Background: The SERVQUAL (service quality) technique is one of the best techniques to evaluate customers' expectations and perceptions of the quality of the services they have received.Objectives: This study aimed to assess the quality gap in the services provided by rehabilitation centers in Iran using the SERVQUAL technique. Patients and Methods: This was a cross-sectional study conducted in Ahvaz, Iran. The study sample was composed of 255 patients randomly selected from 5 rehabilitation centers. The research data was collected using a valid questionnaire, consisting of 22 items and 5 dimensions of service quality. Results: Most of the patients included in this study were female (72.9%), and the mean age of the patients was 40 ± 13.2 years. The total mean scores of the patients' expectations and perceptions were 3.73 (SD = 0.3) and 3.56 (SD = 0.5), respectively. According to the gap analysis, there was a negative quality gap in each of the five SERVQUAL dimensions, but in the assurance dimension, this gap was very low, and not found to be significant. The quality gap was more negative in the tangiblesfactor (-0.33) and reliability (-0.30) than in the other factors. Conclusions: There was a negative gap between the patients' expectations and what they actually perceived in the studied rehabilitation centers (with the exception of one public clinic); therefore, improvements are needed across all five dimensions.

Introduction:Efficiency is one of the most important indicators of hospital performance evaluation.Aim:The study was conducted to measure the efficiency of public hospitals.Material and methods:This was a cross-sectional and panel data study. Data were retrospectively collected using hospital records and hospital information system. In this study, panel data of 17 public hospitals affiliated with Ahvaz University of Medical Sciences, in southwest of Iran were studied during 2012-2016. The output-based data envelopment analysis technique and variable return to scale assumption (VRS) were used. Regression model was used to assess factors affecting hospital efficiency. Data were analyzed using Deap2.1 and R software.Results:The mean of technical efficiency, managerial efficiency, and scale efficiency of the hospitals during 2012-2016 were 0.230, 0.272 and 0.732, respectively. Assessment of return to scale results over 5 years showed that 65% (11 cases) of hospitals had a decreasing return to scale, 24% (4 cases) had a constant return to scale, and 12% (2 cases) had an increasing return to scale. Also, mean of technical managerial, and scale efficiency in specialized hospitals were higher than other hospitals (0.331, 0.353, and 0.873). Beta regression analysis showed the effect of both variable length of stay and number of beds on hospital efficiency was significant (p-value <0.05)..Conclusions:The results showed that efficiency of selected public hospitals was the poor. Technical efficiency and managerial efficiency were lower than scale efficiency rate. Also, Multi- specialized hospitals were in critical status considering resource management and economies of scale.

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.

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts’ viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran’s health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.

In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran.