Change in health spending after implementation of a health transformation plan in Iran: an interrupted time series analysis

Reza Esmaeili,Masoud Khandehroo,Samad Rouhani,Jamshid Yazdani Charati

doi:10.1186/s12962-021-00286-4

Abstract

BackgroundHealth transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients. This study aimed to assess the impact of HTP on health spending in Iran.MethodsThis was a quasi-experimental design using Interrupted Time Series. All registered impatient records in Iran health insurance organization (IHIO) for the population of Mazandaran province (1,628,919 population in 2011), north of Iran from March 2010 to February 2019 were included. Data for three depended variables: hospitalization rate, average inpatient cost and inpatient expenditure per capita was extracted in 96 monthly observations. Segmented regression analysis was done in R version 3.6.1.ResultsHospitalization rate in 2010 was 6.6 in 1000 people and its level change was 0/799 immediately after HTP (P < 001). Post-reform level and trend changes for monthly average inpatient cost of registered admissions in IHIO were also significant (P < 001). IHIO inpatient expenditure per capita for 1,628,919 population in Mazandaran province was 24,436 Rials in 2011 and increased significantly immediately following HTP as 34,459 Rials (P < 001).ConclusionsThree important components of health spending including hospitalization rate, average inpatient cost and inpatient expenditure per capita were increased dramatically after HTP. Cost containment strategies and strengthening the preventive care initiatives is required to control the escalating trends of inpatient expenditure in Iran.

Highlights

Health transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients
Sustainable Progress in Universal Health Coverage (UHC) needs to address the attributes of high-performing health systems: quality, efficiency, equity, accountability, sustainability and resilience in health reforms monitoring and evaluation [2]
For better understanding about changes in health spending after HTP in Iran, this study investigated empirical evidence about the level and trend of inpatient spending throughout three areas: hospitalization rate, average cost per inpatient and per capita expenditure using Interrupted Time Series (ITS) analysis

Summary

Introduction

Health transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients. Moving toward Universal Health Coverage (UHC), in the context of economic crisis and limited resources, requires sustainable financing and more effective resource allocation mechanisms throughout the implementation of new health reforms [1]. Sustainable Progress in UHC needs to address the attributes of high-performing health systems: quality, efficiency, equity, accountability, sustainability and resilience in health reforms monitoring and evaluation [2]. Inpatient and day curative care accounted as Reforming public hospitals for improving access to health care and decreasing health inequality were done in some countries such as China [6, 7] and Iran [8] in the last decade. Post-reform health spending monitoring are needed to examine the implementation and effects of these reforms.

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Conclusion