Journal of Health Economics and Development1120190401Socioeconomic Determinants of Systolic Blood Pressure; Minorities’ Diminished Returns11188938ENShervin AssariCharles R Drew University of Medicine and Science, Los Angeles, CA, USAJournal Article20190117<strong>Background:</strong> Although socioeconomic position (SEP) is associated with better health, the protective effects of high SEP may be smaller for racial and ethnic minorities than Whites, as explained by Minorities' Diminished Returns theory. It is still unknown whether the association between SEP and systolic blood pressure (SBP) differs for racial and ethnic groups. The current study racial and ethnic variation in the association between SEP (education attainment and household income) and SBP among American adults.<br /> <strong>Methods</strong>: The National Health and Nutrition Examination Survey (NHANES; 2005-2006) included 4773 adults 20 years or older. Education attainment and household income were the predictor variables, SBP was the outcome variable, age and gender were the covariates, and race/ethnicity was the effect modifier. Multiple linear regression models were used in the pooled sample and each race/ethnicity.<br /> <strong>Results</strong>: In the pooled sample, higher education attainment and household income were associated with lower SBP, net of race, ethnicity, age, and gender. Race/ethnic stratified linear regression models showed protective effects of education attainment and household income against high SBP for Non-Hispanic Whites, a protective effect of household income for Other Hispanics, and no protective effects of education attainment or household income for other race/ethnic groups.<br /> <strong>Conclusions</strong>: The health gain that follows SEP (education attainment and household income) are simply larger for the socially and economically privileged group (non-Hispanic Whites) and minimized for racial and ethnic groups. Given that the Minorities’ Diminished Returns exist, policies and solutions that merely focus on reducing the racial gap in SEP may not eliminate the pervasive racial and ethnic gap in health problems including high SBP.https://www.hedjournal.com/article_88938_d0f03c9e2607bdaeee1aa93938267b33.pdfJournal of Health Economics and Development1120190401Value-based Oncology in Iran: A Scoping review122089059ENSiavash MoradiEducation Development Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IranGhasem JanbabaiGastrointestinal Cancers Research Center, Mazandaran University of Medical Sciences, Sari, IranParisa IslamiParkoohiVice Chancellery for Research and Technology, Mazandaran University of Medical Sciences, Sari, IranFatemeh SadeghiGhyassiResearch Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, IranBarmak YaaghoobianDepartment of Community Medicine, North Khorasan University of Medical Sciences, Bojnurd, IranJournal Article20190215Introduction: Evidence synthesis about economic analysis of cancer control and management in Iran was inconsistent. <br />Objective: The objective of this scoping review was to examine and map the rang of studies acknowledged this issue in Iran. <br />Methods: Several databases such as Cochrane Library, PubMed, ProQuest، Embase، and Google Scholar have been searched with relevant search strategy. Studies published from January 1, 2000, to January 1, 2017 were examined. <br />Results: Finally, forty-four articles were deemed appropriate for this study and were analyzed. Twenty-three studies had performed cost analysis, twelve cost-utility analysis (CUA), eight cost-effectiveness analysis (CEA), and only one cost-minimizing analysis. In only six articles the total cost (direct and indirect) had been evaluated. The incremental cost-effectiveness ratio (ICER) index had been measured in all eight articles on CEA. In studies on CUA, only one case had considered the disability adjusted life years (DALY) index.<br />Conclusion: After cost analysis which is highly popular, researchers in the field of cancer economy in Iran are often interested in CEA studies and, consequently, CUA ones. Results of the present study indicate that most analyses in this field have employed appropriate methodology, leading to accurate estimations of ICER in which can be used for appropriate meta-analysis in near future.https://www.hedjournal.com/article_89059_cf6ed07db85966332664c0fdf188ccaf.pdfJournal of Health Economics and Development1120190401Parental Educational Attainment and Academic Performance of American College Students; Blacks’ Diminished Returns213188998ENShervin AssariCharles R Drew University of Medicine and Science, Los Angeles, CA, USAJournal Article20190616Background. As suggested by the Minorities' Diminished Returns (MDR) theory, socioeconomic status (SES) systemically results in smaller outcomes for non-Whites compared to Whites. We still know very little about diminished trans-generational returns of SES resources such as parental educational attainment (PEA). <br />Purpose. This cross-sectional study explored racial variation in the effect of PEA on the college students’ grade point average (GPA) in the US. <br />Methods. The Healthy Mind Study (HMS, 2016–2017) is a national telephone of college students in the US. The total sample was 18,072 domestic undergraduate college students who were either non-Hispanic Whites (n = 16,718; %92.50) or non-Hispanic