Health Transformation Plan Research Articles

The impact of health reform on poverty estimates in Iran: Implications for monitoring the first goal of Sustainable Development Goals.

Iran launched a series of health reforms called Health Transformation Plan (HTP) in order to improve financial protection and access to health care in 2014. This study aimed to investigate the extent of impoverishment due to out of pocket (OOP) payments during 2011-2016 and to assess the implications of health expenditures to overall national poverty rate before and after the HTP implementation, with a focus on monitoring the first Sustainable Development Goals (SDGs). The study relied on data from a nationally representative household income and expenditure survey. Two measures of poverty were estimated in this study: the prevalence (poverty headcount) and the intensity of poverty before and after OOP health payments (poverty gap). Proportion of the population fell into poverty due to OOP spending for health care from total poor population calculated for 2years before and after the HTP implementation using three poverty lines suggested by the World Bank for global poverty comparison ($1.90, $3.2 and $5.5 per day in 2011 purchasing power parity (PPP) $). Our results indicate that the incidence of impoverishing health expenditures has remainedrelatively low during 2011-2016. At the 2011 PPP $5.5 daily poverty line, the average incidence rate at the national level was 1.36% during the period. The percentage of population impoverished due to OOP health expenditures increased after HTP implementation, irrespective of the poverty line used. However, the proportion of individuals that pushed further into poverty decreased after HTP implementation. It was estimated that around 12.5% of total poor population fell below poverty line due to paying OOP payments in 2016. Although health care costs are not major causes of impoverishment in Iran, the relative impact of OOP spending for health is not negligible. To attain SDG 1, pro-poor interventions that aim to reduce the burden of OOP payments should be advocated and implemented with an inter-sectoral approach.

Socioeconomic inequality in informal payments for health services among Iranian households: a national pooled study

BackgroundThere is limited evidence on the prevalence and socioeconomic inequality in informal payments (IP) of households in the Iranian health system. This study was conducted to investigate the prevalence of IP and related socioeconomic inequalities among Iranian households in all provinces.MethodData on Household Income and Expenditure Surveys (HIES) for 91,360 households were used to examine the prevalence and inequality in informal health sector payments in the years 2016 to 2018. The Normalized Concentration Index (NC) was used to examine inequality in these payments and the decomposition analysis by the Wagstaff approach was used to determine the share of variables affecting the measured inequality.ResultsOf the total households, 7,339 (7.9%) reported IP for using health services. Urban households had higher IP (10%) compared to rural ones (5.42%). Also, the proportion of households with IP in 2016 (11.69%) was higher than in 2017 (9.9%), and 2018 (4.60%). NC for the study population was 0.129, which shows that the prevalence of IP is significantly higher in well-off households. Also, NC was 0.213 (p < 0.0001) and -0.019 for urban and rural areas, respectively (p > 0.05). Decomposition analysis indicated that income, sex of head of household, and the province of residence have the highest positive contribution to measured inequality (with contributions of 156.2, 45.8, and 25.6%, respectively).ConclusionThere are a significant prevalence and inequality in IP in Iran's health system and important variables have shaped it. On the whole, inequality was pro-rich. This may lead to increasing inequality in access to quality services in the country. Our findings showed that previous health policies such as regulatory tools, and the health transformation plan (HTP) have not been able to control IP in the health sector in the desired way. It seems that consumer-side policies focusing on affluent households, and high-risk provinces can play an important role in controlling this phenomenon.

Modeling on number of children ever born and its determinants among married women of reproductive age in Ethiopia: A Poisson regression analysis

