Effect of Two Major Health Reforms on Health Care Cost and Utilization in Fars Province of Iran: Family Physician Program and Health Transformation Plan

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.

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Effect of Two Major Health Reforms on Health Care Cost and Utilization in Iran: Family Physician Program and Health Transformation Plan

10.21203/rs.2.15265/v1 ◽

2019 ◽

Author(s):

Mohsen Bayati ◽

Khosro Keshavarz ◽

Farhad Lotfi ◽

Abbas KebriaeeZadeh ◽

Omid Barati ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Family Physician ◽

Laboratory Tests ◽

Fars Province ◽

Short Term ◽

Utilization Of Services ◽

The Impact ◽

Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in the short term, but in an increase in costs in the long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policy makers must adopt an agenda to revise and re-design the plan.

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Effect of Two Major Health Reforms on Health Care Cost and Utilization in Fars Province of Iran: Family Physician Program and Health Transformation Plan

10.21203/rs.2.15265/v3 ◽

2020 ◽

Author(s):

Mohsen Bayati ◽

Khosro Keshavarz ◽

Farhad Lotfi ◽

Abbas KebriaeeZadeh ◽

Omid Barati ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Family Physician ◽

Laboratory Tests ◽

Fars Province ◽

Short Term ◽

Utilization Of Services ◽

The Impact ◽

Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.

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Direct access physiotherapy for patients with musculoskeletal disorders: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz186.335 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Demont ◽

A Bourmaud ◽

A Kechichian ◽

F Desmeules

Keyword(s):

Systematic Review ◽

Health Care ◽

Adverse Events ◽

Usual Care ◽

Musculoskeletal Disorders ◽

Health Care Costs ◽

Family Physician ◽

Direct Access ◽

The Impact ◽

Care Costs

Abstract Background Although the benefits of physiotherapy is well supported in the literature, the impact of having direct access to physiotherapy is not well established. Update of the current available evidence is warranted. The aim of this systematic review was to update the current evidence regarding the impact of direct access physiotherapy compared to usual care for patients with musculoskeletal disorders. Methods Systematic searches were conducted in 5 bibliographic databases up until May 2018. Two independent raters reviewed studies and used the Quality Assessment Tool for Quantitative Studies to conduct the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction and health care costs. Results Sixteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual family physician led care and direct access physiotherapy. However, three studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. Five studies did not observe any adverse events with direct access physiotherapy. Three studies showed shorter waiting time and four studies reported fewer number of physiotherapy visits with direct access. Three studies showed that patients with direct access were less likely to have medication and imaging tests prescribed compared to usual care. Five studies reported higher levels of satisfaction for direct access. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care. Conclusions Emerging evidence, although of weak to moderate quality, suggest that direct access physiotherapy provides equal or better outcomes than family physician led care models for musculoskeletal disorders patients. More methodologically strong studies are needed. Key messages This review supports the efficacy, safety and cost-effectiveness of direct access PT, while increasing access to care with a more efficient use of resources. There is a need for more methodologically strong studies to evaluate the efficiency of direct access models of care of physiotherapy for patients with MSKD.

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The Impact of General Usage of Stents on Short- and Long-Term Health Care Costs following Percutaneous Coronary Intervention

Cardiology ◽

10.1159/000105547 ◽

2007 ◽

Vol 109 (2) ◽

pp. 85-92

Author(s):

Annika Odell ◽

Per Landelius ◽

Karin Åström-Olsson ◽

Lars Grip

Keyword(s):

Health Care ◽

Percutaneous Coronary Intervention ◽

Health Care Costs ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Short And Long Term ◽

The Impact ◽

Care Costs

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A Novel Estimation of the Impact of Treatment with Entecavir on Long-Term Mortality, Morbidity, and Health Care Costs of Chronic Hepatitis B in China

Value in Health Regional Issues ◽

10.1016/j.vhri.2013.02.002 ◽

2013 ◽

Vol 2 (1) ◽

pp. 48-56 ◽

Cited By ~ 6

Author(s):

Lai Wei ◽

Shanlian Hu ◽

Jinlin Hou ◽

Gordon Liu ◽

Hong Ren ◽

...

Keyword(s):

Health Care ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Health Care Costs ◽

The Impact ◽

Care Costs ◽

Long Term Mortality

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Evaluation of Discontinuation of Atypical Antipsychotics Prescribed for ICU Delirium

Journal of Pharmacy Practice ◽

10.1177/0897190012465987 ◽

2012 ◽

Vol 26 (3) ◽

pp. 253-256 ◽

Cited By ~ 31

Author(s):

Karalea D. Jasiak ◽

Ellen A. Middleton ◽

James M. Camamo ◽

Brian L. Erstad ◽

Linda S. Snyder ◽

...

Keyword(s):

Health Care ◽

Adverse Effects ◽

Hospital Discharge ◽

Health Care Costs ◽

Atypical Antipsychotics ◽

Prescribing Patterns ◽

Short Term ◽

Icu Delirium ◽

Care Costs

A number of trials suggest that short-term use of atypical antipsychotics may be useful in the treatment of delirium associated with critical illness. However, long-term use of such agents for this indication has not been studied and may be associated with risks of adverse effects as well as unnecessary health care costs. A retrospective study of prescribing patterns of atypical antipsychotics initiated for the treatment of intensive care unit (ICU) delirium was performed to identify whether these agents were being discontinued prior to or upon hospital discharge. Of the 59 patients who met inclusion criteria and survived to hospital discharge, 28 (47%) were continued on the atypical antipsychotic upon discharge from the medical ICU. For those continued on the agent, 20 patients (71.4%) were prescribed continued therapy as an outpatient. Inpatient costs for atypical antipsychotics during the 9-month study period were increased by approximately $888. Annual cost of the medication as outpatient therapy is assessed at approximately $45 107. Although short-term trials of atypical antipsychotics may be useful for ICU delirium, caution is advised regarding potential adverse effects and added health care costs when use is prolonged.

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Reflections on the Cost Consequences of the New Gene Technology for Health Policy

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300008151 ◽

1994 ◽

Vol 10 (4) ◽

pp. 546-561 ◽

Cited By ~ 4

Author(s):

Pauline Vaillancourt Rosenau

Keyword(s):

Health Care ◽

Health Care Costs ◽

Subjective Assessment ◽

Genetically Engineered ◽

Gene Technology ◽

Short Term ◽

New Gene ◽

The Cost ◽

The Impact ◽

Care Costs

AbstractThis article presents a preliminary and necessarily tentative and subjective assessment of the impact of new gene technology on health care costs. In the short term, diagnosis and treatment of genetic disease are likely to increase costs. Treatment with nongene therapy will continue to be far less expensive than gene therapy where it is available. Research developments to monitor as indicators of forthcoming cost reductions in genetic therapy are set forth. Some forms of genetic screening may soon reduce health care costs, and an example is provided. Genetically engineered Pharmaceuticals are described and their impact on costs reviewed. Conditions under which they are likely to reduce health care costs are indicated.

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