The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis

Siavash Beiranvand,Meysam Behzadifar,Mohammad Keshvari,Masoud Behzadifar,Mandana Saki,Ahad Bakhtiari,Nicola Luigi Bragazzi

doi:10.1186/s12913-020-05186-6

Abstract

BackgroundHealthcare policy- and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms. In May 2014, the Iranian Ministry of Health and Medical Education has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP). This study aimed to determine the effect of the HTP on hospitalization rate in Iranian public hospitals affiliated to the Ministry of Health and Medical Education.MethodsThis study was designed as a quasi-experimental, counterfactual study utilizing the interrupted time series analysis (ITSA), comparing the trend of hospitalization rate before and after the HTP implementation in 16 hospitals in the Lorestan province. Data was collected from March 2012 to February 2019.ResultsIn the first month of the HTP implementation, an increase of 2.627 [95% CI: 1.62–3.63] was noted (P < 0.001). Hospitalization rate increased by 0.68 [95% CI: 0.32–0.85] after the HTP implementation compared to the first month after the launch of the HTP (P < 0.001). After the HTP implementation, monthly hospitalization rate per 1000 persons significantly increased by 0.049 [95% CI: 0.023–0.076] (P < 0.001).ConclusionsThe HTP implementation has resulted in an increased hospitalization rate. Health planners should continue to further improve this service. ITSA can play a role in evaluating the impact of a given health policy.

Highlights

Healthcare policy- and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms
Before the Health Transformation Plan (HTP) implementation, the temporal trend was slightly decreasing with a monthly reduction by 0.018 [95% confidence interval (CI): 10.72–11.4], which, was not statistically significant (P = 0.11)
In the first month of the HTP implementation in the Lorestan province, an increase of 2.627 [95% CI: 1.62– 3.63] was noted and achieved the significance threshold (P < 0.001)

Summary

Introduction

Healthcare policy- and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms. Nine main packages of healthcare services and provisions were considered as the core of the plan, including: i) reducing out-of-pocket expenditure, ii) increasing healthcare coverage, especially in remote, rural areas and recruiting physicians, healthcare workers and personnel in underserved areas, iii) providing specialist doctors in hospitals, iv) improving the quality and timing of patient visits, v) enhancing the quality of accommodation services, vi) promoting natural childbirth, by reducing the choice of cesarean section, vii) ensuring that diseases with long and expensive treatment are covered by adequate financial protection, viii) changing health tariffs to reduce informal payments and promote costeffective interventions, and ix) building ambulance helicopter base centers [5] This has enabled to provide health services to nearly 9–10 million people from marginalized areas in Iran [5]

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Results