fa عدالت در نظام سلامت ایران تخصصي Special مروري Review Article <div style="text-align: justify;"><span style="font-size:8pt"><span style="line-height:18pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span style="letter-spacing:-0.15pt"><b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:"><span style="letter-spacing:-.3pt">زمینه و هدف: </span></span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:"><span style="letter-spacing:-.3pt">یکی از اهداف مهم در سیاست‌گذاری حوزه سلامت تأمین عدالت در سلامت است. عدالت در سلامت به مفهوم پرهیز از تفاوت‌های سیستماتیک و بالقوه قابل برطرف کردن در یک یا چند جنبه از سلامت در یک جمعیت و زیرگروه‌های اقتصادی، اجتماعی، دموگرافی و جغرافیایی است.</span></span></span></span></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:8pt"><span style="line-height:18pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span style="letter-spacing:-0.15pt"><b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">روش:</span></span></b> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">این</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">مطالعه</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">از</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">طریق</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">مرور</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">ادبیات</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">متون</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">علمی</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">موجود</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">با</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">بررسی</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">مقاله‌ها، پایان‌نامه‌ها،</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">گزارش‌ها و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">منابع</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">موجود</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">در</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">پایگاه‌های</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">اطلاعاتی</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">داخلی</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">خارجی</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">کنفرانس برگزار شده توسط فرهنگستان علوم پزشکی با</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">استفاده</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">از</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">کلید</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">واژه‌های مرتبط، در محدوده</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">زمانی</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">10</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">سال</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">گذشته</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">انجام</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">شده</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">است</span></span>.<span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Nazanin""></span></span></span></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:8pt"><span style="line-height:18pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span style="letter-spacing:-0.15pt"><b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">یافته‌ها:</span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:"> روند حرکت شاخص سیاست‌های بخش سلامت نتوانسته تغییر معنی‌داری در جهت بهبود عدالت ایجاد کند. تبعیض در پوشش</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">خدمات، تبعیض در جنسیت، دسترسی به خدمات در مردم مناطق دور افتاده و عدم برخورداری از خدمات سلامت در اقشار کم درآمد باوجود دستاروردهای 40 ساله انقلاب و تأکید در برنامه‌های توسعه اول تا پنجم همچنان وجود دارد. با وجودی که طرح تحول توانست هزینه‌های خدمات بستری را کاهش دهد؛ اما هزینه‌های عدالت در مشارکت مالی و شاخص هزینه‌های سلامت فقرزا همچنان بالا است.</span></span></span></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:8pt"><span style="line-height:18pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span style="letter-spacing:-0.15pt"><b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">نتیجه‌گیری: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">کسری بودجه تکرارشونده در بخش سلامت نشان از عدم پایداری منابع مالی این بخش دارد.</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">ناهماهنگی‌های بین وزارت بهداشت، درمان و آموزش پزشکی، وزارت اقتصاد و رفاه به عنوان یکی از عواملی است که می‌تواند در عدم دستیابی به تأمین عدالت در سلامت مؤثر باشد. یکی از راهکارهای بهبود شاخص‌ها و کنترل</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">هزینه‌ها</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">در همه</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">جوامع مدیریت</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">منابع محدود</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">سلامت می‌باشد.</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">براساس</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">قانون</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">برنامه پنجم توسعه</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">اجرای</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">کامل</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">برنامه پزشک</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">خانواده</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">نظام</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">ارجاع</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">و گسترش</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">پوشش</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">بیمه‌ها</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">می‌تواند</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">به</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">ارتقای</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">عدالت</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">در</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">سلامت و</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">کاهش</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">هزینه‌ها</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">از</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">جیب</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">مردم</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">منجر</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" nazanin="" style="font-family:">شود.