مدل‌سازی استراتژی‌های توانمندسازی افراد در نظام بیمه درمان مبتنی بر روش نگاشت‌شناختی زی نامبر
محورهای موضوعی : -مدارک پزشکیمصطفی ایزدی 1 , رسول نورالسنا 2 , حمیدرضا ایزدبخش 3
1 - دانشجوی دکتری مهندسی صنایع، واحد علوم تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - استاد، گروه مهندسی صنایع، دانشگاه علم و صنعت، تهران، ایران
3 - استادیار، گروه مهندسی صنایع، دانشگاه خوارزمی، تهران، ایران
کلید واژه: نگاشت‌شناختی زی نامبر, نظام سلامت, توانمندسازی بیمه شدگان, استراتژی, بیمه درمان,
چکیده مقاله :
مقدمه: کارایی و اثربخشی نظام‌های سلامت و میزان پوشش بیمه های درمانی بعنوان یکی از مولفه های اصلی در توسعه یافتگی کشورها قلمداد می شود. توانمندسازی افراد در نظام سلامت بعنوان یکی از راهکارهای موثر و کارامد از سوی سازمان بهداشت جهانی معرفی شده است. هدف از این پژوهش مدل سازی راهبرد های موثر بر توانمندسازی افراد در نظام بیمه درمان کشور ایران است. روش پژوهش: این پژوهش به لحاظ هدف کاربردی و به لحاظ روش توصیفی- تحلیلی است و از نظر ابزار جز تحقیقات کیفی می باشد. در این پژوهش با استفاده از دانش ضمنی خبرگان و روش تحلیل محتوی روابط علّی میان استراتژی های موثر بر توانمندسازی افراد/ بیمه شدگان در نظام بیمه درمان مشخص شد. بمنظور پوشش ابهام و عدم اطمینان در اظهارات خبرگان، از روش توسعه یافته نگاشت شناختی زی نامبر برای مدل سازی استفاده شده است. نرم افزارهایFCMapper و Pajek برای ترسیم و تعیین میزان اهمیت شاخص‌ها و رتبه بندی آنها مورد استفاده قرار گرفته شده است. یافته‌ها: بر اساس شاخص‌های تاثیرگذاری، تاثیرپذیری و مرکزیت، استراتژی های موثر بر توانمندسازی افراد در نظام بیمه درمان مورد ارزیابی قرار گرفتند. استراتژی ظرفیت سازمان محلی با امتیاز 2/62 بالاترین شاخص تاثیرگذاری، استراتژی صیانت از حقوق با امتیاز 2/67 بالاترین شاخص تاثیر پذیری و استراتژی مشارکت جویی با 4/91 بالاترین شاخص مرکزیت را بدست آوردند. نتیجه‌گیری: پیاده سازی رویکرد توانمندسازی افراد در سازمان بیمه سلامت ایران دارای ابعاد مختلفی در میان استراتژی موثر بر آن است که مدل سازی ارتباطات علّی میان آنها نقش موثری در اجرای صحیح این رویکرد می تواند ایفا نماید.
Introduction: The efficiency and effectiveness of health systems and the amount of health insurance coverage are considered as one of the main components in the development of countries. Empowerment of people in the health system has been introduced as one of the effective and efficient solutions by the World Health Organization. The purpose of this study is to model effective strategies for empowering people in the health insurance system of Iran. Methods: This research is applied in terms of purpose and descriptive-analytical in terms of method and is a qualitative research in terms of tools. In this study, using the tacit knowledge of experts and the method of content analysis, the causal relationships between strategies affecting the empowerment of individuals / insured in the health insurance system were identified. Due to the ambiguity and uncertainty in the statements of experts, the developed method of cognitive numbering has been used for modeling. Result: Based on the indicators of effectiveness, impressiveness and centrality, effective strategies on empowerment of individuals in the health system were evaluated. Local organization capacity strategy with a score of 2.62 with the highest impact index, rights protection strategy with a score of 2.67 with the highest impact index and participation strategy with a score of 4.91 with the highest centrality index. FCMapper and Pajek software were used to draw and determine the amount of indicators. Conclusion: Implementation of empowerment approach in health insurance organization of Iran has different dimensions among effective strategies that modeling causal relationships between them can play an effective role in proper implementation of this approach.
