Health Reform Plan Research Articles

Assessment of Family Physicians Service Quality Gap in Rural Regions of Khorasan Razavi Province, before and after the Health Reform Plan

Assessment of Family Physicians Service Quality Gap in Rural Regions of Khorasan Razavi Province, before and after the Health Reform Plan

Measuring Equity in Iranian Healthcare System Financing: Experiences of Recent Health Reform Plan

Background and objectives: One of the main goals of the health system is the fair contribution of people to healthcare financing. Therefore, the current study not only evaluated the status of fair financial contribution, but also investigated the impacts of the health reform plan on the financial pillars of the Iranian healthcare system. Method: To conduct this retrospective descriptive study, the data of Income and Expenditure Survey (2011-2015) commissioned by Statistical Center of Iran were used. To measure fairness of financing, four indices were used. Data were analyzed using the Excel and SPSS software. Findings: The results show that although the health reform plan has increased insurance coverage of both rural and urban households, out of pocket, and even its proportion to household capacity to pay continues to rise. Prevalence of catastrophic health expenditures in the baseline year in rural and urban areas was 2.19% and 1.04%, reaching 3.69% and 2.39% at the end of the study, respectively. Accordingly, fair financial contribution in rural and urban areas was obtained 0.830% and 0.850% in the baseline year, reaching 0.823% and 0.850% in the last year of the study, respectively. Conclusion: Although indices of fair financial contribution during the 5-year period varied, they ultimately showed a worse situation compared to the baseline year. Thus, it is assumed that the health reform plan has not yet been successful in meeting the goal of improving fair financial contribution to the health system.

Investigation of informal payments and related factors in Iran state hospitals after health system reform plan implementation

Background: Informal payments in many developing countries, are a serious obstacle towards to improving healthcare system and has negative effects on the function of healthcare system. In order to reduce the unofficial payments and direct payments from patient's pocket, the health reform plan executed. This study was conducted to assess the Informal payments in the hospital related to government. Methods: This study was a survey based on descriptive analytic method in Zahedan University of medical science in 2017. The study population included all patients hospitalization to the two genera) hospitals of Zahedan in 2017, in which 500 patients were selected by multistage cluster sampling. The data collection tool was a standard questionnaire that was conducted by interview method. Data were analyzed by using spss v22 and descriptive statistics and chi-square test. Results: in this study,98% patients were male, 484(96.8%) lived in the urban area, about 2% had informal payment, the average informal payment to nurses were 300 thousand tomans.The highest number of informal payment was in the maternity ward with 50%.The doctors didn't have any informal payment, and all of people disagreed this type of payments. Conclusion: The results of the study showed that the rate of informal payments in the hospitals related to government in Southeast of Iran after execution of health reform plan, Is minimal. Poor economic status of the patients and well executed health reform plan are the reasons for minimal informal payments. Solutions including constant supervision on employees and realization of the health costs and proportion of insurance companies are effective steps towards elimination of informal payments.

The Relationship between the Kind of Delivery and 5 Indexes of Mother and Baby's Health Before and After Implementing Health Reform Plan in Selected Hospitals of Azarbaijan Sharghi

Introduction and aim: To improve the individuals' health, reforms should be made in the health systems. As a result, assessing the impacts of reforms is a way to evaluate the effectiveness of the health system. The aim of this study was to study the relationship between the kind of delivery and the five indexes of mother and baby's health before and after implementing the health reform plan in selected hospitals of Azarbaijan Sharghi, Iran. Issues and methods: This descriptive-analytical study was conducted in 2017. The study was conducted among eight educational, medical, and private hospitals. Before and after the program, 800 files were selected using simple random sampling method. The researcher made a check list with confirmed validity to extract the data. The data were analyzed using descriptive statistics and T-tests by SPSS-22. Results: The average age of mothers in the two intervals was 27 years. Most participants did not deliver before and their education was diploma or lower. The rate of natural delivery from 34.5% (before the plan) reached 44.2% (after the plan)(p<0.05). The rate of mothers and babies' mortality reduced from 0.3 and 0.8 to 0 and 0.5, respectively. Mothers and babies' mortality and stillbirth had no significant difference based on the kind of delivery (p>0.05). Conclusion: Findings indicated significant increase of natural delivery after the reform plan in health system. Moreover, the rate of mothers and babies' mortality decreased. These results can guide the policymakers for deciding about the course of plan and its review.

