Safarpoor Zeynab, Lotfi Farhad, Bayati Mohsen, Moordzade Hossein, Goudarzi Zahra, Keshavarz Khosro
Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Cost Eff Resour Alloc. 2025 Jun 16;23(1):30. doi: 10.1186/s12962-025-00637-5.
Health system reforms are essential. In Iran, some of the most significant changes include the implementation of the Family Physician Program (FPP) and the Health Transformation Plan (HTP). The aim of this study was to assess the impact of these programs on the cost and use of services.
This quasi-experiment targeted insured individuals under the Iranian Health Insurance Organization in Fars province from 2010 to 2021. ANOVA, T-tests, and interrupted time-series analysis were used to investigate the impacts of FPP and HTP on service utilization and cost changes before and after the introduction of these programs.
FPP decreased specialist visits, drug utilization, and drug expenditure in the short run. But eventually, it resulted in more general practitioner (GP) consultations, laboratory services, and imaging, hospitalization, and drug spending. The HTP first resulted in more GP consultations, laboratory services, drug use, and hospitalization but less use of imaging services and more total service spending. Eventually, the HTP resulted in more GP consultations, fewer GP prescriptions, and less laboratory test and imaging service spending.
FPP was successful in achieving some initial goals, such as decreasing expenditure and service usage through a referral system. It was finally unsuccessful in the long run due to the dissolution of this system and lack of proper supervision. At the beginning, the HTP imposed significant costs to insurance providers; however, it ultimately led to a reduction in the cost for particular services over a prolonged interval.
卫生系统改革至关重要。在伊朗，一些最重大的变革包括实施家庭医生计划（FPP）和健康转型计划（HTP）。本研究的目的是评估这些计划对服务成本和使用情况的影响。
这项准实验针对2010年至2021年期间法尔斯省伊朗健康保险组织下的参保个人。使用方差分析、t检验和中断时间序列分析来研究FPP和HTP在这些计划引入前后对服务利用和成本变化的影响。
FPP在短期内减少了专科就诊、药物使用和药物支出。但最终，它导致了更多的全科医生（GP）咨询、实验室服务、影像检查、住院治疗和药物支出。HTP首先导致了更多的GP咨询、实验室服务、药物使用和住院治疗，但影像服务使用减少，总服务支出增加。最终，HTP导致了更多的GP咨询、更少的GP处方以及更少的实验室检查和影像服务支出。
FPP成功实现了一些初始目标，例如通过转诊系统减少支出和服务使用。但从长远来看，由于该系统的解体和缺乏适当监管，最终未能成功。一开始，HTP给保险提供者带来了巨大成本；然而，它最终在较长一段时间内导致了特定服务成本的降低。