Blacks (n = 1,354; %7.50). The independent variable was PEA. The main outcome was GPA measured using self-reported data. Age, gender, sexual orientation, transgender status, and financial difficulty, were covariates. Race/ethnicity was the effect modifier. Linear regression models were used to analyze the data. <br />Results. Overall, higher PEA was associated with a higher GPA, independent of all possible confounders. Race/ethnicity, however, showed a significant interaction with PEA on students’ GPA, indicating a smaller positive effect of PEA on non-Hispanic Blacks compared to non-Hispanic Whites college students’ GPA. Race/ethnicity stratified models also showed a larger effect for White than Black students. <br />Conclusions. The boosting effect of PEA in GPA is smaller for Black compared to White college students. US should systematically reduce extra costs of upward social mobility for racial and ethnic minority families.https://www.hedjournal.com/article_88998_0ea5f9591eeaa2aee5c592ea962a7541.pdfJournal of Health Economics and Development1120190401Assessing the catastrophic health expenditure and impoverishment in Iran in 2012 and 2015 (before and after the implementation of HSEP in Iran)323793090ENAli MaherAssistant Professor of Health Services Management, Department of Health Services Management, Tehran North Branch, Islamic Azad University, Tehran, IR Iran.Zahra FazelDepartment of Economic, Alzahra University, Tehran, IR Iran.Journal Article20190914Healthcare in many developing countries is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care. Although, Iran has made great achievements in Health Sector and health financing after the implementation of Health Sector Evolution Plan, there are still some provinces and expenditure groups which suffered from health payments and pushed them under poverty line. This study aimed to compare the rates of households with CHE and the effect of health spending on national poverty estimates before and after the implementation of HSEP in Iran. To do that, statistical data were acquired from two surveys conducted by Iran statistic Centre (2012 and 2015). Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national poverty line is used.It is necessary to mention that,about 10.476 and 3.122 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure in 2012 and 2015, respectively. At the threshold of 40 % of capacity to pay, 1.249 (2012) and 0.283 % (2015) of the total household incurred catastrophic health expenditures. About 611 and 5895 households were forced into poverty due to paying for health care in 2012 and 2015, respectively. Despite the high achievements of HSEP in Iran, a significant proportion of the population was forced into poverty due to out-of-pocket payments for health care. The Iranian government should pay more attention to the actual conditions in different provinces, further to make policy decisions according to the local knowledge.Journal of Health Economics and Development1120190401Determining and Prioritizing the Quality Dimensions of Services Provided to Patients from the Point of View of the Managers of Amiralmomenin Hospital (AS) in Islamic Azad University, Tehran, Iran Using Topsis Tool (TOPSIS)93447ENJournal Article20190921<strong>Introduction:</strong> Quality is only factors affecting customer satisfaction, and as consumers' perceptions of product or service quality levels are higher, their level of customer satisfaction and loyalty will be higher. The aim of this study was to determine and prioritize the quality dimensions of services provided to patients from the viewpoint of the managers of Amiralmomenin Hospital (AS) of Islamic Azad University of Tehran using the Tapsis tool.
<strong>Methods:</strong> The present study is a descriptive-exploratory study. The statistical population included all the managers of Amiralmomenin Hospital in Islamic Azad University of Tehran during 1969-2012. The samples were counted and equal to 33 people. A standard SERVQUAL questionnaire for the quality of hospital services was used to collect the data. The number of specific questions in the questionnaire consisted of 32 questions with 5 Likert scale (totally opposite, opposite, no opinion, agree and completely agree), and the specific questions of the 32-item questionnaire with 6 components of tangibility, reliability, accountability, trust, empathy and the process of service is measured. In order to analyze the data, both descriptive and inferential statistics were used.
<strong>Results:</strong> 66.7% were male managers. 62.5% of managers were between 40 and 50 years old. 78.50% of managers, married, and average working experience of managers in this study are 19.04 years. There was a significant statistical difference between expectations and perceptions in all questionnaires constructs (P <0.05). Also, prioritizing the quality of hospital services from the managers perspective was to ensure service, reliability, physical and palpable, empathy, accountability and access to care. <strong>Conclusion:</strong> According to the findings of this study, mobile management is recommended to continuously evaluate their systems in terms of quality, to address problems, increase the quality of service to customers and, ultimately, create an appropriate hospital environment for continuous cooperation between the organization and his colleagues.