Inequality Assessment of Hospital Resources Distribution in West Azarbaijan Province Using Economic Indicators, Before-After Health System Reform plan

Background: Equity in access to health care services is one of the main goals of health systems, so that inequality in the geographical distribution of health resources will make it difficult for individuals to access the health care facilities. This study aimed to determine the distribution status of hospital resources and inequality coefficient in the West Azarbaijan province before and after implementation of the health system reform plan. Methods: This cross-sectional and descriptive-analytic study aimed to investigate inequality in the distribution of health resources in cities of West Azarbaijan province before and after health system reform plan using concentration ratio and Hall Tiedman indices. The required data for estimating these indices were the number of specialist physicians and hospital beds, which were extracted from the data base of treatment deputy in Urmia University of Medical Sciences. Data analysis was conducted by Excel software. Results: The results indicated a high spatial concentration in distribution of the health resources in the province, so that fixed beds and specialist physicians were more concentrated in the capital city of province; Urmia. Moreover, inequality in distribution of the resources in cities of the province was highly related to population. Comparisons of the results before and after the health system reform plan showed that the distribution of fixed beds and specialist physicians had decreasing and increasing trends, respectively. Conclusion: The results showed that inequality in distribution of the hospital beds was intensified after implementation of the health reform plan. Furthermore, distribution of specialist physicians after the reform plan, despite its improvement, was not according to the population distribution. Therefore, inappropriate distribution of the above-mentioned resources should be readjusted by adopting redistributive policies.

Qualitative Explanation of the Effect of Changes in the Educational System on the Development of Professionalism in Medical Residents

Background The development of professionalism is one of the fundamental goals of educational systems, especially in medical sciences. Medical students, in addition to acquiring clinical knowledge and skills, should somehow benefit from moral values and professionalism in order to practice in a professional manner. The development of professional ethics is heavily influenced by the hidden curriculum affected by changes in the educational system. The health reform plan is launched in Iran in recent years. Objectives The current study aimed at qualitatively explaining the effects of changes to the educational system on the development of the professionalism in medical residents. Methods The current qualitative study was performed by the content analysis method. A total of 26 interviews were conducted with 12 prominent professors of medical education, 13 third-year internal medicine residents, as well as a focus group including 10 residents. The purposive sampling method with maximum diversity was used in the current study and continued until data saturation. Data were analyzed using the content analysis method. The Lincoln and Guba criteria were used to increase the credibility of the findings. Results The most important finding of the current study was the challenge of developing professionalism due to environmental changes. The main theme included the challenges of professionalism development in the existing educational system, changes related to the sociocultural environment of the community, changes related to health reform plan, and the shift from training to health services and promtion of faculty member. Conclusions Changes and interventions in the health care services sector, such as the health reform plan, greatly affect the development of professionalism in medical residents. The plans that affect the health system, a special attention should be paid to the education section and the educational documents should be prepared initially and implemented simultaneously.

The Effect of Health Reform Plan on Job Satisfaction among Nurses in Governmental Hospitals at Ardebil and Khalkhal Cities

Background: Nurses are one of the main members of the health and treatment team; therefore, attention to job satisfaction is an important factor affecting the quality of health services provided by them. In recent years, improving healthcare has been one of the main concerns of staff in this area. This study aimed to investigate the effect of the health reform plan (HRP) on job satisfaction of nurses working in public hospitals at Ardebil and Khalkhal cities. Materials and Methods: This descriptive-analytic study was conducted on the 380 nurses who worked in public hospitals of Ardebil and Khalkhal cities, in 2017. Job satisfaction was assessed via Whiskey and Chrome occupational satisfaction, and researcher-made questionnaires on the effect of change design on nurses' satisfaction. Data were analyzed using SPSS software. Results: The findings of this study showed that the mean total score of nurses' satisfaction was 22.14±6.75. Also, the mean total score of satisfaction of the HRP was 22.14±6.75. The moderate satisfaction of the HRP among nurses was 35.62%. Also, HRP could not change job satisfaction in 51.84% of nurses. Conclusion: The findings of this study indicate that nurses' job satisfaction was moderate and that the implementation of HRP has not been able to improve their satisfaction.

