Document Type : Original Article


Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran


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


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