Journal of Health Scope
Volume:7 Issue: 1, Feb 2018

Iran’s Health Transformation Plan (HTP) was implemented to decrease households’ out of pocket and protect them from facing catastrophic health expenditure and impoverishment from 2014. It is needed to assess the effect of HTP; therefore, the study aimed to examine the households’ impoverishment due to health expenditure after HTP.
A household survey was carried out in 2017 in Sistan and Baluchestan province in southeast Iran. About 2400 households were selected as the study sample using a multi-stage sampling technique. The household section of the World Health Survey questionnaire was used to collect data. Independent variables contained households’ characteristics, household income, chronic illness status, the use of health services, and health spending. The dependent variable was whether the household was faced with health spending impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the impoverishment using SPSS software 21.
About 7.5% of the households had no basic insurance and 757 (31.6) heads’ of the households were unemployment. The results showed that about 5.4% of the households impoverished due to health expenditure. The households in the furthest region were forced with impoverishment more than other regions (23.0%). Living in a rural area, unemployment, economic status, and inpatients and outpatient costs were the main determinates on impoverishment (P In general, despite the implementation of HTP, healthcare expenditures leading to impoverishment of high percent of the households and Iranian development goals have not been fulfilled in this region. Economic poverty of the people may also be an important factor in this regard. It is recommended that outpatient services are covered by health insurances.

Informal payments, as one of the components of out-of-pocket (OOP) payments, are often a form of corruption and outside the official bill. The purpose of the present study was to investigate the frequency of informal payments for inpatient services and its related factors in Tehran, Iran.
In this cross-sectional study, the samples included 450 patients who were admitted to hospital’s clinics affiliated to Shahid Beheshti University of Medical Sciences in Tehran, to receive follow-up and post-surgical care. After obtaining patient consent, data were collected via a 28-item questionnaire included two parts of patient’s demographic characteristics and informal payments experience that it’s validity and reliability were confirmed. Data were analyzed using descriptive statistics and regression analyses in SPSS 16 software.
The findings showed 21.1% of the patients had informal payments, paid voluntarily, mostly in cash, for service’s staff, in public hospitals, after discharge and, due to the employee's proper behavior and attention. The average informal payments per patient were 5,304,630 IRR (175.4 USD). There was no significant relationship between the informal payment behavior and the patient demographics characteristics (P > 0.05).
Despite the efforts made in the HTP to eliminate informal payments in inpatient services, the goal has not been fully realized. A part of the payments was paid at the provider's request and before the patient's admission that these compulsory informal payments are illegal and unethical and therefore, must be controlled and eradicated. Policymakers can take steps to reduce informal payments by improving the healthcare quality, supervision, setting salary and benefits, enforcing laws, and increasing staff incentives.

The Health Transformation Plan (HTP) is one of the recent reforms adopted in the health system of Iran.
This study aimed to investigate the effect of implementing of the HSRP on the performance indicators of teaching hospitals in Iran.
This descriptive-analytic study was carried out in 10 teaching hospitals of Shiraz University of Medical Sciences in 2017. After referring to the concerned hospitals, 10 performance indicators were extracted and analyzed at 2 stages (before (2013) and after (2015) implementing of the HSRP). Paired sample t-test was run in the SPSS software23 to compare the obtained data.
Investigating the mean differences of performance indicators before and after the implementation of the HSRP indicated a significant increase (P The implementation of the health reform plan has been accompanied by significant changes in the performance indicators of the hospitals. Regarding the reduction of the normal delivery rate in comparison with caesarean section after the implementation of the plan, it is suggested to improve the awareness and culture of mothers and society regarding the importance and benefits of natural delivery through the intersectional interactions.

Medicalization of the natural lifelong socio-biological phenomena is one of the epitomes of challenges in front of modern societies. Empirical research findings have reveled that demand for some of the health care services is expanding, especially after commencement of the Health Transformation Plan (HTP) in Iran. Given the evidence about the precedents and probable streamline role of the sovereign market and consumers’ demands on the country’s surging medicalization trend, this study was aimed at exploring the healthcare professionals’ (HCPs) prospects about the demand side portrayal of the phenomenon.
Purposive and snowball sampling method were used to recruit a total of 31 key national informants to participate in 14 semi-structured interviews and 3 focus group discussions that were planned to acquire data and insights that were not accomplished during the interview sessions. The data were collected, transcribed, and analyzed from March 2016 to February 2017 using content analysis (inductive and deductive) approach to identify certain concepts and explore the underlying facts behind the discourses. The transcribed texts were indexed and codes were extracted and categorized into subthemes and themes. MAXQDA 12 software was used for better organizing and managing the data.
Data were organized in 4 categories and 10 subcategories. Factors relating to national/provincial health policies and plans, healthcare consumers, the public expectations about health care professionals’ affluence, and community context were considered as key sets of factors to infuriate unnecessary medicalization in Iran with the HTP having considerable role as a suitable platform to boost the incongruous phenomenon.
The socio-cultural context and health policy making mechanisms could have a significant role in over utilization of health services and unrestrained medicalization in Iran. The dilemma should be regarded as a multidimensional embarrassment and until a multifaceted approach was not applied for its control, no major success could be expectable.