BackgroundOne of the main components of population dynamics that determine the size, structure, and composition of a country’s population is the number of ever-born children. Psychological, economic, social, and demographic factors all have a strong influence on and predict it. However, there is little information on its current status in Ethiopia. As a result, modeling the number of children ever born and its determinants is critical for the Ethiopian government to develop appropriate policies and programs. MethodsA total of 3260 eligible women were used as a study sample in this study to assess the number of children ever born and determinants among married reproductive age women in Ethiopia. Secondary data were culled from the 2019 Ethiopian Demography and Health Survey datasets. The factors associated with the number of children born were identified using a Poisson regression model (CEB). ResultsThe average number of children per mother was 6.09, with a standard deviation of 8.74. There were 2432 (74.6%) rural residents among the total respondents, 2402 (73.7%) have no formal education, and three out of five women are not currently working. The participants' average age was 41.66, with a standard deviation of 3.88. When compared to urban residents, the number of CEB for rural residents is 1.37 times higher. When compared to women with no education, the number of CEB for women with higher education was reduced by 48%. For every unit increase in respondents' current age, the percent change in the number of children ever born increases by 2.4%. For every unit increase in the family's wealth index status, the percent change in the number of children ever born decreases by 1.7%. ConclusionWhen compared to the target of Ethiopia’s health transformation plan, the average number of children born is higher. Improving the household wealth index, women’s education, and employment status all contribute to a reduction in the number of CEB, which is important in balancing population growth with natural capacity and the country’s economic development.

The Experiences of Health Transformation Plan in Southeast Iran: A Qualitative Study

Background. Considering the need for new health programs, the Health Transformation Plan, as one of the largest health system reform programs, has been implemented in Iran since 2014. Methods. This cross-sectional, applied study was conducted qualitatively on 27 participants in 2019 (19 service providers and 8 service recipients). The data collection tool was a semi-structured interview guide that was validated through a comprehensive literature review, and consultation with health strategy transformation experts. The research plan was approved by the ethics committee and the research work commenced accordingly. The research work was carried out at the research participants’ workplace (employees) via interviewing process. All the interviews were recorded daily. The data interpretation and analysis were conducted through coding and content analysis approach. Results. The data analysis for participants’ groups (i.e., service givers, human resources, infrastructure, education, and service recipients), using the open coding stage and the initial concept in the sub-coding stage, indicated 10 minor and 5 major categories. Conclusion. Appropriate education, quality of services, financial support, and specialized manpower can be considered as possible ways to cope with the challenges in the health transformation plan.

The Survey of Presenting New Health Services to Middle-aged Population in Health Transformation Plan: a Qualitative Study

Introduction: Providing health services to middle-aged people is of special importance due to the large population, productivity, and the impact of health behaviors of this age group on various aspects of family health. The purpose of this study is to evaluate the provision of middle-aged health services.&#x0D; Methods: This was a qualitative study performed in 2017 in comprehensive health centers of Yazd city. Central part of Iran. Sixty two individuals (specialists, general practitioners and experts) providing health services in comprehensive health centers were selected through targeted sampling . Interviews were done with a semi-structured individualized method. Questions were asked in the following domains: weaknesses and strengths and recommendations about the method of providing services and its content.&#x0D; Results: According to the results, 15 weak points and 5 strong points in the method of providing services, and 8 strong points and 7 weak points about the content of health service packages and 17 recommended mechanisms about the improvement of the providing services and 11 recommended mechanisms about improvement of the content of packages were extracted. The main weak points in providing services were such as not observing referring system, lack of insurance coverage for some services, problems in Integrated Health Record System. The weak points of the packages of health services for middle-aged people were as lack of predicting the service packages for levels 2 and 3, repetition of the questions in evaluation, and low attention to social health and traditional medicine.&#x0D; Conclusion: Concentrating on the improvement of the service providing and the contents of the packages of new health services by utilizing presented recommendations according to professional viewpoints of health service providers helps improve health level in this age group and increase the efficiency in the middle-aged people.

Measuring inequality in the distribution of health human resources using the Hirschman-Herfindahl index: a case study of Qazvin Province