</span></span></span></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:12pt"><span style="line-height:12.0pt"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt">Background:</span></b><b> </b><span style="font-size:10.0pt">One of the important goals in health policy is to ensure equity in health. Equity in health means absence of systematic and potentially remediable differences in one or more aspects of health in a population and economic, social, demographic and geographic subgroups.</span><b><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="font-family:"B Lotus""></span></span></b></span></span></span></div> <div style="text-align: justify;"><span style="font-size:12pt"><span style="line-height:12.0pt"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt">Methods: </span></b><span style="font-size:10.0pt">This study was conducted by reviewing available scientific literature and texts and examining articles, theses, reports and resources available in internal and external databases and the conference held by the Academy of Medical Sciences by using relevant keywords. A time frame of the last 10 years was considered for queries.</span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:12pt"><span style="line-height:12.0pt"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt">Results:</span></b><span style="font-size:10.0pt">&nbsp; Analysis of the studies showed that the progress of the index of the policies of the health sector has not been able to create a significant change in the direction of improving equity. Discrimination in service coverage, gender discrimination, access to services in remote areas and lack of health services in low-income groups still exist despite the 40-year achievements of the revolution and emphasis on this issue in the first to fifth development programs. Although the transformation plan was able to reduce costs of inpatient services, the costs of justice in financial participation and the index of health costs of the poor is high.</span><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="font-family:"B Lotus""></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:12pt"><span style="line-height:12.0pt"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt">Conclu</span></b><b><span style="font-size:10.0pt">s</span></b><b><span style="font-size:10.0pt">ion: </span></b><span style="font-size:10.0pt">Recurring budget deficit in the health sector shows the instability of the financial resources of this sector. The inconsistencies between the Ministry of Health and Medical Education and the Ministry of Economy and Welfare are effective in not achieving justice in health.</span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:12pt"><span style="line-height:12.0pt"><span new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt">One of the approaches to improve indicators and control costs in all societies, whether rich or poor, is management of limited health resources. According to the law of the fifth development plan, full implementation of the family physician program, the referral system, and expansion of insurance coverage can help improve equity in health and reduce costs for the public.</span></span></span></span></div> استانداردهای عدالت در سلامت, عدالت در سلامت, نظام سلامت ایران Health Equity, Health Equity Standards, Iran Health System 292 301 http://ijhp.ir/browse.php?a_code=A-10-254-1&slc_lang=fa&sid=1 azam kamali اعظم کمالی a.kamali82588@gmai.com 10031947532846009262 10031947532846009262 No Health Services Management,Islamic Azad University,North Tehran Branch, Tehran, Iran مدیریت خدمات بهداشتی درمانی، دانشگاه آزاد اسلامی واحد تهران شمال، تهران، ایران Khalil Ali Mohammad Zadeh خلیل‌ علی‌محمدزاده Alimohamadzadeh@iautmu.ac.ir 10031947532846009263 10031947532846009263 Yes Health Services Management Department, Islamic Azad University North Tehran Branch, Health Economics Policy Research Center Tehran Islamic Azad university of Medical Sciences, Tehran, Iran گروه مدیریت خدمات بهداشتی درمانی دانشگاه آزاد اسلامی واحد تهران شمال، مرکز تحقیقات سیاست‌گذاری اقتصاد سلامت، دانشگاه علوم پزشکی آزاد اسلامی ‌تهران، تهران، ایران Seyed Shahabedin Sadr سیدشهاب‌الدین صدر 10031947532846009264 10031947532846009264 No Physioligy,Department of Physiology, Mdical School Electrophysiology Research Center,Neurological Rehabilitation Research Institute, Tehran University of Medical Sciences, Associate Member of the Academy of Medical Science, Tehran, Iran دانشگاه علوم پزشکی تهران، دانشکده پزشکی، مرکز تحقیقات الکتروفیزیولوژی، پژوهشکده بازتوانی عصبی دانشگاه علوم پزشکی تهران، تهران، ایران Ahmad Fayaz Bakhsh احمد فیاض‌بخش 10031947532846009265 10031947532846009265 No Health Sciences Education Development,school of Public Health,Tehran University of Medical Science,Tehran,Iran گرو ه توسعه علوم بهداشتی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران Shahram Tofighi شهرام توفیقی 10031947532846009266 10031947532846009266 No Department of Forecasting, Theory building and Health Observatory, Medical Academy of IRI, Tehran, Iran عضو هیئت علمی‌دانشگاه علوم پزشکی بقیه‌الله اعظم (عج)، تهران- عضو گروه آینده‌نگری، نظریه‌پردازی و رصد کلان فرهنگستان علوم پزشکی جمهوری اسلامی ایران، تهران، ایران Alireza Olyaee Manesh علیرضا اولیایی‌منش 10031947532846009267 10031947532846009267 No National Institute of Health Research and Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran مؤسسه ملی تحقیقات نظام سلامت، مرکز تحقیقات عدالت در سلامت، دانشگاه علوم پزشکی تهران، تهران، ایران Abolghasem Pourreza ابوالقاسم پوررضا 10031947532846009268 10031947532846009268 No Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran گروه آموزش و ارتقای سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران Narges Tabrizchi نرگس تبریزچی 10031947532846009269 10031947532846009269 No Community Medicine. Academy of Medical Sciences of I.R Iran, Tehran, Iran فرهنگستان علوم پزشکی جمهوری اسلامی ایران، تهران، ایران