Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Medical strategies for Disease Covid-19 80 84 FA Hosein Aliahmadi Jeshfaghni Assistant Professor, Department of Science and Technology Policy, School of Progress Engineering, Iran University of Science and Technology, Tehran, Iran Following the outbreak of Covid-19, many related studies were published rapidly around the world. In this study, we examined published or in-publication studies over the strategies to deal with Covid-19. To this end, 16 published scientific papers were investigated using content analysis and meta-analysis. As a result, 16 medical strategies and 3 macro-management strategies were extracted. Finally, some practical suggestions were reported. Based on the results, the main strategies in the studies included medical strategies, while general management strategies were considered rarely.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Assessment of Health Budget during the First to Fifth Socioeconomic Developmental Programs in Iran 85 88 FA Mahboubeh Neamatshahi Assistant Professor, Department of Community Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Hossein Ebrahimipou Professor, Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran zahra keyvanlo MSc in Health Services Management, Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran Mohammad Khajedaluee Professor, Department of Community and Family Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Aghil Keykhosravi Assistant Professor, Department of Pediatrics, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Health is the most important and expensive components of the socioeconomic development in social development of any country. In each country, the economic resources are annually allocated to various sections of the industry, agriculture, health, and etc. The health budget is due to the views and priorities of the policy makers and planners in any country. This study evaluated the health budget trend and allocation of the total budget to it during the first to fourth socioeconomic developmental programs. This study focused on the analysis of the health policies. The collected data were based on the books “Law of the country budget" in four socioeconomic developmental programs. The allocated percentage to health and the growth trend of total and health budgets were calculated during the fifth developmental programs. All three budgets in the total and health areas have increased in five programs except in the last year of the fourth program. The allocated budget to the health from total budget in industry, agriculture, and etc. was decreased from 5.99 % in the first program to 0.81 % in the fourth socioeconomic developmental program but it increased in the fifth program. Despite the growth in health budget from the first to the fourth program, the allocated budget to health was constantly decreasing compared to the other sections such as industry and so on. Therefore, policy makers and planners should pay more attention to allocation of resources to health.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Investigation of Nonlinear Effects of Health Tourism on Iran's Economic Growth: Self-regression approach with distributive intervals 89 100 FA Jafar Haghighat Professor, Department of Economic Sciences, School of Economic and Management, University of Tabriz, Tabriz, Iran Sara Masoomzadeh Ph.D. student of Economic Sciences, School of economic and management, University of Tabriz, Tabriz, Iran Background: Since oil is not a sustainable source of income for oil-rich countries, economic planners have focused on non-oil sources of income. In this regard, the tourism industry is one of the most lucrative industries in the world.Tourism includes services that have a great impact on economic and social activities. Health tourism is one of the most important areas of the tourism industry. So, the aim of this study was to investigate the effect of health tourism shocks on economic growth in 2005-17 using the self-regression approach with distributive intervals. Methods: In this applied analytical research, the required statistics and information in terms of logarithm were collected through documentary and library methods from 2005 to 2017. Results: The experimental findings of the present study showed that the short term increase in the number of health tourists had a positive effect on the country's economic growth. The decreased number of health tourists also led to a decrease in the country's economic growth. The effective exchange rates and the number of medical services providers to tourists had negative and positive effects on the country's economic growth, respectively. In the long run, increased number of health tourists had a positive effect on economic growth, while a decrease in the number of health tourists had a negative effect on economic growth. The exchange rate and the number of health service providers to tourists had negative and positive effects on economic growth. Conclusion: Both in the short- and long-term, entry of health tourists has a positive effect on the country's economic growth. So, authorities are recommended to invest in this area to provide better services to health tourists on the economic planners and policymakers' agenda.