BackgroundAchieving equity in the distribution of health services is one major goal in the health system. This study aimed to determine equality in distributing health human resources (physicians) in the Qazvin University of Medical Sciences before and after the Health Transformation Plan (HTP) based on the Hirschman-Herfindahl index (HHI).MethodsIn this descriptive-analytical study, the statistical population was general practitioners (GPs), specialists and subspecialists in the Qazvin University of Medical Sciences from 2011-to 2017. We extracted demographic statistics of the cities from the Statistical Center of Iran. Physicians’ statistics were obtained from the Curative Affairs Deputy at the Qazvin University of Medical Sciences. We assessed inequality using the HHI.ResultsThe highest number of GPs was in 2014, and specialists and subspecialists were in 2017. The lowest number of GPs, specialists, and subspecialists were in 2016, 2011 and 2015. The HHI for GPs in 2011–2017 was between 4300 and 5200. The lowest concentration for specialists before the HTP plan was the cardiologist with 3300, and after the HTP, the internal specialist with 3900. Also, the numerical value of this index for all subspecialty physicians after the HTP was 10,000, the highest level of concentration.ConclusionThe values obtained from the HHI index indicate the high concentration and disproportionate and inequitable distribution of human resources in the health sector in this province. The number of specialists in some cities is still much less than acceptable, and some cities even have shortcomings in the critical specialists.

Iran's Health Transformation Plan; Main Issues and Opportunities for Improvement: A Systematic Review.

The Health Transformation Plan (HTP), as the latest reform of Iran's health system, has been implemented gradually in several phases to facilitate the achievement of universal health coverage. We aimed to identify the achievements and challenges of the HTP from the beginning of its implementation in Iran health system. In this qualitative systematic review, English papers were searched in PubMed, Scopus, Web of science, and Google Scholar search engines in addition to Persian databases such as Magiran and SID from 2014-2020. The Mixed-Methods Appraisal Tool (MMAT) checklists were used to assess the quality of the studies. Study selection, quality assessment, data extraction, and data analysis were done independently by two people. For analyzing the data, the Framework Analysis Method, based on the health system function framework of the WHO, was used. Overall, 32 papers were included based on the inclusion criteria. The results were divided into four main themes: stewardship, financing, resource generation and service delivery, and 20sub-themes in the form of achievements and challenges. Regulatory and standardization, service packages, medical equipment and supplies, and the quality of health services were more repetitive. Considering the challenges of HTP, purchase process, motivational factors, and health services capacity were more repetitive. The administrative challenges in the implementation of the HTP have prevented the sustainability of the outcomes and their main goals. The use of strategic dynamic planning, anticipating sustainable financial resources, and strengthening the monitoring mechanisms could lead to further achievements.

Iranian Health Transformation Plan in Physiotherapy Services: Comparison of Household Based Financial Outcomes

Background: Physiotherapy services are important because they help disabled patients to return to work and other social activities. High out-of-pocket payments of physiotherapy services are one of the major barriers to the utilization of these services. In 2014 a reform was implemented in Iran named as Health Transformation Plan aimed to improve Universal Health Coverage of Iranians. We tried to find the effects of HTP on the financial outcomes of physiotherapy services.

Measuring Progress toward Universal Health Coverage in Iran: Two Years after the Implementation of the Health Transformation Plan

Introduction: One of the most important 2015-post agendas of countries’ health systems is achieving Universal Health Coverage (UHC), so countries should monitor the activities carried out. The present study aimed to investigate the UHC status two years after Health Transformation Plan (HTP) in Iran.&#x0D; Methods: This is a secondary analysis of the national household income and expenditure survey (with close 40,000 households as the survey sample). The survey was used to estimate financial protection indicators (out-of-pocket payment, catastrophic and impoverishment health expenditure) in 2016. Estimation for service coverage index provided by international databases was applied at the country level. Indicators of financial protection and service coverage were evaluated in relation to each other using the World Health Organization joint levels assessment method, which indicates UHC attainment in terms of a plot with four zones. The relationship was estimated for the entire population, first quintile, and fifth quintile in 2000, 2017, and 2030.&#x0D; Results: The average per capita of OOP annually was 1,940,613 Rials (162.415 PPP int $). About 15.85% of households endured catastrophic health expenditures at the 10% threshold. The impoverishment health expenditure is about 0.6. Accordingly, Iran is on the border between zones 1 and 2 in 2017 in terms of achieving UHC and will move to zone 1 in 2030 with the current trend.&#x0D; Conclusion: According to the results of this study, universal health coverage has not been achieved even despite the implementation of the HTP. Even with improved service coverage, achieving UHC by 2030 may seem impossible with the current trends.

