Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Basic Health Insurance Stewardship in Line with the Upstream Laws and Policies: Conflicts and Contradictions!!! 108 112 FA Ebrahim Jaafaripooyan Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Farnoosh Azizi Ph.D. student of Health Services Management, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Aida Asghari Ph.D. student of Health Services Management, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Maryam Babaei Aghbolagh Ph.D. student of Health Services Management, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran One of the serious challenges regarding interactions between Iran’s social security system and health system is basic health insurance stewardship. It has existed for a long time and has been given a special place concerning the related laws and policies in recent years. In this regard, it seems that approving of rules conflicting with upstream laws and policies has increased existing conflicts. This is done by creating ambiguity in the position of basic health insurance. But, it should not be forgotten that the main goal is universal health coverage and effective insurance protection against financial risks caused by illness. Therefore, any decision in these areas should be made with respect to the social, cultural, economic and political conditions of the country and according to the historical experiences and structural characteristics.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Evaluation of Technical Efficiency of Hospitals during COVID-19 Crisis: A Case Study of Kohgiloyeh and Boyer-Ahmad Hospitals 113 124 FA saman najafi MSc student in Health Economics, School of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran zahra meshkani Ph.D. of Health Economics, Management Sciences and Health Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Abdollah Poursmad Assistant Professor, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran mohsen barouni Associate Professor, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Background: Hospitals are the most important executive part of healthcare systems. During COVID-19 crisis, they faced a sudden demand, and spent the hospital resources and equipment in order to provide treatment services to COVID-19 patients. Considering that the provision of services was focused on these patients, the efficiency of hospitals during this crisis was not clear. The purpose of the current research is to investigate the efficiency of hospitals affiliated with Kohgiluyeh and Boyer Ahmad University of medical sciences, as well as the imaging units as the most important diagnostic department in the time of this pandemic. Methods: This was a quantitative and retrospective study which examining technical efficiency of 6 hospitals affiliated with Kohgiluyeh and Boyer Ahmad University of medical sciences. In addition, the technical efficiency of the imaging units (CT scan, radiology and ultrasound) in these hospitals was evaluated. Technical efficiency was calculated and compared through different scenarios based on different inputs and outputs during the pandemic. The model used in this research was multi-stage DEA. To analyze the data, the output maximization model and variable returns to scale were used. Relevant data were collected for a one-year period, from October 2020 to October 2021. Technical efficiency was calculated using Deap 2.1. Results: The average technical efficiency of the hospitals affiliated with Kohgiluyeh and Boyer Ahmad University of medical sciences during COVID-19 pandemic was 0.80 which was satisfactory. The average efficiency of CT scan, ultrasound and radiology units in the studied hospitals and based on the defined scenarios was 0.67, 0.44 and 0.40, respectively. This shows that the ultrasound and radiology units are far from efficient. Conclusion: The hospitals under study as well as CT scan units were efficient during COVID-19 crisis. Examining the efficiency of the returns compared to the scale showed that increasing the number of beds as well as the equipment would not increase efficiency. Paying attention to the needs of population under study and financing them accordingly, would lead to the financial efficiency of the hospitals.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Prioritization of COVID-19 Patients for Admission in the Intensive Care Unit in the Context of Hospital Bed Shortages: An Integrated Multi-criteria Decision Making Approach 125 139 FA Seyyed Mahdi Hosseini Sarkhosh Assistant Professor, Department of Industrial Engineering, School of Engineering, University of Garmsar, Garmsar, Iran Mahdieh Taghvaei Internal Medicine Specialist, Department of Internal Medicine, Shohadaye Pakdasht Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyyed Farshad Allameh Associate Professor, Department of Gastroenterology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Background: When an epidemic occurs, resources, including hospital beds, are severely limited and not all patients can be treated; so, hospital bed rationing is inevitable. Therefore, the aim of this study is to provide a method for evaluating and prioritizing patients with COVID-19 for admission to the intensive care unit. Methods: This was a descriptive-survey study in terms of data collection method conducted in the summer of 2021. Following the formation of an expert panel with 4 specialists, a three-stage approach to evaluating and prioritizing COVID-19 patients was adopted by combining multi-criteria decision analysis methods. In the first stage, effective