Medical Journal of The Islamic Republic of Iran (MJIRI)

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  Abstract

  Background: Traumatic or congenital events can result in injury and functional

  deficiency in the hand and we need to reconstruct the fingers at times. Studies are

  available in the pediatric and adult age groups to assess the length of the thumb. But

  to the best our knowledge no measurement of the relative clinical length of all fingers

  has been reported in the literature. We performed this study to assess the clinical relative lengths of the fingers of the human hand by using surface landmarks.

  Methods: Fifty male and fifty female healthy participants were involved in the

  study. We assessed the distances between the tips of fingers from the distal wrist

  crease while the thumb and other fingers were held in adducted position. We also assessed the ratio of all fingers including the thumb to the middle finger.

  Results: One hundred normal hands in 100 healthy volunteers were included in

  the study, 50 women and 50 men the average age was 32(20- 50) years. The distance

  of tips of fingers from distal wrist crease were 93.6(86-120), 156.4 (142-185), 166.9

  (150-200), 156.3(150-188), 132.4(114-168) millimeter in females respectively for

  the first to the fifths fingers and the same figures for male participants were

  107.9(102-121),170.6(153-191),182.6(166-204),172.2(158-193),144.1(129-168)

  millimeter. The ratios of first, second, fourth and fifth fingers to the middle finger

  were 60 %, 94 %, 95 %, 79 % for males respectively and 59 %, 94 %, 94 %, 78 % for

  females.

  Conclusion: The authors believe that, the relative length of fingers can help the

  surgeon to decide confidently in the reconstruction of hand and fingers because this

  method is simple and easy use.

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Background: Since approximately 45% of basic health insurance (BHI) resources are spent and distributed based on the Relative Value of Health Services (RVHS) book, therefore, any revision in this book will most probably affect the behavior of health insurance organizations. The present study was prospected to determine the effect of revising RVHS on behavior of BHI funds as the main providers of treatment resources. 
   Methods: This is a qualitative study in which data were analyzed using content analysis method.  Semi-structured interviews were used to gather the required data. 27 interviewees were chosen using purposive sampling method. Finally, MAXQDA software was used to analyze and code the data.
   Results: According to the results, revision of RVHS influenced the behavior of health insurance organizations. The most important changes in the behavior of health insurance funds involved the following: formation of a committee for cost management and handling the insurance documents, creating a uniform coding system for health services, redesigning the handling process of documents, increased share of insurance funds from health expenditures, with 300 new services added to basic package and revising the package according to the new version of the book. Furthermore, the rest of the changes included in the global payment method based on the new book, delay in paying claims, increased deductions based on the payment of expensive services on treatment protocols, holding periodic training courses, and teaching the new book as well as the procedures for handling the documents.     
   Conclusion: With regard to the revision of RVHS and considering the incremental approach in revision of relative values, the increased claims of health services delivery centers and delay in payment of these claims were the most important changes in the behavior of health insurance funds. Health policy makers can overcome such issues and provide proper financial conditions through reduction of conversion factor and mobilization of resources. Such policies will open the space for best management of the behaviors affected by revision of relative values.

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Background: Developing countries, such as Iran, have been struggling with high rates of insurance deduction. As part of the Health Transformation Plan (HTP) in Iran, a new reference book was introduced to update the medical tariffs. This study aimed to compare the rates and extent of insurance deductions before and after HTP in Iran’s public hospitals.
   Methods: This was a quasi-experimental study. Overall, 400 medical bills were selected from Iran’s national Health Information System using multilevel random sampling before and after HTP implementation (2014 and 2017). Insurance deductions were divided into 5 groups: (1) diagnostic procedures, (2) medication and medical appliances, (3) accommodation and human capital provision, (4) surgery, and (5) other services. Using STATA Version 14.0, independent t test and Fisher’s exact test were used for data analysis. Significance level was set at 0.5.
   Results: There was a significant decrease in insurance deductions among Iran’s Health Insurance (HI) and Social Security Insurance (SSI). Accordingly, before HTP, the average amount of insurance deductions was 58.9% and 71.3% in HI and SSI, respectively. Moreover, there was a significant decline in all 5 groups between the pre- and postimplementation of HTP (p<0.05). Based on the results, hospitalization time (OR=2.31, 95% CI=1.9-3.2), patients in general hospitals (OR=1.49, 95% CI=1.4-2.7), coverage by SSI (OR=2.54, 95% CI=1.8-5.6), and having surgery (OR=3.5, 95% CI=2.0-7.3) increase the chance of insurance deduction significantly (p<0.05).
   Conclusion: Findings of this study showed that after HTP, insurance deductions were decreased significantly. The causes of this decline may be due to the range of services covered by public insurances, increase in insurance coverage, and improvement in health providers-insurance companies communication.