The Impact of Health Transformation Program on Per Capita Referrals and the Cost of Inpatient Services for the Insured of the Iran Health Insurance Organization

The implementation of Health Transformation Plan (HTP) with the aim of expanding the quality of inpatient services and financial protection of inpatients in order to reduce out-of-pocket payments and provide the services required by inpatients by the hospital has increased hospitalization rate and costs in hospitals. The purpose of this study was to investigate the impact of the implementation of this program on the service costs, hospitalization of the insured of Iran Health Insurance Organization (IHIO).

This cross-sectional study was conducted to investigate the hospitalization rate and cost of the insured of IHIO by implementing HTP in the period of April 2012 to March 2016. The data sources were gathered from the books of performance report of the IHIO from 2012-2016. Data was categorized using Excel software version 2013. Then Data was analyzed by SPSS software version 21 and E-Views version 8 using the Interrupted Time Series (ITS) model.

The results of ITS showed a significant increase in hospitalization rate per capita after 4 months of the implementation of HTP. So that every month, on average, for every one million people insured, 156 people werr added to the number of hospitalized referrals of the insured of this organization. Also, the implementation of the HTP has increased the per capita fixed cost of service hospitalization of the insured insurance in the country.The increase in the per capita fixed cost of hospitalization after 4 months from the beginning of the Health Transformation Program and at the same time with the start of the third phase of the program has been the reason for reviewing the book Relative Values of Health Services.The Findings showed that the implementation of the program, on average per month, for each insured person, the amount of 1,544.8 Rials has been added to the cost of each hospital service.

The implementation of the HTP has increased the hospitalization rate and cost of per- insured of the IHIO.
Also, the implementation of this program has increased the per capita cost of proving the hospitalization of the insured of the organization. Due to the limited financial resources of the organization, in order to control and manage financial resources, policies such as referral system and creating a waiting list for hospital services in the treatment of non-emergency diseases should be adopted immediately.