Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

Background: Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran�s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods: We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results: About 17 of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40 of the respondents chose only accessibility, 4 selected only availability, 78 chose only responsibility, and 13 selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion: It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status. © 2021, The Author(s)

Evaluating hospital safety index in Susa public hospital: An action research study

Introduction: The role of the hospital in maintenance and promotion of public health is more important in times of crisis because the hospitals also act as public shelters and a ray of hope for the affected population in the crisis. Therefore, preparation and continuous improvement of the hospital's safety against probable disasters is one of managerial key tasks. The aim of this research was to evaluate hospital safety index in Susa public hospital before and after interventions. Method: This is an action research study which was conducted from July 2015 to July 2016 in Susa public hospital, Khuzestan, Iran. The study was performed using Hospital Safety Index (HSI) checklist of the Iranian National Institute of Health Research (INIHR). The checklist has three main modules and 145 measures. The hospital was categorized based on A,B, and C level of safety. Result: The results showed that hospital safety index in the first year was at level C which after planned managerial interventions was promoted to the level B in the second year. Despite the partial improvement in the overall hospital safety index level in the second year, the safety level of three main modules including functional, structural, and non-structural safety was still at level C in both years. Despite the improvement of the overall hospital safety score in the second year, the safety score in three main modules remained at a level C. Conclusion: Therefore, the hospital's managers should address the hospital safety weaknesses using safety improvement techniques and quality improvement tools