Governmental support for achieving “VISION 2020: the Right to Sight” in Iran: the cataract surgical rates

PurposeThe aim of this study was evaluate the effect of governmental support in the form of Health Transformation Plan (HTP) on increasing the cataract surgical rate.MethodsThe number of cataract surgeries was collected from Iranian cataract surgery clinics during 2019. HTP was implemented in 2014. Forty-seven major and forty-five minor surgery centers were selected from all provinces. In each center, sampling was done from 2012, 2013, 2015, and 2016.ResultsOn average, 6202 and 7134 cataract surgery rate were performed before and after HTP, respectively. The cataract surgical rate rose by 15.03% after the HTP. After HTP, the proportion of cataract surgery increased by 21.32% in governmental centers and decreased by 17.56%, 24.45%, and 14.89% in private, insurance, and charity centers, respectively. The cataract surgical rate was 4093 and 6026 in the first economic quartile (the poorest), 3669 and 4595 in the second quartile, 5884 and 5928 in the third quartile, and 8427 and 9681 in the fourth quartile (the richest) before and after HTP, respectively. The highest growth in the cataract surgical rate was seen in the first quartile (47.24%) followed by the second (25.26%), fourth (14.88%), and third quartiles (0.74%).ConclusionThe Health Transformation Plan has been successful in increasing the cataract surgical rate in the low-income group and identifying differences in the services as well as the economic groups within the population.

The Effect of Iran's Health Transformation Plan on Job Involvement of the Clinical Faculty Members in Ahvaz Jundishapur University of Medical Sciences

Introduction: Given the role of job involvement in job satisfaction and improving the organizational performance of the staff, the present study was conducted to evaluate the effect of Iran's Health Transformation Plan (HTP) on job involvement of the clinical faculty members.&#x0D; Methods: This descriptive study was conducted in the academic year of 2018-2019 and in educational hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences in Iran, and finally, 90 clinical faculty members participated in this study by using a convenience sampling method. To collect data, a researcher-made questionnaire was based on the standard Lodahl and Kejner's job involvement questionnaire. The data were analyzed using descriptive statistics (mean, standard deviation, percentage), inferential statistics (independent t-test and analysis of variance), and SPSS22 software.&#x0D; Results: The results revealed that the level of Iran's Health Transformation Plan on job involvement of the clinical faculty members was moderate (48.73 ± 14.40).Variables such as gender, age, education, academic rank, employment history, and having a private clinic and hospital where faculty members work, did not have a significant effect on their job involvement.(P-value &gt; 0.05)&#x0D; Conclusion: The HTP is currently one of the most important and costly health care reforms in Iran, and for better success and the staff's satisfaction, it is recommended to pay more attention to effective and influential factors in improving and increasing job involvement of service providers, especially clinical faculty members in their periodic evaluation.

Explaining the Role of Physicians in Urban Comprehensive Health Service Centers After Implementing Health Transformation Plan in Southeast of Iran: A Qualitative Study

Background: Health transformation plan (HTP) in Iran was established in 2014 to promote primary health care through expanding and strengthening the first level of services in urban and rural areas. The activities of physicians and their colleagues in comprehensive health service centers have increased access and improved community health. Conducting various studies on the urban physicians’ roles can help policymakers achieve the goals. Objectives: This study aimed to explain the role of physicians working in urban, comprehensive health service centers after implementing the HTP. Methods: Participants in this qualitative study consisted of physicians, healthcare providers, managers, and experts, working in urban health centers selected by a purposive sampling method. The data were collected by semi-structured interviews. After data saturation, they were analyzed by conventional content analysis. Results: After interviewing 35 people and several stages of review, coding, and using the experience of experts, the data were classified into six main categories, 11 subcategories, and 33 codes. Factors influencing the role of physicians were service delivery, electronic health records, resources, community culture, monitoring, supervision, and practical suggestion. The participants expressed the workload, referral system, integrated electronic health record, financial resources, human resources, equipment, and public participation as some aspects related to the role of physicians. Conclusions: Based on the current study, human and financial resources should be managed to retain the physicians in this plan. In addition, increasing the quality of services, improving electronic health records, and attention to public culture can be considered.

