Abdolvahed Khodamoradi

Bio: Abdolvahed Khodamoradi is an academic researcher from Tehran University of Medical Sciences. The author has contributed to research in topics: Health care & Payment. The author has an hindex of 3, co-authored 6 publications receiving 29 citations.

A systematic review of empirical studies on methodology and burden of informal patient payments in health systems

Abstract: SummaryIntroduction Informal patients' payments (IPPs) is a sensitive subject. The aim of current study was to assess the trends in informal payment studies and explore methods of IPPs measurement, prevalence, and features (payment type, volume, and receiver) in various contexts. Methods A search strategy was developed to identify peer-reviewed articles addressing informal payments on PubMed, Science Direct, Web of Science, Scopus, and CINAHL. A total of 1252 studies were identified initially. After screening process, 38 studies were included in the systematic review. The selected studies were appraised, and findings were synthesized. Result Among selected studies, quantitative approaches were mostly used for measuring IPPs from general public and patients' perspective, and qualitative methods mainly targeted health care providers. Reported IPP prevalence in selected articles ranges between 2% and 80%, more prevalent in the inpatient sector than in outpatient. Conclusion There are a number of strategies for the measurement of IPPs with different strengths and weaknesses. Most applied strategies for general public were quantitative surveys recruiting more than 1000 participants using a face-to-face structured interview, and then qualitative studies on less than 150 health care providers, with focus group discussion. This review provides a comprehensive picture of current informal patients' payments measurement tools, which helps researchers in future investigations.

The trend of population aging and planning of health services for the elderly: A review study

Abstract: :شزیذپ خیرات هدیکچ هنیمس :فده و یکی ٍب نادىملاس تیعمج شیاشفا ٌدیدپ ٌسيزما شلاچ سا ماظو یدج یاَ تمتاس یااَ .تسا ٌدش لیدبت دازفا هیا سایو درًم تمتس تامدخ هیمات تُج سا یزیًارت ٍا ارا اٍالاام هایا سا فدَ ٍماوزب هیيدت ي نازیا ي ناُج رد نادىملاس تیعمج دشر دوير یشایر ي ااَ تاسایس ٍا ارا یازاب مسز یااَ عمج سا زشق هیا یازب یوامرد ي یتشادُب تامدخ یم تی .دشاب شور :اه یريزم ٍعلاطم کی ٍلاام هیا یدىملاس صًرخ رد .تسا ًاضًم اب طبتزم تزاام کاواب رد یتاعتطا EMBASE ا Google Scholar ا Scopus ي PubMed رد .داش شازاتاسا ي ییااساىش ٌداد لیلحت ي شازاتسا ٌدش فیزعت شيزخ ي ديري یاَرایعم ٍب ٍجًت اب دعب ٍلحزم آ یير زب اَ ترًاو ااُو .تفزگ :جیاتن داد ناشو اَ ٍتفای تیعمج ٍک ناُج ٍب تعزس لاح رد دىملاس ندش تسا شیپ ي یم یىیب سا دًش ديدح 5 / 10 لاس رد تیعمج % 2002 ديدح ٍب 8 / 22 لاس رد % 2050 داوير شایو نازایا رد .دبای شیاشفا رد ٍک تسا نآ سا یکاح یتیعمج تازییغت هیب ٌيزگ یاَ افلتام یىس هیزتاشیب زاو داشر ٍاب ًابزم شیپ .تسا نادىملاس یم یىیب لاس رد دًش 2050 ا 21 .دىَد لیکشت نادىملاس ار ناُج تیعمج % هجیتن :یزیگ افح رًشک رد دىملاس تیعمج نيشفا سير دشر ٍب ٍجًت اب دًابُب ي تیعاضي تمتاس ي

Evaluation of informal payments to health care professionals and the influential factors in Urmia city hospitals, Iran.

Abstract: Informal payments refer to sums that patients may pay to individual or organizational health care providers outside of the official payment channels or approved fee schedules. The aim of the current research was to investigate informal payments and related influential factors in Urmia city hospitals. The present study was a cross-sectional survey conducted among post-discharged patients from all Urmia city hospitals during one Iranian calendar month (January 21 to March 19, 2013). Simple random sampling was used to recruit 265 patients to undergo assessment via phone call interviews and complete a questionnaire. Data analysis was performed using SPSS software for descriptive reports, and EViews software for determination of factors affecting informal payments. Eleven percent of the patients had made informal payments to physicians (mean amount: 503,000 Tomans, equivalent of $412), 5% to nurses (mean amount: 20,000 Tomans, equivalent of $16), and 17% to other employees (mean amount: 16,000 Tomans, equivalent of $13). Hospital ownership, patients' place of residence, education and income significantly influenced the payments. Most substantially, patients receiving surgical care were 100 times more likely to make informal payments compared to those who had received non-surgical inpatient care. The present study showed that although informal payment is illegal in Iran, it is a common practice among hospitalized patients, and has now become a challenge for the health system. Considering the high prevalence of informal payments and their severe impacts on equity and justice, policymakers have focused on this phenomenon to reduce and eliminate it.

Measuring Equity in Iranian Healthcare System Financing: Experiences of Recent Health Reform Plan

Abstract: Background and objectives: 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. Method: 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. Findings: 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.

Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches

Abstract: Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage.Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability.Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector.Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise.Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.

The sustainable development goals as a framework to combat health-sector corruption.

Abstract: Corruption is diverse in its forms and embedded in health systems worldwide. Health-sector corruption directly impedes progress towards universal health coverage by inhibiting people’s access to quality health services and to safe and effective medicines, and undermining systems for financial risk protection. Corruption is also a cross-cutting theme in the United Nations’ sustainable development goals (SDGs) which aim to improve population health, promote justice and strong institutions and advance sustainable human development. To address health-sector corruption, we need to identify how it happens, collect evidence on its impact and develop frameworks to assess the potential risks and put in place protective measures. We propose that the SDGs can be leveraged to develop a new approach to anti-corruption governance in the health sector. The aim will be to address coordination across the jurisdictions of different countries and foster partnerships among stakeholders to adopt coherent policies and anti-corruption best practices at all levels. Combating corruption requires a focused and invigorated political will, better advocacy and stronger institutions. There is no single solution to the problem. Nevertheless, a commitment to controlling corruption via the SDGs will better ensure the integrity of global health and human development now and beyond 2030.

A critical interpretive synthesis of informal payments in maternal health care

Abstract: Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. These include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care. Similarly, there are proximal and distal impacts, including on household finances, patient satisfaction and provider morale. Informal payments have been studied and addressed from a variety of different perspectives, including anti-corruption, ethnographic and other in-depth qualitative approaches and econometric modelling. Summarizing and discussing the advantages and disadvantages of these and other paradigms illustrates the value of an inter-disciplinary approach. The same tacit, hidden attributes that make informal payments hard to measure also make them hard to discuss and address. A multidisciplinary health systems approach that leverages and integrates positivist, interpretivist and constructivist tools of social science research can lead to better insight. With this, we can challenge 'master narratives' and meet universalistic, equity-oriented global health objectives.

New insight into the informal patients' payments on the evidence of literature: a systematic review study.

Abstract: Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. Themes related to informal payments in external context of health system were demographic features of health service consumers, patient’s personality features and social & cultural backgrounds of the community. Health system challenges’ themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources’ organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems’ goals and policies should be investigated due to the consideration.

Health informal payments and their main determinants: The case of Iran:

Abstract: Introduction:Informal payments are a serious obstacle to equitable access and universal health coverage in developing countries. This study aimed to identify the most important factors affecting he...