Arash Rashidian1, Hossein Joudaki1, Elham Khodayari-Moez2, Habib Omranikhoo1, Bijan Geraili3, Mohamad Arab1. 1. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran 1417613191, Islamic Republic of Iran . 2. Faculty of Medicine, Tarbiat Modarres University, Tehran, Islamic Republic of Iran . 3. Aligoodarz Primary Health Care Network, Lorestan University of Medical Sciences, Khorram Abad, Islamic Republic of Iran .
Abstract
OBJECTIVE: To assess the effects on hospital utilization rates of a major health system reform - a family physician programme and a social protection scheme - undertaken in rural areas of the Islamic Republic of Iran in 2005. METHODS: A "tracer" province that was not a patient referral hub was selected for the collection of monthly hospitalization data over a period of about 10 years, beginning two years before the rural health system reform (the "intervention") began. An interrupted time series analysis was conducted and segmented regression analysis was used to assess the immediate and gradual effects of the intervention on hospitalization rates in an intervention group composed of rural residents and a comparison group composed of urban residents primarily. FINDINGS: Before the intervention, the hospitalization rate in the rural population was significantly lower than in the comparison group. Although there was no significant increase or decline in hospitalization rates in the intervention or comparison group before the intervention, after the intervention a significant increase in the hospitalization rate - of 4.6 hospitalizations per 100 000 insured persons per month on average - was noted in the intervention group (P < 0.001). The monthly increase in the hospitalization rate continued for over a year and stabilized thereafter. No increase in the hospitalization rate was observed in the comparison group. CONCLUSION: The primary health-care programme instituted as part of the health system reform process has increased access to hospital care in a population that formerly underutilized hospital services. It has not reduced hospitalizations or hospitalization-related expenditure.
OBJECTIVE: To assess the effects on hospital utilization rates of a major health system reform - a family physician programme and a social protection scheme - undertaken in rural areas of the Islamic Republic of Iran in 2005. METHODS: A "tracer" province that was not a patient referral hub was selected for the collection of monthly hospitalization data over a period of about 10 years, beginning two years before the rural health system reform (the "intervention") began. An interrupted time series analysis was conducted and segmented regression analysis was used to assess the immediate and gradual effects of the intervention on hospitalization rates in an intervention group composed of rural residents and a comparison group composed of urban residents primarily. FINDINGS: Before the intervention, the hospitalization rate in the rural population was significantly lower than in the comparison group. Although there was no significant increase or decline in hospitalization rates in the intervention or comparison group before the intervention, after the intervention a significant increase in the hospitalization rate - of 4.6 hospitalizations per 100 000 insured persons per month on average - was noted in the intervention group (P < 0.001). The monthly increase in the hospitalization rate continued for over a year and stabilized thereafter. No increase in the hospitalization rate was observed in the comparison group. CONCLUSION: The primary health-care programme instituted as part of the health system reform process has increased access to hospital care in a population that formerly underutilized hospital services. It has not reduced hospitalizations or hospitalization-related expenditure.
Authors: Daniel Cobos Muñoz; Paloma Merino Amador; Laura Monzon Llamas; David Martinez Hernandez; Juana Maria Santos Sancho Journal: Int J Public Health Date: 2016-08-29 Impact factor: 3.380
Authors: Mohammad Ranjbar Ezatabadi; Arash Rashidian; Mohammad Shariati; Abbas Rahimi Foroushani; Ali Akbari Sari Journal: Iran Red Crescent Med J Date: 2016-05-23 Impact factor: 0.611