ijhpm.com/article_2928_1929e17220efa360d096d2ef9805c484.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201On Health Policy and Management (HPAM): Mind the Theory-Policy-Practice Gap361363291910.15171/ijhpm.2014.122ENDavidChinitzHebrew University-Hadassah, Jerusalem, IsraelVictor GRodwinWagner School of Public
Service, New York University, New York, NY, USAJournal Article20140928We argue that the field of Health Policy and Management (HPAM) ought to confront the gap between theory, policy, and practice. Although there are perennial efforts to reform healthcare systems, the conceptual barriers are considerable and reflect the theory-policy-practice gap. We highlight four dimensions of the gap: 1) the dominance of microeconomic thinking in health policy analysis and design; 2) the lack of learning from management theory and comparative case studies; 3) the separation of HPAM from the rank and file of healthcare; and 4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking the field of HPAM by embracing broader perspectives, e.g. ethics, urban health, systems analysis and cross-national analyses of healthcare systems.https://www.ijhpm.com/article_2919_39cc81079e4f6a09446da27799778bd2.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Essential Drugs Production in Brazil, Russia, India, China and South Africa (BRICS): Opportunities and Challenges365370291710.15171/ijhpm.2014.118ENZoheirEzzianeHigher Colleges of Technology, Al Ain, UAEThe Wharton Entrepreneurship and Family Business Research Centre, University of Pennsylvania, CERT Technology Park, Abu Dhabi, UAEJournal Article20140711The objective of this work is to elucidate various essential drugs in the Brazil, Russia, India, China and South Africa (BRICS) countries. It discusses the opportunities and challenges of the existing biotech infrastructure and the production of drugs and vaccines in member states of the BRICS. This research is based on a systematic literature review between the years 2000 and 2014 of documents retrieved from the databases Embase, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organizations, research institutions and philanthropic organizations. Findings vary from one member state to another. These include useful comparison between the BRICS countries in terms of pharmaceuticals expenditure versus total health expenditure, local manufacturing of drugs/vaccines using technology and know-how transferred from developed countries, and biotech entrepreneurial collaborations under the umbrella of the BRICS region. This study concludes by providing recommendations to support more of inter collaborations among the BRICS countries as well as between BRICS and many developing countries to shrink drug production costs. In addition, this collaboration would also culminate in reaching out to poor countries that are not able to provide their communities and patients with cost-effective essential medicines.https://www.ijhpm.com/article_2917_93957259544ea86037d24ed55bc6d135.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Morality and Markets in the NHS371376292110.15171/ijhpm.2014.123ENBarnabas JGilbertHarvard University, Cambridge, MA, USAEmmaClarkeGreen Templeton College,
University of Oxford, Oxford, UKLaurenceLeaverGreen Templeton College,
University of Oxford, Oxford, UKJournal Article20140929Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.https://www.ijhpm.com/article_2921_bf419e7bacdf439fade685014bda81f7.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Factors Affecting Family Physicians’ Drug Prescribing: A Cross-Sectional Study in Khuzestan, Iran377381290210.15171/ijhpm.2014.103ENMohammadArabDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran0000-0002-5637-287XAminTorabi PourDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IranDepartment of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran0000-0002-8937-8004AbbasRahimifrooshaniDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IranArashRashidianDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran0000-0002-4005-5183NayebFadaiDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran0000-0002-8937-8004RoohollahAskariDepartment of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IranJournal Article20140507Background <br />Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians’ drug prescribing. <br /> <br />Methods <br />We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 324 urban and 97 rural family physicians) were selected randomly. A multivariate Poisson regression was used to investigate potential determinants of the number of prescribed drug per patient. <br /> <br />Results <br />The mean of medication per patient was 2.6 ± 1.2 items. In the majority (91.9%) of visits a drugs was prescribed. The most frequent dosage forms were tablets, syrups and injection in 30.1%, 26.9%, and 18.7% of cases respectively. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics were 29.7% and 17.1% of prescribed drugs respectively. The tablets were the most frequent dosage forms (38.6% of cases) in adult’s patients and syrups were the most frequent dosage forms (49% of cases) in less than 18 years old. Paracetamols were popular form of NSAIDs in two patients groups. The most common prescribed medications were oral form. <br /> <br />Conclusion <br />In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran.https://www.ijhpm.com/article_2902_848c9b74a26775dec8554fe781049540.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Cholecystectomy and Diagnosis-Related Groups (DRGs): Patient Classification and Hospital Reimbursement in 11 European Countries383391292010.15171/ijhpm.2014.121ENGerliPaat-AhiPRAXIS Centre for Policy Studies, Tallinn, EstoniaDepartment of Public
Health, University of Tartu, Tartu, EstoniaAinAaviksooPRAXIS Centre for Policy Studies, Tallinn, EstoniaTechnomedicum of TUT, Tallinn University of Technology, Tallinn, EstoniaMariaŚwiderekDepartment of City and Regional Management, Faculty of Management, University of Lodz, Lodz, PolandNational Health Fund, PolandJournal Article20140520Background <br />As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. <br /> <br />Methods <br />National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. <br /> <br />Results <br />European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. <br /> <br />Conclusion <br />Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.https://www.ijhpm.com/article_2920_1adfaf40fd69e21d1a9feeba435f17a5.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201‘Only Systems Thinking Can Improve Family Planning Program in Pakistan’: A Descriptive Qualitative Study393398292210.15171/ijhpm.2014.119ENSairaZafarHealth Systems & Policy Department, Health Services Academy, Islamabad, PakistanBabar TasneemShaikhHealth Systems & Policy Department, Health Services Academy, Islamabad, Pakistan0000-0002-2056-4132Journal Article20140602Background <br />Family Planning (FP) program in Pakistan has been struggling to achieve the desired indicators. Despite a well-timed initiation of the program in late 50s, fertility decline has been sparingly slow. As a result, rapid population growth is impeding economic development in the country. A high population growth rate, the current fertility rate, a stagnant contraceptive prevalence rate and high unmet need remain challenging targets for population policies and FP programs. To accelerate the pace of FP programs and targets concerned, it is imperative to develop and adopt a holistic approach and strategy for plugging the gaps in various components of the health system: service delivery, information systems, drugs-supplies, technology and logistics, Human Resources (HRs), financing, and governance. Hence, World Health Organization (WHO) health systems building blocks present a practical framework for overall health system strengthening. <br /> <br />Methods <br />This descriptive qualitative study, through 23 in-depth interviews, explored the factors related to the health system, and those responsible for a disappointing FP program in Pakistan. Provincial representatives from Population Welfare and Health departments, donor agencies and non-governmental organizations involved with FP programs were included in the study to document the perspective of all stakeholders. Content analysis was done manually to generate nodes, sub-nodes and themes. <br /> <br />Results <br />Performance of FP programs is not satisfactory as shown by the indicators, and these programs have not been able to deliver the desired outcomes. Interviewees agreed that inadequate prioritization given to the FP program by successive governments has led to this situation. There are issues with all health system areas, including governance, strategies, funding, financial management, service delivery systems, HRs, technology and logistic systems, and Management Information System (MIS); these have encumbered the pace of success of the program. All stakeholders need to join hands to complement efforts and to capitalize on each other’s strengths, plugging the gaps in all the components of FP programming. <br /> <br />Conclusion <br />All WHO health system building blocks are interrelated and need to be strengthened, if the demographic targets are to be achieved. With this approach, the health system shall be capable of delivering fair and responsive FP services.https://www.ijhpm.com/article_2922_0c50c9470275bdf35d19b8874bf3df19.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean Countries399407292410.15171/ijhpm.2014.124ENFadiEl-JardaliDepartment of Health Management and Policy, American University of Beirut,
Beirut, LebanonKnowledge to Policy (K2P) Center, Faculty of Health Sciences,
American University of Beirut, Beirut, LebanonCenter for Systematic Reviews
of Health Policy and Systems Research (SPARK), American University of
Beirut, Beirut, LebanonResearch, Advocacy and Public Policy-Making, Issam