criteria and sub-criteria for patients’ prioritization were identified by a panel of experts and related studies, and the hierarchy of criteria was drawn. In the second stage, the Fuzzy best-worst method was used to determine the weight of criteria and sub-criteria. Finally, in the third stage, a combined compromise solution method was performed to prioritize 10 patients in need of COVID-19 and the most critical patient was selected. Results: According to the experts, among the 15 criteria studied, respiratory rate, PaO2/FiO2, impaired consciousness, mean arterial pressure and age were identified as 5 of the most important criteria in prioritizing COVID-19 patients for intensive care unit admission. In addition, 10 COVID-19 patients referred to Shohadaye Pakdasht Hospital were evaluated and prioritized with the proposed approach. Conclusion: The proposed method can be used as a useful tool in the evaluation of COVID-19 patients for admission to the intensive care unit and to support the vital decisions of physicians.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Investigating the Relationship between Social Capital and Mental Health in the Provinces of Iran 140 151 FA sahebe mohammadian mansoor Assistants Professor, Department of Economics, Payam Noor University, Tehran, Iran abolghasem golkhandan Ph.D. of Public Sector Economics, School of Economics and Administrative Sciences, Lorestan University, Khoram Abad, Iran Background: Social capital has an effective role in promoting the mental health of people in the community by providing emotional and psychological support. Accordingly, the main purpose of this study is to investigate the effect of social capital on mental health in provinces of Iran. Methods: This was a descriptive-analytical and applied study. It investigated the long-term relationship between mental health index, social capital, per capita income, unemployment, education and urbanization from 2006 to 2019 using the panel data of Iran's provinces. The data used were collected from Central Bank and Statistics Center of Iran. For this purpose, based on Putnam and Colman's approach to measuring social capital, 3 levels of participation, trust and unity have been considered. In order to combine the indicators used in these levels, factor analysis method has been used. Model estimation was also conducted using the Generalized Method of Moment (GMM) and data analysis was performed using Eviews 9  and Stata 12 software. .Results: Based on the results obtained from the model estimation, increasing social capital will improve the mental health index in the provinces of the country in the long term. 1 percent increase in social capital in the long run, reduces the suicide rate in the provinces of the country by 0.27 percent. Based on other results, in the long term, per capita income and education have a positive and significant effect and the unemployment rate has a negative and significant effect on mental health in the provinces of the country. Conclusion: Based on the findings of this study, authors can conclude that the greater amount of social capital in the provinces of the country leads to higher mental health.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Knowledge Translation in Research Centers of Iranian Universities of Medical Sciences: Experience of Kerman University of Medical Sciences 152 162 FA Asma Saber Mahani Associate Professor, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran Vahid Yazdi-Feyzabadi Associate Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran salman bashzar Ph.D. student of Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Background: Despite significant expansion, indigenous research regarding health system still faces challenges in the field of research application. They include lack of reliable evidence, late arrival of evidence by policymakers or inappropriate language of evidence related to the field of knowledge exchange and translation. The aim of this study is to investigate the status of knowledge translation in research centers of Kerman University of Medical Sciences. Methods: This was a cross-sectional study conducted in 2020 in research centers affiliated with Kerman University of Medical Sciences. Centers entered the study through census and a standard questionnaire of self-assessment regarding knowledge-producing organizations was used. It contained 50 questions in 4 areas of research question, knowledge production, knowledge transfer and promotion of using evidence. After collecting and coding, the data were entered into SPSS 25 software and analyzed using descriptive statistics and non-parametric Mann-Whitney U test. Results: 20 clinical research centers and 6 non-clinical centers participated in this study. Only 3.85 % of the centers scored more than 80 % in total. Regarding the research question, knowledge production, knowledge transfer and promotion of using evidence, the mean standard deviation of scores were 35/85 ± 9/93, 31/50 ± 7/54, 76/65 ± 16/35 and 9/31 ± 3/27, respectively. The best situation was related to knowledge production with 70 % of the score. Findings of the Mann-Whitney U test showed that the mean of all domains in the two groups were not different. Conclusion: This study demonstrated a moderate level of knowledge translation. But, factors such as creating a structure for knowledge translation committee, considering the process of exchange, translation and transfer of knowledge in the process of approving student dissertations and research projects, reviewing research policies and creation of motivational mechanisms to promote the status of researchers can play an important facilitating role in achieving the appropriate level of knowledge exchange and translation.