Farhad Habibi Nodeh, Ibrahim Jafari Pooyan, Iraj Harirchi, Mohamad Arab,
Volume 31, Issue 1 (1-2017)
Abstract
Background: Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran’s health system.
Methods: Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and English-language databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts.
Results: Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran’s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural).
Conclusion: The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.
Asma Shafaeipour, Mohammad Shirkhoda, Mohammad Yasin Karami, Fatemeh Moosaie, Amirmohsen Jalaeefar, Maziar Motiee-Langroudi, Iraj Harirchi,
Volume 38, Issue 1 (1-2024)
Abstract
Background: The COVID-19 pandemic brought significant challenges for oncology centers and cancer patients, necessitating the implementation of various preventive and restrictive protocols and postponing elective surgeries. We aimed to assess and compare tumor characteristics, including the size, metastasis, and duration of hospitalizations between the periods before and during COVID-19 in patients with thyroid cancer.
Methods: The present cross-sectional study was performed at The Institute of Cancer, Tehran University of Medical Sciences, with 143 patients observed 2 years before the pandemic and 92 during March 2020 and March 2022. Clinical and pathological tumor characteristics were compared between the 2 groups, including surgical details, hospitalization and intensive care unit (ICU) admission durations, time intervals between diagnoses and surgeries, and various metastatic factors. All data were analyzed using SPSS software 21. The chi-square test was used for the statistical analysis of qualitative data, and the t test was used for the statistical analysis of continuous data. P < 0.05 was considered statistically significant.
Results: The most frequent tumor type was papillary thyroid cancer (134 [93.7%] and 82 [89.13%]; P = 0.209). The right lobe was the most prevalent tumor site both before and during COVID-19, respectively (55 [38.5%] and 29 [31.5%]; P = 0.278). Central (64 [50.8%] and 62 [49.2%]; P < 0.001), and lateral (45 [34.5%] and 45 [48.9 %]; P = 0.045) lymph node metastasis in the first surgery and recurrence (P = 0.006 and P = 0.022, respectively) were significantly higher in patients admitted during the COVID-19 pandemic, respectively. The mean interval between the first surgery and subsequent surgery due to recurrence (P < 0.001), duration of ICU admission (P = 0.010), and hospitalization after the second operation were significantly lower during the pandemic (P = 0.006).
Conclusion: During the COVID-19 pandemic, patients exhibited larger tumors, increased lymph node metastasis, and shorter intervals between surgeries. This underscores the need for healthcare decision-makers to implement effective thyroid cancer management strategies in future outbreaks.
Our study stands out by analyzing hospitalization and ICU admissions and duration for each patient, unlike any other study. Moreover, we extended our observation period beyond the typical duration found in most of the literature.