Fares Institute for Public Policy and International Affairs, American University of Beirut, Beirut, LebanonDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada0000-0002-4084-6524TaghreedAdamAlliance for Health Policy and
Systems Research, World Health Organization, Geneva, SwitzerlandNourAtayaDepartment of Health Management and Policy, American University of Beirut,
Beirut, LebanonDianaJamalDepartment of Health Management and Policy, American University of Beirut,
Beirut, LebanonKnowledge to Policy (K2P) Center, Faculty of Health Sciences,
American University of Beirut, Beirut, Lebanon0000-0002-1852-1643MahaJaafarDepartment of Health Management and Policy, American University of Beirut,
Beirut, LebanonJournal Article20140718Background <br />Systems Thinking (ST) has recently been promoted as an important approach to health systems strengthening. However, ST is not common practice, particularly in Low- and Middle-Income Countries (LMICs). This paper seeks to explore the barriers that may hinder its application in the Eastern Mediterranean Region (EMR) and possible strategies to mitigate them. <br /> <br />Methods <br />A survey consisting of open-ended questions was conducted with a purposive sample of health policymakers such as senior officials from the Ministry of Health (MoH), researchers, and other stakeholders such as civil society groups and professional associations from ten countries in the region. A total of 62 respondents participated in the study. Thematic analysis was conducted. <br /> <br />Results <br />There was strong recognition of the relevance and usefulness of ST to health systems policy-making and research, although misconceptions about what ST means were also identified. Experience with applying ST was very limited. Approaches to designing health policies in the EMR were perceived as reactive and fragmented (66%). Commonly perceived constraints to application of ST were: a perceived notion of its costliness combined with lack of the necessary funding to operationalize it (53%), competing political interests and lack of government accountability (50%), lack of awareness about relevance and value (47%), limited capacity to apply it (45%), and difficulty in coordinating and managing stakeholders (39%). <br /> <br />Conclusion <br />While several strategies have been proposed to mitigate most of these constraints, they emphasized the importance of political endorsement and adoption of ST at the leadership level, together with building the necessary capacity to apply it and apply the learning in research and practice.https://www.ijhpm.com/article_2924_1c7862be2a2460f19ec87df5e9c49db3.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201On the Cost of Shame; Comment on “Nudging by Shaming, Shaming by Nudging”409411292310.15171/ijhpm.2014.125ENEmmaTieffenbachSwiss Center for Affective Sciences, University of Geneva, Geneva, SwitzerlandJournal Article20140915In his editorial, Nir Eyal argues that a nudge can exploit our propensity to feel shame in order to steer us toward certain choices. We object that shame is a cost and therefore cannot figure in the apparatus of a nudge.https://www.ijhpm.com/article_2923_c5434349d7d9eedf2a8674300923a7e2.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Localization of Determinants of Fertility through Measurement Adaptations in Developing-Country Settings: The Case of Iran; Comment on “Analysis of Economic Determinants of Fertility in Iran: A Multilevel Approach”413415292610.15171/ijhpm.2014.127ENAmirErfaniDepartment of Sociology, Nipissing University, North Bay, Ontario, CanadaJournal Article20141021Studies investigating fertility decline in developing countries often adopt measures of determinants of fertility behavior developed based on observations from developed countries, without adapting them to the realities of the study setting. As a result, their findings are usually invalid, anomalous or statistically non-significant. This commentary draws on the research article by Moeeni and colleagues, as an exemplary work which has not adapted measures of two key economic determinants of fertility behavior, namely gender inequality and opportunity costs of childbearing, to the realities of Iran’s economy. Measurement adaptations that can improve the study are discussed.https://www.ijhpm.com/article_2926_9ed3515e5981cba70d6cbf5821175d81.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59393720141201Preventing the Emergence of Ebola Disease in Unaffected Countries: Necessity of Preparedness417418291410.15171/ijhpm.2014.117ENSaurabh RamBihariLalShrivastavaDepartment of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, TamilNadu, India0000-0001-6102-7475Prateek SaurabhShrivastavaDepartment of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, TamilNadu, India0000-0001-5290-6312JegadeeshRamasamyDepartment of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, TamilNadu, IndiaJournal Article20141031https://www.ijhpm.com/article_2914_7d519d2a3efdce4be2ee502c65ac21b2.pdf