Document Type : Original Article
Authors
- . Pouran Raeissi
- . Farbod Ebadi Fard Azar
- . Aziz Rezapour
- . Mohammad Afrouzi
- . Saeed Sheikh Gholami
- . Noureddin Niknam
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Abstract
INTRODUCTION: Hospitals are the main axis of health‑care reforms or national health plans;
therefore, accurate recognition of hospital costs based on operational indexes to these plans is
necessary. The impact of implementing national health plans on the performance of health systems
is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare
Reform Plan (HRP) on the micro level (e.g., educational or university hospitals).
METHODS: This study was a descriptive retrospective study that research variables are checked
in 1 year before and mean of 3 years after implementation of HRP by self‑administrated checklist in
selected public‑educational hospitals covered by the medical universities in Tehran. The final analysis
of the data was performed using cost–performance ratio and independent t‑test for comparing the
variables’ changes before and after HRP.
RESULTS: Unlike adjusted hospitalization costs, most operational indexes were not significant.
The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased
49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48%
and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared
to before HRP (P < 0.001).
CONCLUSION: Given the lack of alignment in adjusted cost changes in exchange for functional
indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the
hospitals.
Keywords
- MFragkiadakis G, Doumpos M, Zopounidis C, Germain C.
Operational and economic efficiency analysis of public hospitals
in Greece. Ann Oper Res 2016;247:787‑806.
2. Laudicella M, Olsen KR, Street A. Examining cost variation across
hospital departments – A two‑stage multi‑level approach using
patient‑level data. Soc Sci Med 2010;71:1872‑81.
3. Chilingerian JA, Sherman HD. Managing physician efficiency and
effectiveness in providing hospital services. Health Serv Manage
Res 1990;3:3‑15.
4. Chilingerian JA, Sherman, D. Health‑care applications: From
hospitals to physicians, from productive efficiency to quality
frontiers. In: Cooper WW, Seiford LM, Zhu J, editors. Handbook
on Data Envelopment Analysis. New York: Springer; 2011.
p. 445‑93.
5. Bahadori M, Ravangard R, Alimohammadzadeh K, Hosseini SM.
Plan and road map for health reform in Iran. BMJ 2015;351:h4407.
6. Hoomans T, Ament AJ, Evers SM, Severens JL. Implementing
guidelines into clinical practice: What is the value? J Eval Clin
Pract 2011;17:606‑14.
7. Olesen OB, Ankjær‑Jensen A, venning A. Anvendelse af DRG
til produktivitetsanalyser P a afdelingsniveau. Tidsskr Dan
Sundhedsvæsen 2002;78:106‑14.
8. Olesen OB, Ankjaer‑Jensen A, Svenning AR. DRG for
departmental productivity analysis ‑ Application of DEA. J Dan
Healthcare 2002;78:329‑35.
9. McCueMJ, Thompson JM, Dodd‑McCueD. Association of market,
mission, operational, and financial factors with hospitals’ level of
cash and security investments. Inquiry 2000;37:411‑22.
10. Rezapour A, Ebadifard Azar F, Yousef Zadeh N, Roumiani Y,
Bagheri Faradonbeh S. Technical efficiency and resources
allocation in university hospitals in Tehran, 2009‑2012. Med J
Islam Repub Iran 2015;29:266.
11. Moradi‑Lakeh M, Vosoogh‑Moghaddam A. Health sector
evolution plan in Iran; equity and sustainability concerns. Int J
Health Policy Manag 2015;4:637‑40.
12. Arab Zozani M, Bagheri Faradonbeh S, Jaafari Pooyan E. The role
of health technology assessment in improving healthcare quality.
Payavard Salamat 2015;9:400‑14.
13. President: This Government is Called Health Government:
Dolat – Iran’s Government Official Website [Farsi]. 2016 [Cited
2018 Jun 18]. Available from: www.president.ir
14. President: Health is the Government’s Top Priority [Farsi]. Official
IRNA News Agency. 2016. Available from: www.president.ir.
[Last Cited on 2018 Jan 18].
15. Rouhani H. Insurance Umbrella is Extended to all People of the
Land, ISNA [Farsi]. Iran’s University Students News Agency; 2015.
Available from: http://isna.ir/fa/news. [Last Cited on 2018 Jan 13]
16. Heshmati B, Joulaei H. Iran’s health‑care system in transition.
Lancet 2016;387:29‑30.
17. Mahdavi M, Parsaeian M, Jaafaripooyan E, Ghaffari S. Recent
Iranian health system reform: An operational perspective to
improve health services quality. Int J Health Policy Manag
2017;7:70‑4.
18. Kiaei MZ, Moradi R, Hasanpoor E, Mohammadi M, Taheri A,
Ahmadzadeh MS. Hospital managers’ perception of recent health
care reform in teaching hospitals of Qazvin, Iran. Biotechnol
Health Sci 2015;2:4‑5.
19. Ebadifard Azar F, Sarabi Asiabar A. Does leadership effectiveness
correlates with leadership styles in healthcare executives of
Iran university of medical sciences. Med J Islam Repub Iran
2015;29:166.
20. Atashbar T, Arani AA, Antoun J, Bossert T. Health reform
policy‑making: Fiscal sustainability matters (The case of Iran’s
President Care). J Policy Model 2017;39:1086‑101. - 21. Hajavi A, Azar FE, Meidani Z. Medical records standards in
selected countries and Iran: A comparative study. New J (Inst
Health Rec Inf Manag) 2005;46:4‑6.
22. Moghri J, Nateghi E, Arab M, Moghri M, Sari AA, Omranikhoo H,
et al. Measurement of patient safety culture in Iranian hospitals:
A national baseline study. J Clin Res Gov 2013;2:47‑52.
23. Daneshkoshan A, Baratimarnani A, Zohoor A, Ebadi FA.
Comparative study of health system management development
assessment models in selected countries. Journal of Health
Information Management. 2011;8;2(18):0.
24. Saleh Ardestani A, Sarabi Asiabar A, Ebadifard Azar F, Abtahi SA.
The relationship between hospital managers’ leadership style and
effectiveness with passing managerial training courses. Med J
Islam Repub Iran 2016;30:465.
25. Hung JH, Chang L. Has cost containment after the national health
insurance system been successful? Determinants of Taiwan
hospital costs. Health Policy 2008;85:321‑35.
26. Central Bank of the Islamic Republic of Iran [Internet]. 2017.
Available from: www.cbi.ir. [Last Cited on 2018 Jun 15].
27. McKay NL, Deily ME. Cost inefficiency and hospital health
outcomes. Health Econ 2008;17:833‑48.
28. Miller F, Wang J, Zhu J, Chen Y, Hockenberry J. Investigation of
the impact of the Massachusetts health care reform on hospital
costs and quality of care. Ann Oper Res 2017;250:129‑46.
29. Magnussen J, Nyland K. Measuring efficiency in clinical
departments. Health Policy 2008;87:1‑7.
30. Tan SS, Hakkaart‑van Roijen L, van Ineveld BM, Redekop WK.
Explaining length of stay variation of episodes of care in the
Netherlands. Eur J Health Econ 2013;14:919‑27.
31. Bishop CE, Gilden D, Blom J, Kubisiak J, Hakim R, Lee A, et al.
Medicare spending for injured elders: Are there opportunities for
savings? Health Aff (Millwood) 2002;21:215‑23.
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