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  Introduction: In Emergency Departments (ED), seconds and minutes are vital for the patients. Therefore, a logical decision making is crucial to manage the patients’ waiting time. Simulation, a decision supporting technique, is used to analyze risk factors and strategies in decision making. The purpose of this research was to apply this method to reduce patients' waiting time in the ED at Ayatollah-Kashani Hospital.

  Methods: The population of this applied- analytical study included the patients referred to the ED at Ayatollah-Kashani Hospital in Isfahan during May 2008. Having recognized the patients’ workflow, the researchers gathered the required data concerning the time of patients’ arrival and service delivery at various stations for 663 patients during 2 weeks. The data were used to design a simulation model for the ED using simul8 software. The validity of the model was verified through comparing the results obtained from the manual system with those from the simulation model which led to the formation of the finalized model.

  Results: The results showed an increase in the waiting time when implementing alternatives 2, 9, 10 and 12 while a decrease was observed in other alternatives. In alternatives 6 and 13-17, the total waiting time decreased more than the other alternatives. The most amount of reduction was observed in alternative 15, so much so that the waiting time of receiving emergency services reduced from 112.19 to 99.24 minutes. This could be due to the placement of an intern student at Eye- Nose-Throat (ENT), Neurology, and Orthopedic stations which caused reduction in the waiting time from 38.89, 13.31 and 12.13 to 26.54, 6.58 and 5.98 minutes, respectively.

  Conclusion: Since health care managers, especially in the ED, are mostly physicians not

  experienced enough in statistical analysis, it is essential to provide them instruments with which they can readily achieve scientific approaches to reduce costs and patients’ waiting time. Applying various research methods such as simulation can satisfy these goals.

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Introduction: This article proposes a method which could improve the performance of an Emergency Department (ED) in a large hospital in Tehran, where the long waiting times cause patients’ and ED staff ’s dissatisfaction. ED is considered as a bottleneck in hospitals. To reduce long waiting time and improve patient satisfaction, application of system improvement methods is required.
Methods: Using discrete- event simulation, it first models patient flow and identifies bottlenecks. In simulation model, patient arrival is assumed to be non-homogenous and operations of medical tests are detailed and consequently patient queues and virtual specimen queues can be considered separately. The analytic hierarchy process (AHP) was used to specify weights for each criterion and PROMETHEE to rank scenarios.
Results: Based on simulation results and important criteria, what-if scenarios were designed to evaluate system reactions. Using this method, 10 scenarios were designed. Implementing the best scenario would reduce waiting time by approximately 6%.
Conclustion: Considering ED overcrowding, simulation is used to reflect current situation. Based on the simulation reports, what-if scenarios were used to design scenarios which could improve ED performance. Multi criteria decision making method was used to find the best scenario based on criteria like waiting time, utilization, leave with own responsibility (LWOR) and cost.

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Introduction: Unmet needs are defined as the difference between services judged necessary to deal appropriately with health problems and services actually received. Unmet needs are considered as simple tools in monitoring the accessibility and the extent of inequity in access and use of health care.
Methods: This is a cross-section health survey. The sample consists of 792 households living in Tehran. Data were collected by the WHO (households) questionnaire in 2012, and were analyzed using Logistic Model and STATA12 software.
Results: The outcomes show that economical problems, lack of time, self-treatment, long distance to reach health facilities, deprivation of insurance coverage, and lack of adequate information about the locations of health care centres are all factors affecting patients’ willingness to refer to these centres. The socio-economic factors which can enhance the probability of fulfilment of health care needs were found to be settlement ownership and poverty reduction
 Conclusion: Unmet needs can cause detrimental effects, such as worsening health situation and quality of life, increasing the risk of mortality and causing mental and psychosomatic disorders therefore, policy makers should give high priority to eliminating socio-economic barriers, as lack of insurance coverage, as well as reducing the costs and economic inequalities, and payment systems reform. Key words: Equity in health, Health care accessibility, Unmet needs, Tehran households, Logistic Model