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Investigating the Relationship between Knowledge Management Criteria and the Level of Development in Medical Universities 163 171 FA Majid Mehrvarz Ph.D. student of Public Management, Department of Public Management, Kerman Branch, Islamic Azad University, Kerman, Iran shiva madahian Assistant Professor, Department of Public Management, Kerman Branch, Islamic Azad University, Kerman, Iran Zahra shokooh Assistant Professor, Department of Public Management, Kerman Branch, Islamic Azad University, Kerman, Iran sanjar Salajegheh Associate Professor, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Background: Knowledge management helps organizations to improve their capabilities using the intelligence and skills of employees. Knowledge management impacts the improvement of organizational performance and its development. Therefore, this study aimed to examine the relationship between knowledge management criteria and the level of development in medical universities. Methods: This was a descriptive, analytical, and cross-sectional study conducted in 2020. The statistical population was all the faculty members of medical universities with a sample size of 377 people. A multi-stage cluster sampling method was used. Data collection tools included Lawson’s knowledge management questionnaire and the development questionnaire of Andesh et al. whose validity and reliability were assessed and confirmed. The collected data were analyzed using SPSS 22 software through descriptive statistics (mean and standard deviation) and inferential statistics of univariate t-test and ANOVA. Results: Results showed that the mean score of knowledge management in medical universities was more than average. The highest and lowest mean were related to the dimensions of knowledge creation and knowledge storage, respectively. Furthermore, the mean of development was moderate to high. The highest and lowest mean were related to the dimensions of students' educational facilities and university's education and research facilities, respectively. In addition, there was a significant relationship between knowledge management and its dimensions, except for the knowledge creation dimension, and the level of development. Conclusion: The overall result of this study indicated that the development level in the country’s medical universities has been at a moderate to high level. Since knowledge management has a positive and significant effect on the development of universities, more attention to knowledge management can be useful in the universities’ development.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Assessment of Primary Healthcare System in Areas Covered by Family Physician Project in Southeastern Iran 172 180 FA khalil kalavani Ph.D. student of Healthcare Management, Student Research Committee, School of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran Zohreh Eskandarizadeh MSc in Healthcare Management, School of Management and Medical Information Sciences, Kerman University of Medical Sciences Kerman, Iran Reza Dehnavieh Professor, Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Background: Community's health depends on the primary healthcare sector of a country. In recent years, health systems have sought to assess the quality of services provided. Therefore, this study was conducted to evaluate the primary health care system with the Primary Care Assessment Tool (PCAT) in areas covered by the family physician in southeastern Iran. Methods: This was a descriptive-analytical study conducted cross-sectionally. It was performed on 330 recipients of services in health centers implementing the family physician project at Kerman, Bam, Jiroft and Rafsanjan Universities of Medical Sciences. The sampling method in this study was multistage. The instrument used in this study (PCAT) was based on the principles of primary care and is used as a tool to evaluate primary care. Data were analyzed using Kruskal-Wallis test in the SPSS 19 software. Results: The findings of this study were in 2 groups of adults and children according to the categorization of the questionnaire. Regarding adults, the highest average score of the questionnaire was related to first encounter - utilization in Jiroft University of Medical Sciences, first encounter - access in Bam University, continuity of care in Rafsanjan University, coordination in Jiroft University, coordination of information systems in Kerman, comprehensiveness of services available in Bam, comprehensiveness of services provided in Rafsanjan's family-oriented care in Kerman, community-oriented care in Kerman, and cultural aspects of care in Rafsanjan University of Medical Sciences. The difference between the average score in the dimension of the first encounter - utilization and the dimension of comprehensiveness of the services available in universities was significant (p < 0.05). In children, the highest average score was in the questionnaire is in the dimension of first encounter - utilization in Jiroft University of Medical Sciences, first encounter - access in Jiroft University, continuity of care in Rafsanjan University, coordination in Rafsanjan University, coordination of information systems in Kerman, comprehensiveness of services available in Rafsanjan. The comprehensiveness of services provided in Kerman, family-oriented