After 30 years, Iranian health policy makers developed a new version of relative value units as a replacement for the previous one, the Californian RVUs. We aimed to identify the problems of the new version of RVUs (second edition) in Iran from perspective of health services providers in 2016.
A total of 54 medical practitioners were interviewed. A content analysis approach by Elo et al., was conducted to analyze the interview transcripts.
Criticisms reasons are: lack of clarity of the revision process, overcoming of political lobbying on technical considerations, negligence of the evaluation and management section, ministry of health (MoH) and health insurers’ weakness in regulating and controlling the providers, Ministry of Health (MoH) and health insurers’ insufficient knowledge, lack of considering a transitional phase for implementation, and low level of flexibility regarding certain medical specialties and fields.
Service providers raised some critical views about the technical and policy making of the new version of RVUs (second edition). They stated some pitfalls that seem to be an urgent appropriate response of the state.

Study of individual preferences about different aspects of colorectal cancer screening tests can improve the compliance of people for these tests.
This study aimed to explore the differences in the preferences of average risk populations with different insurance coverage regarding the colorectal cancer (CRC) screening tests.
Individual preferences were identified by a standard questionnaire that was completed by 500 people within the age of 50 to 75 and referred to a large government teaching hospital in Tehran between September 2016 and January 2017. Standard discrete choice models and conditional logit were used for analysis.
The final attributes were the test process, pain, place, sensitivity, interval, preparation, complications risk, reduced mortality rate, and cost. The result of conditional logit regression demonstrated that having complementary insurance coverage had a significant effect on individuals’ preferences.
This study suggests that different insurance coverage may lead to heterogeneity of preferences for CRC screening tests.

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.
In this longitudinal study, a household survey was conducted at the district 17 of Tehran, Iran in 2003, 2008, and 2015. 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.
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 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.

Various pay for performance (PFP) models have been used for different purposes in many countries. The present study aimed to investigate the general framework and feasibility of the PFP program that was implemented in Iran (IR-PFP).
In 2016, a document analysis was performed to achieve the original framework, and to evaluate its validity with the help of 2 expert panels, and both phases were managed using a four-stage Hermeneutic cycle.
The results of reviewing the documentation revealed that the framework required some prerequisites and determining the PFP of the department and individuals. The expert panels confirmed these 3 components, however, a fourth component namely determining the payment time was added to the model. In addition, the status of the key factors in the design and implementation of the program was reported.
The model prerequisites proved helpful in considering the work diversity in hospitals. Furthermore, determining the PFP in 2 stages allowed the inclusion of more indicators in the structure of the program, however, it seems that determining the payment time in 3 months has not been practical for the Iranian health system. The framework has some instruments to strengthen teamwork and decentralize the human resources control and performance measurement in hospitals, however, hospital managers should always be careful about the unwanted side effects.

Recently in Iran, the Health Transformation Plan (HTP) was formulated by policy makers to reduce the amount of the out of pocket expenditures. The HTP caused different effects on medicines and medical supplies. The purpose of this paper was the identification of these effects.
This study was a qualitative research performed in a 14-month interval in Iran during 2014 - 2015. A total of 17 semi-structured interviews were used for data gathering. Participants were health authorities associated with the subject of the research and background in health executive management. They were aware of the HTP. Purposive sampling was done for data saturation. Criteria such as “Credibility”, “Conformability”, and “Dependability” were considered. Interviewees’ anonymity was preserved. The data were transcribed, categorized, and then used the thematic analysis.
According to the thematic analysis, 6 themes and 21 sub-themes were found. Two main categories were identified. (I) The overt effects (3 themes) included optimizing the management of medicine and medical supplies, their cost controlling, and improving of supervision on distribution and consumption of them. (II) The covert effects (3 themes) included an increase in demand for hospitalization, a rise in total costs, and waste of hospital resources
The HTP, besides positive and overt effects, had covert effects. The HTP increased not only in patients’ inclination to stay more in hospitals, but also it increased total health expenditures and wasting resources. It could be suggested that, policy makers use this results to guarantee the success of the HTP.

Healthcare systems have an intrinsic responsibility to meet medial and non-medical expectations of people.
The aim of this study was to investigate the Iranian health system responsiveness in the city of Jahrom.
This study comprised of 600 patients from 6 health centers in Jahrom County. Data were gathered via a standard self-report questionnaire. Logistic regression analysis was used to evaluate data.
Responsiveness of Jahrom health system was reported to be higher than average (3.32 ± 0.41). Being female, being from low income families, and patients on inpatient services were factors directly associated with higher rate of good responsiveness (P The Iranian health evolution plan is expected to have potential to promote responsiveness and quality of healthcare services, an area deserving more investigations.