OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis.METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated.RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%).CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.
Catastrophic Illness ; Confounding Factors (Epidemiology) ; