Induced Demand after Implementing the Health Reform Plan in Selected Emergency Departments Affiliated to Isfahan University of Medical Sciences: a Cross-Sectional Study

Abstract

Introduction: Exactly recognizing the effect of health reform plan (HRP) in emergency departments (EDs) is crucial given the large portion of budget assigned to this plan and the effect of introducing this plan on inducing demand and the associated potentially-unbearable costs. 
Objective: The present study was conducted to assess the demand induced after implementing the HRP in the selected EDs of Isfahan University of Medical Sciences, Isfahan, Iran. 
Method: The present quantitative and descriptive study collected data related to certain emergency services, performance indicators and working hours of emergency staff using a researcher-made checklist and based on hospital records and information in the years before and after implementing the HRP in Iran, i.e. 2013 and 2015. The data collected were analyzed in SPSS-21. 
Results: The obtained results suggested significant increases in emergency admissions (69.97%), radiographic images (65%), clinical tests (27.27%) and specialist visits (69.95%). Significantly increases observed in the performance indicators in the ED included the mean hospitalization duration by 61.14%, the bed occupancy rate by 15.71% and the working hours of the nursing staff by 11.43% and those of emergency medicine specialists by 44.72% in the first year after implementing the HRP compared to in the year before the implementation. 
Conclusion: Although implementing the HRP in Iran significantly changed the performance indicators in the ED, certain infrastructure such as human resource management and the increased demand are considered the main time-consuming and costly challenges in EDs.

1. Frenk J, Gonzalez-Pier E, Gomez-Dantes O, Lezana MA, Knaul FM. Comprehensive reform to improve health system performance in Mexico. Lancet. 2006;368(9546):1524-34.
2. Nakhaei Z, AbdolrezaGharehbagh Z, Jalalmanesh S. A survey on nurses’ satisfaction concerning the health system reform plan in hospitals affiliated to Birjand university of medical sciences in 2016. J Rafsanjan Uni Med Sci. 2017;16(1):61-72.
3. Rezaei S, Arab M. Effects of the new health reform plan on the performance indicators of Hamedan university hospitals. SJSPH. 2016;14(2):51-60.
4. Peikanpour M, Esmaeli S, Yousefi N, Aryaeinezhad A, Rasekh H. A review of achievements and challenges of Iran’s health transformation plan. Payesh. 2018;17(5):481-94.
5. Maharlou HR, Barati O, Maher MH. The study of inpatient services costs provided to cardiovascular patients referred to Al-Zahra heart hospital in Shiraz during 2nd half of 2013 and compare to the same time after Iranian health transformation plan implementation. J Health Sys. 2016;7(2):31-8.
6. Khorasani E, Keyvanara M, Karimi S, Jafarian Jazi M. The Role of patients in induced demand from experts’ perception: A qualitative study. J Qual Res Health Sci. 2014;2(4):336-45.
7. Keyvanara M, Karimi S, Khorasani E, Jafarian-Jazi M. Are health institutions involved in health care induced demand? (a qualitative study). Payavard. 2014;8(4):280-93.
8. Hashemi B, Baratloo A, Forouzafar MM, Motamedi M, Tarkhorani M. Patient satisfaction before and after executing health sector evolution plan. Iran J Emerg Med. 2015;2(3):127-33.
9. Khorasani Zavareh D, Bidgli M, Mahmoodlou F. Exploring factors affecting quality of emergency department services delivery based on client perception: finding from a qualitative study. J Urmia Nurs Midwifery Fac. 2015;1(1):26-35.
10. Roland M, Abel G. Reducing emergency admissions: are we on the right track? BMJ. 2012;345:e6017.
11. Faridfar N, Alimohammadzadeh K, Seyedin SH. The impact of health system reform on clinical, paraclinical and surgical indicators as well as patients' satisfaction in Rasoul-e-Akram hospital in 2013 to 2014. Razi J Med Sci. 2016;22(140):92-9.
12. Emamgholipour S, Jaafaripooyan E, Mohammadshahi M, Yazani EM. The effect of Health Sector Evolution Plan on the performance indices of emergency department in hospitals of Tehran & Iran universities of medical sciences: interrupted time series analysis. Iran J Emerg Med. 2018;5:e9.
13. Mosadeghrad AM, Mirzaee N, Afshari M, Darrudi A. The impact of health transformation plan on health services fees: brief report. Tehran Univ Med J. 2018;76(4):277-82.
14. Lien HM, Ma CT, McGuire TG. Provider–client interactions and quantity of health care use. J Health Econ. 2004;23(6):1261-83.
15. Bardey D, Lesur R. Optimal regulation of health system with induced demand and ex post moral hazard. Ann Econ Stat. 2006;83:279-93.
16. Iversen T. The effects of a patient shortage on general practitioners’ future income and list of patients. J Health Econ. 2004;23(4):673-94.
17. Bastani P, Lotfi F, Moradi M, Ahmadzadeh M. The performance analysis of teaching hospitals affiliated with shiraz university of medical sciences before and after health system reform plan using pabon lasso model. J Rafsanjan Uni Med Sci. 2016;15(8):781-92.
18. Khazaei A, Khatiban M, Saeidi S, karamporian A, Soltanian A, kimiaie AH, et al. Evaluation of factors affecting emergency department length of stay. Sci J Hamadan Nurs Midwifery Fac. 2015;23(3):62-71.
19. Ghorbaninia R, khezri A, kamali S, ghorbani N. Survey of nurses’satisfaction with the healthcare reform plan at pasteur hospital of Bam, Iran, 2016. Health Info Manag. 2017;14(3):138-41.
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IssueVol 4 No 3 (2020): Summer (July) QRcode
SectionOriginal article
Keywords
Emergency Service, Hospital Health Care Reform Health Care Sector Iran

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How to Cite
1.
Shahverdi S, Abazari P, Yazdannik A, Rezvani M. Induced Demand after Implementing the Health Reform Plan in Selected Emergency Departments Affiliated to Isfahan University of Medical Sciences: a Cross-Sectional Study. Front Emerg Med. 2019;4(3):e70.

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