Ph.D. Student, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran.
Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran.
Prim Health Care Res Dev. 2022 Feb 24;23:e7. doi: 10.1017/S1463423618000300.
Studying the effect of primary health care development when simultaneously implemented with health insurance schemes assesses effectiveness and use of health care services and gives us insight on how to develop such interventions in different countries.
To analyze the impact of health insurance and the family physician program on total hospitalizations, and the relation between avoidable hospitalizations and access to family physicians among the rural population in Iran.
We conducted an interrupted time series (ITS) analysis of monthly hospitalization rates between the years of 2003 and 2014 to assess the immediate and gradual effects of these reforms on total hospitalization rates in the rural areas of Tehran province. In addition, we used a sample of 22 570 hospitalizations between 2006 and 2013 to develop a logistic regression model to measure the association between access to a family physician and avoidable hospitalizations.
ITS analysis showed that there was an immediate increase of about 1.96 hospitalizations per 1000 inhabitants (P<0.0001, CI=1.58, 2.34) hospitalization rates after the reforms. This was followed by a significant increase of about 0.089 per 1000 inhabitants (P<0.0001, CI=0.07, 0.1). Hospitalization increase continued up to four years after the policy implementation. Following that, hospitalization rates decreased among the rural population (a decrease of 0.066 per 1000, P<0.0001, CI=-0.084, -0.048). Studying the hospitalizations that occurred between 2006 and 2013 showed that there were 4106 avoidable hospitalizations from among a sample of 22 570 hospitalizations. Results of logistic regression models including gender, age and access to family physician variables showed that there was no statistical relation between access to a family physician and avoidable hospitalizations.
Reforms had access effect and caused increased hospital services uses in people with unmet needs. Also the reforms did not decrease avoidable hospitalizations, and therefore had no efficiency effect.
研究初级卫生保健发展与医疗保险计划同时实施时对医疗服务的效果和利用的影响，可以让我们深入了解如何在不同国家开展此类干预措施。
分析医疗保险和家庭医生计划对伊朗农村人口总住院率的影响，以及家庭医生可及性与可避免住院之间的关系。
我们对 2003 年至 2014 年每月住院率进行了中断时间序列（ITS）分析，以评估这些改革对德黑兰省农村地区总住院率的即时和渐进影响。此外，我们使用了 2006 年至 2013 年期间的 22570 例住院病例的样本，建立了逻辑回归模型，以衡量家庭医生可及性与可避免住院之间的关系。
ITS 分析表明，改革后每 1000 名居民的住院率立即增加了约 1.96 例（P<0.0001，CI=1.58，2.34）。随后，每 1000 名居民的住院率又显著增加了约 0.089（P<0.0001，CI=0.07，0.1）。这种住院率的增加持续到政策实施后的四年。此后，农村人口的住院率下降（每 1000 人减少 0.066，P<0.0001，CI=-0.084，-0.048）。研究 2006 年至 2013 年期间发生的住院情况表明，在 22570 例住院病例中，有 4106 例为可避免住院。包括性别、年龄和家庭医生可及性变量的逻辑回归模型的结果表明，家庭医生可及性与可避免住院之间没有统计学关系。
改革具有准入效应，导致有未满足需求的人群增加了对医疗服务的利用。此外，改革并没有降低可避免的住院率，因此没有效率效应。
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