Assessing Trend of Health System Responsiveness in Iran Using Household Survey (Before and After the Implementation of Health Transformation Plan)

Abstract

Background: One of the 3 main goals of any health system is to meet the non-medical expectations of individuals while interacting with health system. The purpose of this study is to evaluate the health system responsiveness before and after the implementation of the health transformation plan (HTP) in Iran. Methods: In this longitudinal study, a household survey was conducted at the district 17 of Tehran, Iran in 2003, 2008. A sample of 600 families was selected using a two-stage cluster sampling approach. Data were collected using a questionnaire and face-to-face interview. Chi square and One Way Anova were used to analyze the data in the SPSS 16. Results: The importance of all dimensions of responsiveness has decreased compared to previous years in 2015. Dignity (83.46%) had the best performance (high score) and choice (69.23%) had the worst performance (low score) in outpatient services. The best performance score was confidentiality (81.7%) in inpatient services and the worst was autonomy (67.76%). Private centers performed better than other centers in all dimensions of responsiveness. This difference was statistically significant in outpatient services (P value < 0.05) and was significant in inpatient services only in 2001. Principal component analysis found for out-patient care responsiveness are 2 main factors explaining 69.5% of the variance and for in-patient care responsiveness 1 factor explaining 91.7% of the variance. Overall responsiveness level has increased. Conclusions: Given the increasing level of responsiveness in outpatient and inpatient services after the implementation of the HTP, it can be concluded that this plan has been effective. Interaction of patients and service providers is an issue that should be addressed by health sector reform.

Assessing health system responsiveness in primary health care facilities in Tanzania

“…Some evidences from low and middle income countries shows that health system responsiveness in health care delivery tends to be ignored and many times not sufficient to meet patient's non-medical demands [10]. Currently, there is a growing interest in evaluating people's experience with health care services in Low and Middle-income countries so as to ascertain the level of satisfaction of patients to healthcare system [11][12][13][14][15]. In all settings, the individuals who are always and usually touched by poor responding health care system are women, as their demands for the health care system are wide and are multi-dimensional [16].…”

Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study

“…As they are developed from an extensive array of disciplines, responsiveness domains analyse the function of the health care system from the way patients experience care, the treatment procedures and the environment around the services [16][17][18]. Although responsiveness has increasingly been promoted as a key goal of any health system, its measurement remains scarce [11,12,17,19,20]. Studies on responsiveness have been more common in high-income countries [14,[21][22][23] than in LMICs [17,24].…”

“…In the former, health care users have mainly reported concerns regarding trust, long waiting times, lack of empathy and friendliness, and limited involvement in decisionmaking [22,23,25]. In the case of the LMICs, different studies [9,13,15,20] have shown choice of service provider, autonomy, prompt attention, quality of basic amenities and confidentiality as important areas of concern in terms of responsiveness. In sub-Saharan Africa, studies from Nigeria [11] and South Africa [26] have also shown the usefulness of the responsiveness domains in examining the operationalisation of health systems in the context of health insurance schemes.…”

Responsiveness of health care services towards the elderly in Tanzania: Does health insurance make a difference? A cross-sectional study

“…As they are developed from an extensive array of disciplines, responsiveness domains analyse the function of the health care system from the way patients experience care, the treatment procedures and the environment around the services (16)(17)(18). Although responsiveness has increasingly been promoted as a key goal of any health system, its measurement remains scarce (11,12,17,19,20). Studies on responsiveness have been more common in high-income countries (14,21-23) than in LMICs (17,24).…”

“…In the former, health care users have mainly reported concerns regarding trust, long waiting times, lack of empathy and friendliness, and limited involvement in decision-making (22,23,25). In the case of the LMICs, different studies (9,13,15,20) have shown choice of service provider, autonomy, prompt attention, quality of basic amenities and con dentiality as important areas of concern in terms of responsiveness. In sub-Saharan Africa, studies from Nigeria (11) and South Africa (26) have also shown the usefulness of the responsiveness domains in examining the operationalisation of health systems in the context of health insurance schemes.…”