1- Vaez Mahdavi M, Rafiei Far SH, AhmadzadehAsl M. Strategic Plan for Empowering People and Communities to Promote Health and Welfare in the Islamic Republic of Iran. Tehran, Tandispress; 2005. [In Persian]
2- WHO. WHO Globl Strategy on People-centred and Integrated Health Services. 2014. Available: http://www.who.int/servicedeliverysafety/areas/people-centred-car/en/.[Accessed:24-Jul-2014].
3- Global Health Expenditure Database WHO. 2019. Available from https://apps.who.int/nha/database/ /ViewData/Indicators/en.
4- Cyril S, Smith BJ, Renzaho AM. Systematic review of empowerment measures in health promotion. Health promotion international, 2016; 1: 31(4): 809-26.
5- Avelino F, Wittmayer JM, Pel B, Weaver P, Dumitru A, Haxeltine A, Kemp R, Jørgensen MS, Bauler T, Ruijsink S, O'Riordan T. Transformative social innovation and (dis) empowerment. Technological Forecasting and Social Change, 2019; 145: 195-206.
6- Grabe, S. An empirical examination of women’s empowerment and transformative change in the context of international development. American Journal of Community Psychology, 2012; 49(1–2): 233–245.
7- Flaherty A, O'Dwyer A, Mannix-McNamara P, Leahy JJ. The influence of psychological empowerment on the enhancement of chemistry laboratory demonstrators' perceived teaching self-image and behaviours as graduate teaching assistants. Chemistry Education Research and Practice, 2017; 18(4): 710-36.
8- Lardier DT, Garcia-Reid P, Reid RJ. The examination of cognitive empowerment dimensions on intrapersonal psychological empowerment, psychological sense of community, and ethnic identity among urban youth of color. The Urban Review. 2019; 51(5): 768-88.
9- Morley J, Floridi L. Enabling digital health companionship is better than empowerment. The Lancet Digital Health, 2019; 1(4): 155-6.
10- Laschinger HKS, Wong CA, Grau AL. Authentic leadership, empowerment and burnout: A comparison in new graduates and experienced nurses. Journal of Nursing Management, 2013; 21(3): 541–552.
11- Christens BD, Winn LT and Duke AM. Empowerment and critical consciousness: A conceptual cross-fertilization. Adolescent Research Review, 2016; 1(1): 15-27.
12- Shin S, Park H. Effect of empowerment on the quality of life of the survivors of breast cancer: The moderating effect of self‐help group participation. Japan Journal of Nursing Science, 2017; 14(4): 311-9.
13- Samman, S.K. Relational Engagement and Empowerment: Establishing a Foundation to Address Gender and Power. 2016.
14- Tengland PA. Behavior change or empowerment: On the ethics of health-promotion goals. Health Care Analysis, 2016; 24(1): 24–46.
15- Small N, Bower P, Chew-Graham CA, Whalley D, Protheroe J. Patient empowerment in long-term conditions: Development and preliminary testing of a new measure. BMC Health Services Research, 2013; 13(1).
16- Izadbakhsh HR, Barzegar B, Zarinbal M, Ataeipoor S, Tehrani NA, Mohseni A. Insured Empowermwnt An Approach for Iran Health System. Pub, Kharazmi University; 2015. [In Persian]
17- Saleh Al-Subhi SH, Pupo IP, Vacacela RG, Pinero Perez PY. A New Neutrosophic Cognitive Map with Neutrosophic Sets on Connections: Application in Project Management. Neutrosophic Sets and Systems, 2018; 22(1): 6.
18- Shokouhyar S, Pahlevani N, Sadeghi FM. Scenario analysis of smart, sustainable supply chain on the basis of a fuzzy cognitive map. Management Research Review; 2019.
19- Poczeta K, Kubuś Ł, Yastrebov A, Papageorgiou EI. Application of fuzzy cognitive maps with evolutionary learning algorithm to model decision support systems based on real-life and historical data. InRecent Advances in Computational Optimization; 2018: 153-175.
20- Gray S, De Kok JL, Helfgott A, O'Dwyer B, Jordan R, Nyaki A. Using fuzzy cognitive mapping as a participatory approach to analyze change, preferred states, and perceived resilience of social-ecological systems. Ecology and Society; 2015; 20(2).
