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

Abstract

Background Health 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. Methods This 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. Findings Findings 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. Conclusion Based 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.

Providing a Framework for Evaluating the Quality of Health Care Services Using the HealthQual Model and Multi-Attribute Decision-Making Under Imperfect Knowledge of Data

“…During the last 4 decades, the Iranian health care system has designed several major health reforms to improve the quality of health (Ranjbar et al, 2021), most of which have limited achievements for various reasons, such as insufficient attention to its implementation (Mahdavi et al, 2018;Dehnavieh et al, 2018).…”

“…Since May 5, 2014, in order to achieve the vision of 2025, Iranian Ministry of Health and Medical Education has implemented a comprehensive transformation plan (which is still in progess), the so called health transformation plan (HTP), which strives to improve the operational management of health service delivery in Iran (Mahdavi et al, 2018;Ranjbar et al, 2021).…”

“…Government spending on health increased significantly, health insurance coverage was extended to a larger population, and medical tariffs were revised. Also, many hospitals and public health centres were renovated, the number of hospital beds increased, new hospitals and public health facilities were established in deprived areas, and more doctors and nurses were hired in remote areas (Ranjbar et al, 2021). The HTP has various goals, especially improving the quality of health care services to patients (Bahadori et al, 2015).…”

“…However, since the launch of HTP, a variety of research and studies have been conducted, both in terms of content and implementation issues (Mahdavi et al, 2018). A significant portion of the research examined the effects of HTP on various aspects of the health system such as out-of-pocket payments (Doshmangir et al, 2019), and hospital performance from various aspects such as patient health services utilization and medical resources efficiency (Ranjbar et al, 2021;Rezaei et al, 2016). A look at these studies shows that although various aspects of the quality of health care services have been considered, we still need to conduct more extensive research on the results of this program on the quality of services provided to patients.…”

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

“…The HTP was active in the following fields: 1-insuring the population lacking health insurance, 2providing financial protection for patients admitted to hospitals affiliated with the Ministry of Health, 3-supporting the retention of physicians in underserved areas, and 4completing and developing the family physician program and referral system. The HTP provided financial protection for patients at the time of receiving healthcare services from governmental hospitals affiliated with the Ministry of Health in the form of insuring patients lacking health insurance, which reduced the total hospitalization expenditures of patients to 6% in large cities and 3% in cities with less than 20 thousand population [20,[23][24][25]. Moreover, to expand healthcare services in different cities, measures such as equitable increase in healthcare services, support for retention of physicians in underserved areas, and family physician program and referral system were designed and implemented, following which improved the access of people from different economic classes living in different parts of the country to healthcare services, including eye care services.…”