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DESIGNING A MODEL OF MEDICAL EQUIPMENT PURCHASE MANAGEMENT IN HOSPITALS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES

OBJECTIVE: Medical equipment plays an effective and vital role in the diagnosis and treatment of diseases. Each society dedicates a plethora of health resources to these facilities. Since prioritizing and resource allocation are crucial in low-income countries with limited health resources, understanding and improving the purchase management of medical equipment in hospitals is a primary key for preparing high -quality health services. The aim of this study was to design a model for medical equipment purchase management at hospitals affiliated with the Tehran University of Medical Sciences. METHODS: The statistical population for the present applied study, consisted of 623 people and the research sample was comprised of 420 people, which was selected using the stratified random sampling method. Data was collected using a researchermade questionnaire whose variables were extracted from comparative studies and whose validity was measured by the relative content validity coefficient, content validity index and Cronbach's alpha coefficient. The SPSS 18 and AMOS were employed for analyses. RESULTS: The most and the least effective aspects of medical equipment purchase management in the studied hospitals were found to be decision-making (path coefficient of 1.244) and organization respectively (path coefficient of 0. 845). CONCLUSION: It is crucial to take factors into consideration when using the facilities and capacities available in health and treatment centres. The proposed model can best guide buyer institutions to move towards efficient purchase mentioned in upstream policy documents.


INTRODUCTION
Today's rapid and continuous technological evolution, which affects most production sectors, also involves healthcare. Indeed, healthcare technologies have become an essential part of the provided services, as they play increasingly significant roles in the diagnosis and treatment of patients. [1,2] The equipment represents a growing number of equipment is making a significant contribution to the mounting healthcare costs making it contradict the emphasis of making healthcare affordable.
[4] Stewart reported that the number of medical equipment increased by 62% over the past 15 years while the average utilization rate of mobile equipment is only 42%; thus, increasing hospital's acquisition budgets and maintenance cost.
[5] According to surveys conducted by Ably, the annual growth rate of these costs is increasing by 15% to 20%, accounting for about 45% of the operating budget of hospitals [6,7], in which the costs of medical equipment play a significant role in the health expenditure growth. [8] Due to the fact that health centres are usually faced with constrained resources that must be distributed carefully, policymakers across high _and middle _ income countries have grown interested in the role that accurate purchasing could theoretically have in optimizing the cost-effective provision of healthcare services while simultaneously maximizing population health. [9][10] On the other hand, given the growing wave of expectations in updating equipment and technologies in the last decade, it seems that now is the time to consider purchase management of medical equipment in today's world economic conditions. Purchase management of medical equipment has a critical and important role; with clearly defined Purchase management organizations can explain to their employees what purchasing is and how it should be conducted in that specific organization. It also helps employees to quickly grasp the main purchasing processes and activities and can be used for problem-solving and decision-making. [10,11]. It is facing a growing pressure to provide visibility and traceability of the purchase, to reduce fraud, to improve flexibility and to ensure communication between everyone involved.
The complexity of the technological assets and medical equipment found in healthcare facilities, in terms of number and diversity, is reflected in the complexity of purchase management, which must be efficient so that the equipment can always be used safely and appropriately.
Therefore, Due to lack of funding, health care managers struggle to maintain a balance between patients' access to modern health services and the economic stability of these centres; they also try to select and buy the most costeffective medical equipment which ultimately affects the development of every country on a national level. [12][13][14] the uncertainty that comes with purchasing medical equipment make it especially important to select management that can manage the limited organizational resources effectively; these decisions must be made in the changing environment of health policies; patients' demands and hospital competition with other medical centres. [15 -18] Management policies on the efficient hospital purchases of medical equipment are key to providing high-quality health services. [19][20][21] this paper reviews the studies conducted on hospital management around the world and presents a well-organized and systematic effort to make fundamental decisions in the field of medical equipment purchase management.   while only a few had 0-5 years of service.

METHODS
Most of the questions in the measurement model used in this research had the factor load of less than 3, and most of the fit indices were lower than the standard limit; thus, some questions were deleted to improve the fit index. The results of these modifications (deleting some questions with a low factor load and creating three co-variances between three pairs of errors) improved the model fit index. Table 1 illustrates the mean variance coefficient extracted for the main studied variables and represents the CR> AVE condition in managing the medical capital equipment purchase.  (Table 2). After confirmation, the path coefficients and their significance were examined (Table 3, included in appendix 1). In the standard mode, the P-value was significant for all paths. Table 3 in the appendix, "decision making"    Chakravaddi et al. imply that in recent years, India's private sector invested heavily in the purchase of medical equipment by participating in equipment management [38]. In their research, Boyer and Lio stated that in China, medical equipment is procured from the state budget. [27,42] Concerning the control aspect, many governments have

ACKNOWLEDGMENT:
The authors thank all staff members and managers of the hospitals affiliated with the Tehran University of Medical Sciences who supported and contributed to this research.