Mohsen Bayati1, Khosro Keshavarz1, Farhad Lotfi1, Abbas KebriaeeZadeh2, Omid Barati3, Shahram Zareian4, Akbar Amiri4, Sajad Delavari5. 1. Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. 2. Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Pharmaceutical Management & Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran. 3. Hospital Management Research Center, Education Development Center, Iran University of Medical Sciences, Tehran, Iran. 4. Social Security Organization, Shiraz, Iran. 5. Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. sajadd@gmail.com.
Abstract
BACKGROUND: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. METHODS: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. RESULTS: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. CONCLUSIONS: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people's access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.
BACKGROUND: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. METHODS: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. RESULTS:FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. CONCLUSIONS:FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people's access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.
Entities:
Keywords:
Family physicians; Health care costs; Health care reform; Health policy; Interrupted time series analysis; Universal coverage; Utilization
Authors: Mohammad Bazyar; Vahid Yazdi-Feyzabadi; Mona Bahmani; Jamil Sadeghifar; Khalil Momeni; Zahra Shaabani Journal: Prim Health Care Res Dev Date: 2022-09-13 Impact factor: 1.792