Iranian Health Reform Advantages in Health Care System: A Qualitative Study

Background: Iranian Health Reform Plan in health care systems launched in 2014. The aim of this program was to expand equity in the field of health, improve quality, increase accessibility to health services, and increase people’s satisfaction. Objectives: This study designed to explore Iranian health reform advantages in health care systems on the perspective of health managers, health care providers, and clients. Methods: In this content analysis study, participants included 22 health managers, 118 health care providers, and 15 clients affiliated with the health deputy of the Qom University of Medical Sciences. Sampling was conducted in the purposeful method. Individual semi- structured interviews were used for data gathering and data was analyzed by the conventional approach. Similar codes were merged and categorized and the extracted subcategories were named based on their essence. MAXQDA software was used to manage qualitative data. Results: 328 codes, 19 subcategories and 7 main categories were extracted. On the perspective of participants, Iranian health reform advantages in health care system, categorized in 7 main categories included; improvement of general health, improvement of equity in the health system, improvement of health literacy, providing comprehensive health services, providing personalized health services, increased general satisfaction, and providing electronic health records. Conclusions: Health managers, health care providers, and clients expressed their satisfaction from Health Reform Plans and pointed to different aspects of it. On these findings, Iranian Health Reform Plans can facilitate promoting health care services and in sequence, public health.

Assessment of the Efficiency of Hospitals before and after the Implementation of the Health Reform Plan in Qazvin Province Based on the Pabon Lasso Model (2011 - 2016)

Assessment of the Efficiency of Hospitals before and after the Implementation of the Health Reform Plan in Qazvin Province Based on the Pabon Lasso Model (2011 - 2016)

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Lack of well-designed healthcare financing mechanisms and high level of out-of-pocket payments in Iran over the last decades led to implementing Health Transformation Plan, in 2014. This study aims to decompose inequality in financial protection of Iranian households after the implementation of the Health Transformation Plan. The data of Statistical Center of Iran (SCI) Survey on Rural and Urban Households Income-Expenditure in 2015 to 2016 were used. The headcount ratio of catastrophic health expenditures was calculated. The corrected concentration index was estimated. The role of contributors on inequality in the exposure to catastrophic health expenditures among poor and nonpoor households was calculated using Farelie's model. The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.

The Effects of Health Transformation Plan Implementation on the Performance Indicators of Public Hospitals

Background: The Health Transformation Plan (HTP) is one of the recent reforms adopted in the health system of Iran. Objectives: This study aimed to investigate the effect of implementing of the HSRP on the performance indicators of teaching hospitals in Iran. Methods: This descriptive-analytic study was carried out in 10 teaching hospitals of Shiraz University of Medical Sciences in 2017. After referring to the concerned hospitals, 10 performance indicators were extracted and analyzed at 2 stages (before (2013) and after (2015) implementing of the HSRP). Paired sample t-test was run in the SPSS software23 to compare the obtained data. Results: Investigating the mean differences of performance indicators before and after the implementation of the HSRP indicated a significant increase (P < 0.05) for the indicators of bed occupancy ratio, inpatient to constructed beds ratio, the mean length of stay, frequency of patients admitted in the clinical and para clinical sectors, frequency of emergency and elective operations, as well as frequency of cesarean and normal delivery. However, the hospital bed turnover rate revealed a significant decrease compared to the year prior to the implementation of the HSRP (P < 0.05). Conclusions: The implementation of the health reform plan has been accompanied by significant changes in the performance indicators of the hospitals. Regarding the reduction of the normal delivery rate in comparison with caesarean section after the implementation of the plan, it is suggested to improve the awareness and culture of mothers and society regarding the importance and benefits of natural delivery through the intersectional interactions.

Health Reform and Theories of Cost Control

Health care costs and affordability are critical issues to consumers. Just as we assess the coverage impacts of a health reform proposal, we should be able to evaluate how the plan will constrain health care costs: its theory of cost control. This essay provides a framework to assess health reform plans on their theories of cost control, identifying the key policy tools to constrain health care costs organized in a two-by-two matrix across the following dimensions: price vs. utilization and public vs. private payers. It then applies the framework to the Affordable Care Act (ACA) and the Republican's 2017 legislative efforts to repeal and replace the ACA to identify their general theories of cost control, revealing on the plans' strengths, blind spots, and incoherence.

Impact of Protocol Implementation on Rationalization of Albumin Use in a Tertiary Care Teaching Hospital in Tehran, Iran.