21- Pluchinotta I, Esposito D, Camarda D. Fuzzy cognitive mapping to support multi-agent decisions in development of urban policymaking. Sustainable Cities and Society, 2019; 46: 101402.
22- Nápoles G, Espinosa ML, Grau I, Vanhoof K, Bello R. Fuzzy cognitive maps based models for pattern classification: Advances and challenges. InSoft Computing Based Optimization and Decision Models; 2018: 83-98.
23- Zadeh LA. A note on Z-numbers. Information Sciences, 2011; 181(14): 2923-32.
24- Kang B, Wei D, Li Y, Deng Y. Decision making using Z-numbers under uncertain environment. Journal of computational Information systems, 2012; 8(7): 2807-14.
25- Deng Y. Fuzzy analytical hierarchy process based on canonical representation on fuzzy numbers. Journal of computational analysis and applications, 2017; 22(2): 201-28.
26- Reisi M, Mostafavi F, Javadzade SH, Mahaki B, Sharifirad G. Assessment of Some Predicting Factors of Selfefficacy in Patients with Type 2 Diabetes. Iranian Journal of Endocrinology and Metabolism, 2015; 17: 44-52.
27- Golaghaie F, Bastani F. Cross-cultural adaptation of a patient-based tool for evaluating the implementation of patient education in acute care settings. Patient EducCouns, 2014; 96: 210–5.
28- Baghbanian A, Tol A. The introduction of self-management in type 2 diabetes care: A narrative review. J Educ Health Promot, 2012; 1: 35.
29- Yeh MY, Wu SC, Tung TH. The relation between patient education, patient 29- empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research, 2018; 39: 11-7.
30- Bravo P, Edwards A, Barr PJ., Scholl I, Elwyn G, McAllister M. Conceptualising patient empowerment: A mixed methods study. BMC Health Services Research, 2015; 15(1): 252–266.
31- Köhler AK, Tingström P, Jaarsma T, Nilsson S. Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study. BMC family practice, 2018; 19(1): 76.
32- Madmoli M. A systematic Review Study on the Results of Empowerment-Based Interventions in Diabetic Patients. International Research in Medical and Health Science, 2019; 2(1): 1-7.
33- Gómez-Velasco DV, Almeda-Valdes P, Martagón AJ, Galán-Ramírez GA, Aguilar-Salinas CA. Empowerment of patients with type 2 diabetes: current perspectives. Diabetes, Metabolic Syndrome and Obesity, 2019; 12: 1311
34- John JR, Ghassempour S, Girosi F, Atlantis E. The effectiveness of patient-centred medical home model versus standard primary care in chronic disease management: protocol for a systematic review and meta-analysis of randomised and non-randomised controlled trials. Systematic reviews, 2018; 7(1): 215.
35- Tabari F, PedramRazi SH, Asadi Gharabaghi M, Torabi S, Mehran A, Mohamadinejad F, Rezaie Zivlaei M. Effect of education based on family-centered empowerment model on the quality of life of elderly patients with chronic obstructive pulmonary disease (COPD). Medical Science, 2018; 22(91): 301-311.
36- Avery J. A Grounded Theory of Empowerment in Cancer Survivorship and Rehabilitation (Doctoral dissertation. Universitéd' Ottawa/University of Ottawa); 2018.
37- Sahrayi M, Panahi R, Kazemi SS, GoliRostami Z, Rezaie H, Jorvand R. The study of Health Literacy of adults in Karaj. Journal of Health Literacy, 2017; 1(4): 230-8.
38- Hudson S, Rikard RV, Staiculescu I, Edison K. Improving health and the bottom line: The case for health literacy. InBuilding the case for health literacy: Proceedings of a workshop 2018. National Academies Press (US).
39- Vian T. Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches. Global Health Action, 2020; 13: 1694744.
40- Mallinson S, Suter E. Governance and accountability. In Handbook Integrated Care, 2017: 149-163.
41- Sparkes SP, Kutzin J, Earle AJ. Financing common goods for health: a country agenda. Health Systems & Reform, 2019; 5(4): 322-33.
Mira JJ, Carrillo I, Navarro I, Guilabert M, Vitaller J, Pérez-Jover V, Aguado H. Public participation in health. A review of reviews. InAnales del sistema sanitario de Navarra, 2018; 41(1): 91-106.
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1- Vaez Mahdavi M, Rafiei Far SH, AhmadzadehAsl M. Strategic Plan for Empowering People and Communities to Promote Health and Welfare in the Islamic Republic of Iran. Tehran, Tandispress; 2005. [In Persian]
2- WHO. WHO Globl Strategy on People-centred and Integrated Health Services. 2014. Available: http://www.who.int/servicedeliverysafety/areas/people-centred-car/en/.[Accessed:24-Jul-2014].
3- Global Health Expenditure Database WHO. 2019. Available from https://apps.who.int/nha/database/ /ViewData/Indicators/en.
4- Cyril S, Smith BJ, Renzaho AM. Systematic review of empowerment measures in health promotion. Health promotion international, 2016; 1: 31(4): 809-26.
5- Avelino F, Wittmayer JM, Pel B, Weaver P, Dumitru A, Haxeltine A, Kemp R, Jørgensen MS, Bauler T, Ruijsink S, O'Riordan T. Transformative social innovation and (dis) empowerment. Technological Forecasting and Social Change, 2019; 145: 195-206.
6- Grabe, S. An empirical examination of women’s empowerment and transformative change in the context of international development. American Journal of Community Psychology, 2012; 49(1–2): 233–245.
7- Flaherty A, O'Dwyer A, Mannix-McNamara P, Leahy JJ. The influence of psychological empowerment on the enhancement of chemistry laboratory demonstrators' perceived teaching self-image and behaviours as graduate teaching assistants. Chemistry Education Research and Practice, 2017; 18(4): 710-36.
8- Lardier DT, Garcia-Reid P, Reid RJ. The examination of cognitive empowerment dimensions on intrapersonal psychological empowerment, psychological sense of community, and ethnic identity among urban youth of color. The Urban Review. 2019; 51(5): 768-88.
9- Morley J, Floridi L. Enabling digital health companionship is better than empowerment. The Lancet Digital Health, 2019; 1(4): 155-6.
10- Laschinger HKS, Wong CA, Grau AL. Authentic leadership, empowerment and burnout: A comparison in new graduates and experienced nurses. Journal of Nursing Management, 2013; 21(3): 541–552.
11- Christens BD, Winn LT and Duke AM. Empowerment and critical consciousness: A conceptual cross-fertilization. Adolescent Research Review, 2016; 1(1): 15-27.
12- Shin S, Park H. Effect of empowerment on the quality of life of the survivors of breast cancer: The moderating effect of self‐help group participation. Japan Journal of Nursing Science, 2017; 14(4): 311-9.
13- Samman, S.K. Relational Engagement and Empowerment: Establishing a Foundation to Address Gender and Power. 2016.
14- Tengland PA. Behavior change or empowerment: On the ethics of health-promotion goals. Health Care Analysis, 2016; 24(1): 24–46.
15- Small N, Bower P, Chew-Graham CA, Whalley D, Protheroe J. Patient empowerment in long-term conditions: Development and preliminary testing of a new measure. BMC Health Services Research, 2013; 13(1).
16- Izadbakhsh HR, Barzegar B, Zarinbal M, Ataeipoor S, Tehrani NA, Mohseni A. Insured Empowermwnt An Approach for Iran Health System. Pub, Kharazmi University; 2015. [In Persian]
17- Saleh Al-Subhi SH, Pupo IP, Vacacela RG, Pinero Perez PY. A New Neutrosophic Cognitive Map with Neutrosophic Sets on Connections: Application in Project Management. Neutrosophic Sets and Systems, 2018; 22(1): 6.
18- Shokouhyar S, Pahlevani N, Sadeghi FM. Scenario analysis of smart, sustainable supply chain on the basis of a fuzzy cognitive map. Management Research Review; 2019.
19- Poczeta K, Kubuś Ł, Yastrebov A, Papageorgiou EI. Application of fuzzy cognitive maps with evolutionary learning algorithm to model decision support systems based on real-life and historical data. InRecent Advances in Computational Optimization; 2018: 153-175.
20- Gray S, De Kok JL, Helfgott A, O'Dwyer B, Jordan R, Nyaki A. Using fuzzy cognitive mapping as a participatory approach to analyze change, preferred states, and perceived resilience of social-ecological systems. Ecology and Society; 2015; 20(2).