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Introduction: Access to health care is one of the main goals in all societies. This study aimed to investigate the access level in provinces in Iran.
 Methods: This descriptive-applied and cross-sectional study was conducted in 2012. Statistical population consisted of all provinces in Iran. Data were collected through library and online research. The Ministry of Health and Medical Education and Statistics Center of Iran as authorities of Information, were referred to for collecting relevant data. Taxonomy techniques were used to assess the of development level of provinces, Shannon entropy techniques were used to determine the weights of indicators and TOPSIS techniques were employed to rank states in terms of access to health care.
Results: Based on Taxonomy technique from among 31 provinces, 12 provinces were considered to be developed, 9 semi-developed and 10 underdeveloped. Based on Shannon entropy, the ratio of the number of pharmacists to province population was the most important indicator. According to TOPSIS, in term of access to health services Markazi and Ardabil provinces ranked the first and the last respectively.
Conclusion: Due to the large differences among provinces, planners and officials are recommended to allocate the funds according to the development level.

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Introduction: Reciving and using health care services is called utilization and access to services refers to the opportunity and the ability to use them. The purpose of this study was to investigate the pattern of utilization and access to health care disparities and factors affecting them.
Methods: In this cross-sectional study, Quota sampling method was used. To evaluate the health care services used by families and their relationship with Predisposing variables, Chi-square test and Pearson cross-tabulations were used using Excel and Stata.
Results: According to the findings important variables such as Household economic status, insurance, head of household education ages over 65 and less than 12 years had key roles in the use of services. Concentration indices for out-patient and in-patient services were -0.38 and -0.435, respectively..
Conclusion: There are some predisposing variable leading to inequality in use of health services which could be reduced the improvement of socio-economic variables.

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Introduction: Measurement of financial support for health services is determined by household out of pocket expenditure for health which is associated with two approaches: catastrophic and impoverishing health expenditures.

Therefore, this study aimed to investigate the catastrophic and impoverishing health expenditure in Tehran urban population.

Method: This cross-sectional study was conducted in Tehran in 2013. The data were collected through interview and observation using a household expenditure questionnaire. In order to estimate the effects of factors affecting catastrophic health expenditure and impoverishing health expenditure, data analysis was done using Pearson test, one variable and multivariate logistic models, Excel and STATA Software.

Results: According to the finding 2.4% of households fell below the poverty line, 6.7% of families households had to pay out of pocket, and 3.8% were identified as facing catastrophic health expenditures as a result of out-of-pocket payment for health.

Conclusion: There are some key factors influencing health expenditure, such as head of household education level, the presence of people over 60 years in household, the use of inpatient services and the volume of use. Therefore, it is recommended that health policy makers and insurance organizations implement health insurance plans and reduce the health services tariff and out of pocket expenditure on health.

Keywords: Out of Pocket, Catastrophic Health Expenditures, Impoverishing Health Expenditures.

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Introduction: An increase in the use of oral and dental health services and routine examinations can lead to better health and improve health equity indicators. This study aimed to analyze the factors affecting the utilization of oral and dental health services in the households of Ahvaz in 2022.
Methods: The present study is a cross-sectional descriptive-analytical study in which 715 households including 2680 people living in the city of Ahvaz were studied by using the stratified-cluster sampling method. The collection of the required data was performed through a questionnaire, and the logistic model and Stata software were used to analyze the data and estimate the elasticity of the influencing factors.
Results: According to the results of this study, the utilization rate of oral and dental health services is 80.55%, and the odd ratio of the utilization of these services is 0.26% less for women compared to men, which is a statistically significant result. People with tertiary education also have a 1.83 times higher chance compared to other people to receive the services, which is statistically significant. People with income but without work have a 0.29 lower chance of receiving these services compared with unemployed people, although this result is not significant. Furthermore, people who have private insurance have 5.84 times more chances to receive these services, and this result is completely significant. Also, the individuals who exercise less than 3 times a week have the chance of receiving these services by 1.25 times compared to people who do not exercise at all, which is a significant result.
Conclusion: Based on the results of this study, it can be mentioned that employment and household income status, increased insurance coverage, higher education level, and a healthy lifestyle, including engaging in physical exercise, increase the chance of benefiting from dental services.

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