Objective:With respect to the high cost and limited availability of albumin, its use must be restricted to indications strongly supported by solid scientific evidence. It was anticipated that with the implementation of the National Health Reform Plan (NHRP), the consumption of albumin would increase as the result of decreasing patients' out-of-pocket costs. This study aimed to evaluate the efficacy of protocol implementation on the rationalization of albumin use in surgery wards of Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran.Methods:This pre-post interventional study was conducted in 32-month phases from January to November 2014 in an Iranian University hospital. The first phase was before the implementation of NHRP, the second phase was after NHRP, and the last one was after the intervention. The first and second phases were conducted retrospectively. Data extraction was performed by a hospital pharmacist. During the third phase, the physicians were mandated to adhere to a local albumin protocol which had been prepared by clinical pharmacy service and approved by drug and therapeutic committee. Appropriateness of prescriptions regarding indication, dose, and duration based on local guideline was compared among groups.Findings:Although hospital bed-days of care remained consistent among phases, albumin was prescribed for 40, 45, and 8 patients during first, second, and third phases, respectively. This shows about 80% reduction of drug prescriptions in the last phase. The mean duration/dose of albumin in inappropriate indications reduced significantly from 11.3 ± 8.2 days/24.7 ± 21.2 vials in the second phase to 2.6 ± 1.7 days/5.6 ± 3.5 vials in the third phase, respectively (P = 0.001 and P = 0.003).Conclusion:Interactive collaboration through guideline implementation seems effective in rationalizing the use of high-cost medications such as albumin.

Iran's Struggling Health System: An Increase in Natural Childbirth: A Case Study.

Background:The 7th package of health reform in Iran has been implemented in May 15, 1393, is concerned with the “promotion of natural childbirth.” It has been focusing on reducing cesarean section (CS) and promoting normal vaginal delivery (NVD) as broadly as possible. This study evaluated the changes in the vaginal delivery and cesarean before and after implementation of the 7th package of health reform in public and private hospitals of Isfahan Province in 2014.Methods:This was a quasi-experimental research. The population of this study contained all public and private hospitals in Isfahan Province covered by the Health Reform Program. It included 22 public and 6 private hospitals. The data collected from the vice chancellor of treatment in 6 months before and after the implementation of the program have been analyzed. SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA) and independent t-test have been employed for data analysis.Results:It was demonstrated that the increasing rate of NVD (P = 0.001) and decreasing rate of CS in public hospitals (P = 0.027) after the implementation of the plan were significant. On the other hand, the increasing rate of CS in private hospitals was significant (P = 0.026).Conclusions:Although this scheme has achieved its targets in public hospitals of Isfahan Province, it has not met its objectives in private hospitals. It seems CS operations were shifted from public hospitals to private ones, which is conflict with the objectives of the health reform plan.

Health reform policy-making: Fiscal sustainability matters (The case of Iran’s PresidentCare)

The government of Iran has implemented a major health system reform program, called the Health Reform Plan (HRP). HRP covers a wide range of structural, policy, pricing, and tariff reforms in a wide range of health promotion programs, including reducing the share of payment made by patients hospitalizing in public hospitals, promoting natural childbirth, supporting the retention of physicians in underserved areas, and providing financial protection for incurable or needy patients.Two years after the implementation of RouhaniCare, this study aims to review and analyze the main bottleneck of the plan: Fiscal sustainability. The findings of this study, based on a fiscal simulation model, show that, despite some favorable changes in health indicators, including a considerable decrease in catastrophic health expenditure and a reduction in out-of-pocket health costs for inpatient services, the gap to finance HRP will threaten the continuation of the reform in the coming years. HRP will cost approximately 2% of GDP in the medium-long term. Considering the current path of government revenues, this is fiscally unsustainable, and government will face a menu of options in the near future: reallocating current expenditures in favor of health sector spending; increasing tax revenues, including imposing new health sector linked corrective taxes; and reforming HRP so that it places less of burden on public finance spending.

Health System Reform Plan and Performance of Hospitals: an Iranian Case Study.

Background:Health system reform is essential to make desired Changes. In Iran, first phase of Health Reform Plan (HRP) was implemented in hospitals affiliated with Ministry of Health and Medical Education (MHME) in 2014.Aim:The present study was carried out to evaluate the performance of hospitals affiliated with Urmia University of Medical Sciences at the time of the implementation of HRP.Methods:This cross-sectional study carried out in two stages, before (2012- 2013) and during (2014- 2015) implementation of the HRP in district and teaching hospitals. Data collection and evaluation of performance of hospitals was performed using indices issued by MHME using graphical and statistical analysis.Results:Average bed occupancy rate and bed turnover rate increased and the average length of stay decreased in the majority of hospitals during the study period. The highest and lowest bed occupancy rate was observed in district hospitals. All hospitals were shifted toward the third zone in Pabon Lasso (PL) diagram.Conclusion:This study confirmed that the implementation of the defined package of HRP in hospitals affiliated with UUMS resulted in increased admissions and hospitalization and improved performance.

