Background Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran. Methods We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1. Results A decreasing trend by − 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001). Conclusions Family physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.
Background and purpose: Equity in access to health care has become a desirable policy objective. Therefore, accessibility to health care should be provided based on health needs rather than sociodemographic variables. This will lead to a better utilization of health care and improvement of equity in health. The aim of this paper is to examine the effects of family socio-economic status as an indication of individual's socio-economic status on the utilization of their health care. Materials and Methods: This was a cross-sectional study conducted in Ghaemshahr County, Iran in early 2013. In this household survey, 807 individuals were randomly approached at their home. A self-designed questionnaire was applied. The parent or every individual above 18 years were asked to fill the questionnaire for themselves and other member of their family. Using SPSS software analyses were performed with employing correlation coefficient, Chi-square and t-test. Results: About 47.9% and 52.1% of respondents were living at urban and rural area respectively. Respondents were from a quite different socio-economic and demographic background. Utilization of health care had only significant association with the location of respondents. Underutilization of health care has proportionately more evident in a rural area compared with the urban area. Conclusion: Accessibility to and utilization of health care was lower in a rural area. There is a concern of inequity in health at rural area and is going to be expanded. Appropriate policy and intervention are required to improve the situation.
Background and purpose: Since 2005, a reform known as Rural Insurance and Family Medicine Scheme has introduced to primary health care network in Iran in rural areas and small towns. The content of the reform implies a substantial change in those aspects of health centers that mainly could be categorized as structural quality. Although, this is the requirement of all health care providers, they are not identical in those items. In this article, we have tried to report the relation between structural quality of health centers and utilization of curative care in Mazandaran province. Materials and Methods: This was a cross-sectional study conducted in 2013. Secondary and routinely collected data was used to answer the research questions. The source of original data was provincial health authority's data set. A check list containing pre-identified variables was used to extract the data. Using SPSS software package, regression analysis was run to measure the role of different independent variable on dependent variable. Results: There were 215 rural health centers affiliated to 16 cities or small towns that the reform has taken place. The outreach area population of these health centers was 1,330,212 of which 834,189 (62.71%) were covered by rural insurance solely. Health centers are not identical in terms of the characteristics of health centers and their utilization. Among the variables with significant impact on the utilization of outpatient care, except for number of physician in each health centre and existence of state owned pharmacy that were found in some health centers, the rest of variables had significant positive impact on the demand for physician visit. Conclusion: Structural quality has significant impact on the utilization of curative care of primary healthcare units at rural area in Iran. The reform seems well targeted the quality improvement and utilization of effective primary health care. [*Rouhani S. Yazdani J. Mohammadpour RA.
Background and purpose: Although, economically, referral systems make utilization of health facilities at different levels sound, in many countries caretakers often bypass primary care facilities that are regularly costlier for caretakers and health care systems. The main objective of the current study was to assess the utilization of hospital services with more emphasis on economic point of view. Materials and methods:The present study was a facility-based cross-sectional study. A researcher developed questionnaire was used to collect the data. The samples were randomly selected and interviewed on their consent. SPSS Software was also used to analyze the collected data through Chi-2, correlation, and t-test. Results: Just 29.4 percent of the attendees to the hospital were carrying out a referral slip from their family medicine. Five variables including type of care, type of attending, appointment arrangement, satisfaction with family medicine, and vising family medicine were statistically analyzed and found significantly related to carrying referral slip. Conclusion: Because of dysfunction of referral system, Iran's health care system was found to be far from achieving economic advantages of a referral based WHO District Health System. It is actually an inappropriate use of limited health resources in a country like Iran that seriously suffers from shortage of financial and health system resources. This is likely due to deficiencies in the components of its referral system, therefore, a full revision of current reforms and appropriate remedies for deficiencies in the components of referral system was found to be in top priority in Iran. Keywords: Gatekeeping; Referral; Family Practitioner; Hospital Citation: Rouhani S, Alipoor Landy S. The economic standpoint of referral system at using tertiary hospital services in Iran.
Background and purpose: Water is the most important limiting factor of sustainable development. Poor quality of water sources and lack of appropriate management in some regions are the main reasons of water crises in the country. This study was conducted to assess water sources quality and the trend of their change in rural area of Sabzevar County in a five year period. Materials and Methods:In total 43 sources of water in villages or complexes with more than 700 population were selected randomly and their Physico-Chemical and microbiological variables were studied. For microbiological characteristics 801 samples from those 43 sources were taken and examined in a five year period.Results: The results showed that the average microbial contamination of all 801 samples from 43 sources during a five year period was 12.3 with a variance of 13.3. Total Dissolved Solids (TDS) index was 349.02 ppm with variance of 193.704 ppm. In three sources, the TDS index had statistically significantly difference with the maximum level of 500 ppm. The maximum limit of EC of water from wells in a three years period has increased from 2526 in year 1 to 3213 in year three of study. Among 43 sources of rural drinking water, just one source, with average 4.7± 3.9 ppm had statistically significantly difference with the upper limit maximum of 1.5 mg per litter.Conclusion: Having positive result of E-coli in some of water sources and high level of some Physico-Chemical indexes and the increasing trend of declining quality of water sources in a five year period of study, therefore creating a GIS based data bank of water quality for continues monitoring of change in water quality, improvement and filtration of some sources, and replacement with a sources of better quality are essential.
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