Abstract
BackgroundLow and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran.MethodsWe conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1.ResultsA decreasing trend by − 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001).ConclusionsFamily physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.
Highlights
Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC)
* Correspondence: Masoud.khandehroo@gmail.com 1Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran Full list of author information is available at the end of the article (PHC) was experienced in various models such as family physician plans as the main strategy in process moving toward UHC in Iran and around the world [2, 4, 5]
Outcome measure for the time series analysis was hospitalization rate across monthly intervals. As both reforms could have impacts on hospitalization rate, the change on this indicator will be traced on three segments including the period before Family Physician Plan (FPP), from the start of FPP to before the introduction of Health Transformation Plan (HTP), and the period after implementation of HTP
Summary
Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran. Three dimension of UHC (extend to non-covered population, reduce cost sharing and including other services) was aimed in the last health reform in Iran known as HTP for improving service provision with low cost sharing [8]. Health economic literature stated that expanding service coverage with low cost sharing may stimulate service utilization and even moral hazards [9]. Both of recent health reforms in Rouhani et al BMC Health Services Research (2021) 21:658
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