Drug Supply Chain Management and Implementation of Health Reform Plan in Teaching Hospital Pharmacies of Ahvaz, Iran

Background: Drugs play a strategic role as a health commodity. Thus, the supply chain management of drugs is an important issue to reducing costs and thereby improving patient health. Objective: This study evaluated the status of drug supply chain management and health reform in the pharmaceutical sector of teaching hospitals in Ahvaz, Iran. Methods: This cross-sectional study was carried out in pharmacies of teaching hospitals in Ahwaz, Iran in 2015. Data was collected through a checklist extracted from the Evaluation Checklist of the Food and Drug Deputy and related articles. The study checklist examined six dimensions of the Evaluation Checklist, including drug storage, administrative regulations, preparation of medicines, drug distribution, taking medication, and implementation of health reforms in the pharmaceutical sector. The content validity of the checklist was confirmed by experts and pharmaceutical specialists. Data was analyzed for descriptive characteristics such as frequency and percentage using EXCEL version 2010 software. Results: The findings show that hospitals met standards for administrative regulations with 78.5% and preparation of medicines with 77.25%. The dimensions of drug storage with 74.75%, taking medication with 74.25%, implementation of health reforms with 71.5%, and drug distribution with 62.5% were in a near-standard state. Conclusion: Supply chain management systems of medicines in teaching hospitals are near-standard. To improve hospitals, offering proper training to employees, using the fixed-rate shopping system, and providing facilities to patients are recommended.

Threats and Opportunities of the Health Reform Plan from the Nurses’ Perspective in Ilam

&lt;p&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;The Health Reform Plan is one of the greatest state services in Iran. However, this plan has its own weaknesses and strengths. This study was conducted with the purpose of determining strengths and weaknesses of the Health Reform Plan from nurses' perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;METHODS: &lt;/strong&gt;This is a cross-sectional study in which 100 nurses who work in clinical education centers on Ilam participated. The data collection tool was a questionnaire which consisted of 12 items regarding the strengths of the Health Reform Plan and 18 items about the plan's weaknesses on a six-option Lickert scale. Data analysis was carried out using SPSS V. 19 and applying descriptive and inferential statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS:&lt;/strong&gt; The mean score for weaknesses was 79.94 and the mean score for strengths was 52.49. There was a significant statistical relationship between the variable of age and the strengths (P=0.015).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSION: &lt;/strong&gt;If we manage to increase strengths and reduce weakness of the Health Reform Movement, we can be hopeful that this great plan will be administered more efficiently at a national level. It is suggested that future studies be conducted about individuals' perspectives in other occupations in the field of medical sciences working in different medical communities and hospitals in Iran and the results be compared.&lt;/p&gt;

Study of Educational Hospital Employees' Satisfaction with the Administration of the Health Reform Plan in Ghazvin, 2015.

IntroductionEmployee satisfaction is considered to be an important component in the promotion of service quality and increased efficiency and effectiveness in the reform plan for a healthcare system. Neglecting this issue could result in a lack of success in achieving the healthcare system’s objectives. The healthcare reform plan is being implemented to achieve the objectives of the healthcare system. Thus, given the key role of hospital employees in implementing the reform plan, the aim of this study was to determine the levels of hospital employees’ satisfaction with their jobs.MethodsThis was a qualitative study in 2015 that included thematic analysis, and 138 employees of the Kosar, Rajaii, and Ghods Hospitals participated. Data were collected using semi-structured interviews, and the data were analyzed using content analysis.ResultsAfter analyzing the data collected by interviewing the employees, 132 codes were identified. The codes were classified into five general concepts including opinions about 1) the reform plan and its administrative barriers, 2) changes in visits, 3) changes in working conditions, 4) changes in salaries and 5) General satisfaction of personnel.ConclusionIncreasing workloads, stagnant salaries, and the shortage of personnel were the main factors that reduced the satisfaction of the hospitals’ employees with the administration of the healthcare reform plan.

‘Crony Capitalism’ And The ACA

‘Crony Capitalism’ And The ACA