Satisfaction Level with the Health Transformation Plan in Iran: A Systematic Review

Background: The Health Transformation Plan (HTP) had been one of the most significant recent reforms in the Iranian health system. Notwithstanding, it has strengths and weaknesses that should be assessed. One of the most important aspects of assessing programs is the people and the personnel's satisfaction. Consequently, this study has reviewed studies that have measured satisfaction with HTP. Methods: In this systematic review, databases of Web of Science, Scopus, PubMed, Google Scholar were searched until May 2019. The Ministry of Health website, and the National Institutes of Health Research website were also searched. All studies that evaluated HTP satisfaction were included. Data were collected and analyzed utilizing a data extraction form and reported by narrative review. Results: 20 studies were included that were conducted in the period 2014 to 2017. The overall results of the studies indicate that nurses and physicians have not been satisfied with HTP, while retaining physicians in disadvantaged regions and patients have been approximately satisfied with HTP. Only three before and after studies have been conducted, and the rest studies are related to after HTP. Two before and after studies concluded that patients and nurses 'satisfaction is decreased and one study concluded that mothers' satisfaction is increased. Nurses and physicians dissatisfaction was due to the causes such as increasing the number of clients, injustice in payments, unbalanced workload and salary and other working conditions. Conclusion: Influential, comprehensive, and national studies, including satisfactory before- and after-studies, are still not available to draw definite conclusions about public and employee satisfaction with HTP. It appears that despite the expensive cost of HTP and relative satisfaction of patients, the government did not meet all the demands of nurses and some physicians.

The Effect of Health Transformation Plan on Out-of-Pocket Payments of the Hospitalized Patients in Hamedan, Iran

Background: Out-of-Pocket (OOP) payment is categorized among the critical indicators of health system financing. Given the high hospitalization costs of the hospitals, the ministry of health has attempted to implement Health Transformation Plan (HTP) in Iran to reduce OOP. The purpose of this paper is to show the effects of HTP on OOP payments of the hospitalized patients in Hamedan, Iran. Methods: This descriptive-analytical study was carried out on 587 patients in the educational hospitals of Hamedan. The data obtained before and after implementing the HTP was from 2013 to 2015. Data analysis was performed using SPSS16. Results: In this study, each patient's expenditures increased by 32.2 % in 2015, compared to before the implementation of the HTP. Therefore, the health insurance organization's coverage of OOP payments decreased to 8.3 % of the total costs by a 20.2 % reduction in 2015, compared to before the implementation of the plan. Conclusion: According to the study, HTP and government health subsidies were adequate, but the total hospitalization costs had an upward trend in all funds.

Health Transformation Plan Achievements and Outcomes in Iran (2014-2020): A Scoping Review.

Background: The Health Transformation Plan (HTP), the latest reform in Iran's health system to achieve the 3 main goals of financial protection, equity, and quality of health care, was started on May 5, 2014. This study aimed to review all available literature regarding the achievements and outcomes of this reform after 6 years of its implementation. Methods: The 5 English databases were examined by using appropriate keywords to find documents published on the HTP between June 5, 2014, and the end of April 2020. Out of 532 recovered articles, 137 were included in the study. The study's organization was based on the Arkesy and O'Malley framework and data analysis was done using the content analysis method. Results: The findings of the study were divided into 11 sections. Studies on the plan's impact on financial protection (22.6%), performance indicators (14.5%), and natural delivery promotion (14.5%) were the most frequent, respectively. Regarding the impact of the HTP on patient satisfaction ,performance indicators, and efficiency, mostly positive results have been obtained. However, in terms of the impact of the HTP on financial protection and informal payments, the outcomes have been different, contradictory, and sometimes negative. Conclusion: Although the HTP has successfully achieved a number of its goals, in some of the goals, the results are not significant. Given the changing health conditions and funding constraints, it is better to consider measures to fundamentally review the HTP and executive packages.

Investigating the effect of health transformation plan on the public hospitals performance indicators; a case study from Iran

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.