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 The Role of Hospital Service Quality and Informing System in Patients' Willingness to Pay with Mediation of Satisfaction 101 110 FA Ghasem Zarei Associate Professor, Department of Management, School of Literature and Humanities, University of Mohaghegh Ardabili, Ardabil, Iran Hajieh Ghorbani Ardahaei MA student in Accounting, School of Humanities, Islamic Azad University of Sarab, Sarab, Iran Background: The willingness to pay is criteria criterion for measuring the patients' interest to continue their relationship with health centers. The main purpose of this study was to determine the effect of service quality and informing system of hospitals on the patient's willingness to pay with mediating role of patient satisfaction. Methods: This is an applied survey. The statistical population of this study consisted of all patients referring to Imam Khomeini Hospital in Sarab City during the first six months of 2019. Random sampling method was applied and 390 questionnaires were distributed among the patients. Data gathering tools included researcher made questionnaire with confirmed validity and reliability. Experts’ opinion and confirmatory factor analysis were used to confirm the validity. Cronbach's alpha method and combined reliability coefficient were used for reliability. Data were analyzed using structural equation modeling (SEM) test by partial least squares method. To analyze the data, SPSS 20 and Smart PLS 3 software were used. Results: Among the distributed questionnaires, 300 ones were completed and returned. According to the descriptive statistics, mean score of service quality, hospital information system, patient satisfaction, and willingness to pay were 2.98, 2.81, 3.44, and 2.67, respectively. The results obtained from the inferential analysis showed that the quality of services had a significant effect on patients’ satisfaction and willingness to pay. Moreover, the information system had a significant effect on patients’ satisfaction and patients' satisfaction had a significant effect on the willingness to pay. The impact of the information system on the willingness to pay was not confirmed. Conclusion:  Based on the findings, changes in the quality of hospital informing system and service quality with the mediating role of patients’ satisfaction affected their willingness to pay.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Identifying the Executive Challenges of the New Generation of Hospital Accreditation in Iran 111 125 FA Habibeh Khoshamooz Ph.D. student of Public Administration, School of Management and Accounting, Islamic Azad University, Rasht Branch, Rasht, Iran Mehrdad Goudarzvand chegini Professor, Department of Public Administration, School of Management and Accounting, Islamic Azad University, Rasht Branch, Rasht, Iran Hamidreza Rezaee Kelidbari استادیار، گروه مدیریت دولتی، دانشکده مدیریت و حسابداری، دانشگاه آزاد اسلامی، واحد رشت، رشت، ایران Background: Given that hospitals are one of the pillars of the health system, reforming the health system is not possible without improving the performance of hospitals. Accreditation is a regular assessment of hospitals that emphasizes on continuous quality improvement and patient safety. This study aimed to identify the challenges of the new generation of hospital accreditation using the Three-Branch Model and proposing solutions to improve its effectiveness. Method: This mixed exploratory research was conducted using a targeted sampling method of 20 semi-structured interviews along with a content analysis approach. As a result, an initial model was designed. Later, the initial model was modified using the Delphi technique, which was also approved by experts. In order to test the model, a researcher-made questionnaire was distributed among 384 hospital staff based on Morgan's table using stratified quota sampling method. Data were analyzed by confirmatory factor analysis using Smart PlS 3 software. Results: After analyzing and combining, the data were categorized under 31 basic codes, 5 concepts, and 3 main categories by Three-branch Model. The main codes included behavioral challenges, structural challenges, and contextual challenges. Conclusion: According to the findings, the main challenge was related to the behavioral category followed by the structural category, which indiates that the current focus is on intra-organizational issues. Therefore, it can be said that the contextual challenges have received less attention.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Validity and reliability of the Persian version of health-labour questionnaire in Traffic Accident Injured Referring to Hospitals affiliated with Mashhad University of Medical Sciences 126 142 FA Hossein Ebrahimipour Professor, Social Determinate Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Aliasghar Kiadaliri Associate Professor, Department of Clinical Epidemiology, School of Medicine, Lund University of Sweden, Lund, Sweden Hamid Heidarian Miri Assistant Professor, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Mehdi Yousefi Associate Professor, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Mehdi Ariafar MSc in Health Services Management, School of Health, Social Determinate Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Zahra Keyvanlo MSc in Health Services Management, Non-Communicable Diseases Research Center , Sabzevar University of Medical Sciences, Sabzevar, Iran Background: Health- Labour Questionnaire (SF-HLQ) is a measurement instrument for collecting the quantitative data on the relationship between disease and functional status of individuals of productivity losses related to health problems in individuals with paid or unpaid work. Since road traffic injuries are the leading cause of death for disability in the world. In this regard, we aimed to report on validity and reliability of the Persian version of Health- Labour questionnaire in assessing Productivity losses of the Road Traffic Injuries. Methods: In this cross-sectional study, a sample of 30 injured of traffic accident referring to hospitals affiliated with Mashhad University of Medical Sciences were randomly selected. Samples were evaluated in 2 stages and have been interviewed following 1 month by using the health- labour questionnaire and their loss of productivity was calculated by telephone. Face and content validity was performed by 5 health management and economics specialists and 10 students of Master's Degree of Health Services Management and their opinions were applied.  