Abstract
BackgroundHealth systems need constant changes and reforms in their structure to adapt to changing conditions and meet the needs of society. One of the fundamental changes in the health system of Iran is the health transformation plan (HTP), the effects of which must be examined from different aspects. Therefore, the purpose of this study is to investigate the effect of HTP on the performance indicators of public hospitals in Yazd city, Iran.MethodsThis cross-sectional study was carried out in all public hospitals in city of Yazd. Six performance indicators were examined monthly and in two time periods of 12 months before and 12 months after the implementation of Health Transformation Plan (HTP). The data was analyzed by SPSS software program version 22, using the paired T-test, and the Interrupted Time Series (ITS) model.FindingsFindings showed that the performance indicators of the studied hospitals have improved after the implementation of the HTP. According to the ITS model, the implementation of HTP did not have a significant effect on the level and trend of the bed rotation distance, average length of stay and the ratio of surgical operations to bed indicators. However, it had a statistically significant effect on the level and trend of mortality and hospitalization rates. Moreover, the implementation of HTP had a significant effect on the level of the bed occupancy rate, but did not have a significant effect on the trend of this indicator.ConclusionBased on the research findings, all the selected indicators changed to some extent after the implementation of HTP, which showed the effect of this plan on the performance of hospitals. However, not all indicators were statistically significant as the findings sub-section revealed.
Highlights
Health systems need constant changes and reforms in their structure to adapt to changing conditions and meet the needs of society
Based on the research findings, all the selected indicators changed to some extent after the implementation of Health Transformation Plan (HTP), which showed the effect of this plan on the performance of hospitals
As a result of HTP, several main changes occurred in Iran, for instance, government spending on health increased unprecedentedly, health insurance coverage extended to all populations and about 11 million people were covered, medical tariffs were revised and about 1700 medical services were added into the basic benefit package, new hospitals and public health facilities were created in deprived regions, many hospitals and public health facilities were renovated, hospital beds increased, and more physicians and health workers, such as nurses and midwives were recruited in remote areas[11, 20]
Summary
Health systems need constant changes and reforms in their structure to adapt to changing conditions and meet the needs of society. In Iran, several major health reforms have been implemented over the last four decades aiming to improve the Ranjbar et al BMC Health Services Research (2021) 21:1133 health system performance[7,8,9,10,11,12] These reforms include the formation of the Ministry of Health and Medical Education in 1985 to solve problems related to training and supplying of health workforces; establishment of vast District Health Network in 1985 to provide affordable primary health care services for the whole population especially in deprived regions and rural areas; establishment of Universal health Insurance Organization in 1994 to achieve universal health insurance coverage; and implementation of Family Physician Program in the rural areas in 2005 to organize health system [10,11,12,13,14,15,16].
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