Economic Profile of Iranian Rehabilitation Services: 2002-2017

Objective: The role of the service sector in general and healthcare services in particular have been promoting in Iran’s economy. The implementation of the Health System Transformation Plan and the injection of new financial resources into this sector have raised concerns about the health system function. Thus, this is the first attempt to estimate and evaluate the share of rehabilitation services in the Iranian economic and health systems. Materials &amp; Methods: The study utilized longitudinal trend analysis using the National Health Accounts data during 2002-2015. National Health Accounts, through input-output tables, breaks down the share of different sources of financing for different functions of the health system. According to this method, both the share of rehabilitation services in Iran’s economy and the financing sources of these activities have been calculated and compared to other countries. Data on Iran's National Health Accounts has been collected from the Statistical Center of Iran. International data is collected from the World Health Organization's National Health Accounts and the databases of the Organization for Economic Cooperation and Development member countries. Results: Expenditures related to rehabilitation services in Iran increased from 884 billion rials in 2002 to more than 2967 billion rials in 1396, equivalent to 0.02% of Iran's GDP in that year. The share of rehabilitation expenditures in total health expenditures in 2007 was at its highest level (0.3%). In the following years, it has always had a decreasing trend. In 1396 it reached about 22.0%, the lowest amount during 16 Last year. Comparing the economic share of rehabilitation of the country's economic activities with different countries shows that the position of this sector is in no way comparable to developed countries and is even lower than many developing countries. Tunisia, Tonga, and Moldova have a similar situation to Iran's economy, with rehabilitation services accounting for about 0.05 to 0.1 percent of their total economic activity. Comparison of the prevalence of disability in these countries with Iran shows that these countries had a lower prevalence than Iran. Examination of the share of various sources shows that out-of-pocket payments with households with 6.37 percent, the most, and the government with 7.18 percent had the least role in financing rehabilitation services. It is noteworthy that this figure was about 65% before implementing the health system transformation plan. Social insurance in 2017 also covered only 6.24% of rehabilitation costs. Conclusion: Inaccessibility of people with disabilities to healthcare services is a very serious issue in the world. The rehabilitation services expenditures have always been mentioned as one of the most important barriers of accessing to these services. Following the implementation of the Health Transformation Plan, the share of rehabilitation activities in Iran’s health market has been shrunk.

Health Transformation Plan in birth departments in Iranian hospitals: A rapid review

Health Transformation Plan in birth departments in Iranian hospitals: A rapid review

A policy analysis of agenda-setting of Brucellosis in Iran using a multiple-stream framework: health policy and historical implications.

SummaryBackgroundBrucellosis, a major zoonotic disease, is highly present in Iran, especially in Lorestan province. The aim of this study was to understand the issues related to Brucellosis utilizing the multiple streams framework.MethodsA two-step method was adopted: 1) assessment of brucellosis-related documents and 2) interviews with stakeholders. As a first step, all documents related to Brucellosis were reviewed at provincial and national levels. Policy documentation on health issues included the consultation of guidelines, rules and regulations, websites, reports, books, guides, and conferences. These documents were collected by referring to specialized centers, institutions, and organizations. In the second step, semi-structured interviews were conducted to determine the burden of disease with actors and stakeholders involved with the brucellosis program in the Lorestan province. More in detail, physicians, healthcare workers, managers, policy- and decision-makers were selected for interviews.ResultsThe problem stream was characterized by: 1) high prevalence of the disease, 2) traditional livestock production, 3) unsafe animal slaughtering, 4) centers for the sale and distribution of non-authorized dairy products, 5) raw milk and 6) traditional unsafe dairy products consumption, 7) incomplete livestock vaccination, 8) lack of knowledge of Brucellosis, 9) neighboring countries with high prevalence of Brucellosis, 10) lack of livestock quarantine, and 10) nomadic immigration. The policy stream was characterized by 1) primary healthcare networks, 2) guidelines, 3) medicines, insurance, and 4) diagnostic services. Finally, the political stream was characterized by: 1) support of the University of Medical Sciences, 2) sponsorship by the Ministry of Health and Medical Education, 3) Health transformation plan, and 4) Working Group on Health and Food Security in Lorestan.ConclusionThis study examined the brucellosis-related agenda setting: if different issues are taken into consideration, it can be perceived as a health priority.

The impacts of family physician plan and health transformation plan on hospitalization rates in Iran: an interrupted time series

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.