To determine the content validity of the questionnaire, content validity ratio (CVR) and content validity index (CVI) were used, and to determine reliability, Coefficient Correlation Interclass (ICC) for quantitative variables and kappa coefficient of agreement were used to evaluate the reliability of the nominal questions and SPSS 21 software used for data analysis. Results: CVI and CVR were calculated at 0.79- 0.49, Respectively, which is acceptable for this questionnaire. Intra-class Correlation Coefficient and Confidence interval in both lost productivity and lost working day variables were 0.99 (0.98-0.99) and 0.96 (0.93-0.98) respectively. Kappa coefficient of agreement for nominal questions was 0.99. Conclusion: The results of this study showed that the translated version of the health-labour questionnaire had presented excellent validity and reliability in assessing productivity loss in traffic incident patients.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Factors Affecting Induced Demand in Iran's Health System: A Qualitative Study 143 154 FA Hamed Asgari Ph.D. student of Health Services Management, Semnan Branch, Islamic Azad University, Semnan, Iran Nader Khalesi Associate Professor, Department of Health Services Management, Semnan Branch, Islamic Azad University, Semnan, Iran Amir Ashkan Nasiripour Associate Professor, Health Economics Policy Research Center, Islamic Azad University of Medical Sciences, Tehran, Iran Reza Ziyari Assistant Professor, Department of Economics, Semnan Branch, Islamic Azad University, Semnan, Iran Background: Induced demand is defined as the sale of unnecessary services to patients by exercising power and ordering health stakeholders. The purpose of this study is to identify and provide a comprehensive framework of factors affecting the inductive demand in the Iranian health system from the perspective of experts and specialists. Methods: In terms of the type of study, the research was a qualitative content analysis from 2014 to 2018. 14 articles from Iranian data and 101 articles from global citation databases were selected, and 20 related articles were selected according to the purpose of the research. By carefully studying them by qualitative analysis method, a list of main and sub-factors and components of induced demand were identified. Then, the list was modified with the opinions of a group of experts, and the final list was obtained. Results: The final results of the initial analysis and the opinions of experts and experts in relation to the factors affecting the induced demand in the 5 main categories of fundamental, social, organizational structure, economic, stakeholders, and 18 sub-categories and 82 factors were identified and presented. Conclusion: Summarizing the findings of this study shows that due to the expansion and multiplicity of factors and the complex nature of the induced demand phenomenon in the health system, only by identifying the relevant factors can its harmful effects be controlled.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 5 2 2020 9 1 Comparing Iran's Healthcare System Efficiency with OECD Countries Using Data Envelopment Analysis 155 164 FA Hamed Seddighi Ph.D. student of Social Welfare, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Farhad Nosrati Nejad Assistant Professor, Department of Social Welfare Management, School of Educational Sciences and Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Mehdi Basakha Assistant Professor, Department of Social Welfare Management, School of Educational Sciences and Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Background: The health sector is one of the most important service sectors and one of the indicators of development and social welfare. The aim of this study is to evaluate the efficiency of Iran's health system compared to developed countries. Methods: This study used data envelopment analysis to evaluate efficiency. All members of the Organization for Economic Co-operation and Development (OECD), along with Iran, were considered as the decision units in the analysis. Outputs are life expectancy at birth and infant mortality rate; and inputs are health expenditure, number of physicians, and number of hospital beds. DEA Solver software was used for the analysis. Results: The most efficient countries in terms of the health system are Canada, Chile, Estonia, Iceland, Ireland, Israel, Japan, South Korea, Latvia, Luxembourg, Mexico, Slovenia, Spain, Switzerland, Turkey, and Iran. Their inefficiency was calculated using the axial output model. The most inefficient countries were Portugal, Germany, the United States, Poland, the Czech Republic, Slovakia and Hungary. Conclusion: Iran's health system was found efficient, which showed that in terms of life expectancy and infant mortality rate (2 important markers of the health system), Iran performed efficiently comparing to its inputs, health expenditures, physicians, and the hospital bed. However, the Iranian health system was more efficient in this method due to the fewer inputs (physician and hospital bed) with similar outputs to other countries (life expectancy and infant mortality rate). On the other hand, the outbreak of the coronavirus showed that the health systems of the countries should be prepared for such pandemics and be able to increase the number of hospital beds, physicians, and other health system inputs.