A Study on Hospitalized Patients’ Payment in South of Iran after the First Round of Health Sector Reform

Health system reforms are implemented for improvement of the effectiveness, efficiency, quality , equity of health systems and for the ultimate purpose of universal health coverage (1). There is a wide range of experiences with the implementation of health sector change in different countries in the last decade. In Iran, recently Ministry of Health and Medical Education announced master plan for health system reform (HSR) (2). Accordingly, the ministry intended to implement set of seven instructions (3). The first and most focused of these instruc-tions' plan is reduced patients' payments (PP) for inpatient medical services in faculty hospitals with the goal of patient protection against high medical cost. Copayment for patients covered by basic health insurance was fixed to 10% in faculty hospitals and these hospitals were obligated not to refer the patients for purchase of any medicines , equipment, and diagnostic services out of hospital. However, critics have challenged whether this plan could be considered as a major reform as most of the emphasis till now was on inpatients services in governmental hospitals with little attention to other aspects of health system specially outpatient care (which includes high proportion of family payments for health care) (4) and preventive and health promoting plans at national level. This cross-sectional study purposed to evaluate PP before and after (Oct 2013-Oct 2014) implementation of the first instruction of HSR in one of major hospitals of the country in Shiraz, Iran through a matched (according to sex, age, and duration of admission and diagnosis of patients) comparative study. Extracted discharge bill from the hospital information system showed that mean percent of PP/total bill ± SD (Median) for hospital services for patients who had a health insurance was 0.15± 0.20 (0.10) after implementation of reform (vs. 0.27± 0.6 (0.16) before reform), this change was statistically significant (P<0.001). Because gain in this goal is borderline, therefore, achievement of goal of 10% PP payment through this reform needs more planned efforts. However , new NHA studies are strongly recommended to explore the real trend of PP payments in Iran. PP payment for inpatient and rehabilitation services was 6.5% in last Iran' National health account 2008 (5). Mean of PP decreased significantly for cost of medical equipment used inward in the line with the goal of decrease in PP in health sector reform, but mean of total bill for medical equipment used inward increased significantly after implementation of …