care in Kerman, community-oriented care in Kerman, and cultural aspects of care in Jiroft University of Medical Sciences. The difference between the average score in the dimensions of the first encounter - utilization, coordination, coordination of information systems, comprehensiveness of available services, comprehensiveness of provided services, family-oriented care among universities was significant (p < 0.05). Conclusion: The present study demonstrated that various aspects of primary care in the areas covered by the family physician project in southeastern Iran had a relatively satisfactory status. The difference in the mean score of primary care in the studied universities shows that although the basic physical structures and hardware of the family physician program are available, it is crucial to provide the necessary facilities to maintain and improve the quality of services provided.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Comparison of the Effectiveness of Mindfulness-based Cognitive Therapy and Emotion-oriented Therapy on Psychological Well-being in Type 2 Diabetic Patients 181 191 FA maryam motakeffar Department of Health Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran maryam Maryam Bahrami Hidaji Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran Sheida Sodagar Department of Health Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran Najmeh Rahimi Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Background: Generally, patients with type 2 diabetes experience low level of psychological well-being, which may exacerbate their symptoms .Accordingly, the purpose of this study is the effectiveness of mindfulness-based cognitive therapy and emotion-oriented therapy on psychological well-being on type 2 diabetic patients. Methods: This experimental study was of the post-test, pre-test and follow-up type with a control group. The statistical population was all the people with type 2 diabetes who referred to Sabzevar Diabetes Clinic in 2019. 45 patients with type 2 diabetes were selected based on Kuhn table and through convenience sampling method. They were randomly placed in 3 groups of mindfulness-based cognitive therapy, emotion-oriented therapy and control. Data gathering tool was Reef psychological well-being questionnaire (2002). SPSS 24 software and descriptive and analytical statistics (covariance analysis) were used to analyze data. Results: The analysis of covariance showed that mindfulness-based cognitive therapy and emotion-oriented therapy were affective regarding the psychological well-being of type 2 diabetic patients (p < 0.05). The post hoc scores demonstrated that there was no significant relationship (p > 0.05) between mindfulness-based cognitive therapy and emotion-oriented therapy regarding their efficacy.  Conclusion: With respect to the wide variety of factors related to psychological well-being, authors can conclude that mindfulness-based cognitive therapy and emotion-oriented therapy can improve the psychological well-being of type 2 diabetic patients.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 7 2 2022 9 1 Dynamic Network Data Envelopment Analysis Model Usage in Measuring and Ranking the Financial Performance of Social Security Hospitals Based on their Size 192 205 FA Ali Akbar Moosavinezhadnaini Ph.D. student of Financial Management, Department of Management, Masjed-Soleiman Branch, Islamic Azad University, Masjed-Soleiman, Iran Mohammad Tamimi Assistant professor, Department of Accouting, Dezful Branch, Islamic Azad University, Dezful, Iran Allah Karam Salehi Assistant Professor, Department of Accouting, Masjed-Soleiman Branch, Islamic Azad University, Masjed-Soleiman, Iran Background: Measuring the hospitals financial performance in the health care system is of great importance. This is because hospitals with good financial performance can maintain reliable systems and provide necessary resources to improve quality. The aim of this study was to measure, compare and rank the financial performance of social security hospitals based on their size using a dynamic network data envelopment analysis model. Methods: This descriptive-analytical study was conducted using information sources in social security hospitals. Data were collected from financial statements from 2016 to 2019. The network efficiency analysis of the units was performed by GAMS 28 software. Results: According to the findings from 50 hospitals, among the hospitals with less than 100 active beds, the highest financial performance score belonged to Aras Ardabil hospital (0.79) and the lowest to Shabikhani Kashan hospital (0.24). Among the hospitals with 100 to 200 active beds, the highest financial performance score was obtained by Gharzi Malayer hospital (0.78) and the lowest by Imam Reza Islamshahr hospital (0.27). Imam Reza Urmia hospital with a score of 0.87 and Beheshti Shiraz hospital with a score of 0.39, achieved the highest and lowest financial performance in the dynamic network usage, among the hospitals with more than 200 active beds. Conclusion: Using the dynamic network data envelopment analysis model, the researchers measured the input and output of each decision-making unit over time. They also provided information about the system and internal structure in order to achieve overall efficiency. It is suggested that policymakers and hospital managers abandon the idea that a higher input rate determines a higher level of efficiency. They need to consider the compatibility of hospital size and internal structure in order to improve efficiency.