21- Pluchinotta I, Esposito D, Camarda D. Fuzzy cognitive mapping to support multi-agent decisions in development of urban policymaking. Sustainable Cities and Society, 2019; 46: 101402.
22- Nápoles G, Espinosa ML, Grau I, Vanhoof K, Bello R. Fuzzy cognitive maps based models for pattern classification: Advances and challenges. InSoft Computing Based Optimization and Decision Models; 2018: 83-98.
23- Zadeh LA. A note on Z-numbers. Information Sciences, 2011; 181(14): 2923-32.
24- Kang B, Wei D, Li Y, Deng Y. Decision making using Z-numbers under uncertain environment. Journal of computational Information systems, 2012; 8(7): 2807-14.
25- Deng Y. Fuzzy analytical hierarchy process based on canonical representation on fuzzy numbers. Journal of computational analysis and applications, 2017; 22(2): 201-28.
26- Reisi M, Mostafavi F, Javadzade SH, Mahaki B, Sharifirad G. Assessment of Some Predicting Factors of Selfefficacy in Patients with Type 2 Diabetes. Iranian Journal of Endocrinology and Metabolism, 2015; 17: 44-52.
27- Golaghaie F, Bastani F. Cross-cultural adaptation of a patient-based tool for evaluating the implementation of patient education in acute care settings. Patient EducCouns, 2014; 96: 210–5.
28- Baghbanian A, Tol A. The introduction of self-management in type 2 diabetes care: A narrative review. J Educ Health Promot, 2012; 1: 35.
29- Yeh MY, Wu SC, Tung TH. The relation between patient education, patient 29- empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research, 2018; 39: 11-7.
30- Bravo P, Edwards A, Barr PJ., Scholl I, Elwyn G, McAllister M. Conceptualising patient empowerment: A mixed methods study. BMC Health Services Research, 2015; 15(1): 252–266.
31- Köhler AK, Tingström P, Jaarsma T, Nilsson S. Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study. BMC family practice, 2018; 19(1): 76.
32- Madmoli M. A systematic Review Study on the Results of Empowerment-Based Interventions in Diabetic Patients. International Research in Medical and Health Science, 2019; 2(1): 1-7.
33- Gómez-Velasco DV, Almeda-Valdes P, Martagón AJ, Galán-Ramírez GA, Aguilar-Salinas CA. Empowerment of patients with type 2 diabetes: current perspectives. Diabetes, Metabolic Syndrome and Obesity, 2019; 12: 1311
34- John JR, Ghassempour S, Girosi F, Atlantis E. The effectiveness of patient-centred medical home model versus standard primary care in chronic disease management: protocol for a systematic review and meta-analysis of randomised and non-randomised controlled trials. Systematic reviews, 2018; 7(1): 215.
35- Tabari F, PedramRazi SH, Asadi Gharabaghi M, Torabi S, Mehran A, Mohamadinejad F, Rezaie Zivlaei M. Effect of education based on family-centered empowerment model on the quality of life of elderly patients with chronic obstructive pulmonary disease (COPD). Medical Science, 2018; 22(91): 301-311.
36- Avery J. A Grounded Theory of Empowerment in Cancer Survivorship and Rehabilitation (Doctoral dissertation. Universitéd' Ottawa/University of Ottawa); 2018.
37- Sahrayi M, Panahi R, Kazemi SS, GoliRostami Z, Rezaie H, Jorvand R. The study of Health Literacy of adults in Karaj. Journal of Health Literacy, 2017; 1(4): 230-8.
38- Hudson S, Rikard RV, Staiculescu I, Edison K. Improving health and the bottom line: The case for health literacy. InBuilding the case for health literacy: Proceedings of a workshop 2018. National Academies Press (US).
39- Vian T. Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches. Global Health Action, 2020; 13: 1694744.
40- Mallinson S, Suter E. Governance and accountability. In Handbook Integrated Care, 2017: 149-163.
41- Sparkes SP, Kutzin J, Earle AJ. Financing common goods for health: a country agenda. Health Systems & Reform, 2019; 5(4): 322-33.
Mira JJ, Carrillo I, Navarro I, Guilabert M, Vitaller J, Pérez-Jover V, Aguado H. Public participation in health. A review of reviews. InAnales del sistema sanitario de Navarra, 2018; 41(1): 91-106.
