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Original Articles
- A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran
- Zahra Mohammadi Daniali, Mohammad Mehdi Sepehri, Farzad Movahedi Sobhani, Mohammad Heidarzadeh
- J Prev Med Public Health. 2022;55(1):49-59. Published online December 28, 2021
- DOI: https://doi.org/10.3961/jpmph.21.401
- 4,456 View
- 157 Download
- 4 Web of Science
- 8 Crossref
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Abstract
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Supplementary Material - Objectives
Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.
Methods
First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties.
Results
It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider.
Conclusions
This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks. -
Summary
Citations
Citations to this article as recorded by
- Global, Regional and National Burden of Maternal Obstructed Labour and Uterine Rupture, 1990–2021: Global Burden of Disease Study 2021
Zhifeng Guo, Wangquan Ji, Mengqing Yan, Yang Shi, Teng Chen, Fanghui Bai, Yu Wu, Zhe Guo, Linlin Song
Paediatric and Perinatal Epidemiology.2025; 39(2): 135. CrossRef - Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network
David A. Schwartz, Parisa Mohagheghi, Fereshteh Moshfegh, Nazanin Zafaranloo, Narjes Khalili, Mohammad Heidarzadeh, Abbas Habibelahi, Roya Ghafoury, Fatemeh Afrashteh
American Journal of Perinatology.2024; 41(S 01): e1698. CrossRef - Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study
R Peng, Y Tong, M Yang, J Wang, L Yang, J Zhu, Yu Liu, H Wang, Z Shi, Ya Liu
QJM: An International Journal of Medicine.2024; 117(1): 24. CrossRef - Multi-objective mammography unit location–allocation problem: A case study
Marcos Vinícius Andrade de Campos, Romário dos Santos Lopes de Assis, Marcone Jamilson Freitas Souza, Eduardo Camargo de Siqueira, Maria Amélia Lopes Silva, Sérgio Ricardo de Souza
Operations Research for Health Care.2024; 41: 100430. CrossRef - An integrated location–allocation model for reducing disparities and increasing accessibility to public health screening centers
João Flávio de Freitas Almeida, Lásara Fabrícia Rodrigues, Luiz Ricardo Pinto, Francisco Carlos Cardoso de Campos
Healthcare Analytics.2024; 6: 100349. CrossRef - Association Between Maternal Co-morbidities and Cesarean Delivery Outcomes: A Retrospective Study
Sara Farzadi, Fatemeh Hosseinzadeh, Soheil Soltanipour, Samaneh Ghazanfar Tehran, Maryam Kounani, Mahin Tayefeh Ashrafiyeh, Gelareh Biazar
Modern Care Journal.2024;[Epub] CrossRef - Enhancing geographical access to cardiovascular disease healthcare services in Lagos State, Nigeria
Oluwaseun Addie, Olalekan John Taiwo
Open Health.2024;[Epub] CrossRef - An optimization model for equitable accessibility to magnetic resonance imaging technology in developing countries
João Flávio de Freitas Almeida, Samuel Vieira Conceição, Virgínia Silva Magalhães
Decision Analytics Journal.2022; 4: 100105. CrossRef
- The Study on Volume Relationships in Several Diseases.
- Sunhee Lee, Yonggweon Jwa
- Korean J Prev Med. 1994;27(4):793-806.
- 1,826 View
- 19 Download
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Abstract
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- Investigating the existence of volume-outcome relationships for specific disease groups relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. This study examined whether medical costs and lengths of stay as outcomes were affected by changes in volume within hospitals. Based on the claims data obtained from National Federation of Medical Associations, each six disease categories from medical and surgical conditions were selected and 29,720 cases from 1,266 hospitals were analyzed. Main findings of the research can be summarized as follows: 1. Analyzing volume and cost per case relationship, tonsillectomy class 1, hernia procedure class 0, appendectomy and cesarean section class 0,1 in surgical conditions showed negative relationship significantly. In cases of medical conditions, costs per case in respiratory neoplasm class 2, COPD class 1, 2, digestive malignancy were also related to volume negatively. 2. Comparing volume with length of stay per case, lens procedure class 0, hernia procedure class 0, appendectomy class 0,1 cesarean section class 1 in surgical conditions showed negative relationships significantly. In medical conditions, volume of respiratory neoplasm class 2, COPD class 1,2, digestive malignancy class 0 were associated with negatively. 3. within same disease categories, changes in cost and length of stay per case to volume were more remarkable in severe cases. These results suggested a significant inverse relationship between disease cases and cost, length of stay per case as outcome variables.
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Summary
- A Study on the Regional Self-sufficiency for In-patient Care Services.
- Dal Sun Han, Soon Ho Kwon
- Korean J Prev Med. 1990;23(3):285-295.
- 1,910 View
- 23 Download
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Abstract
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- The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.
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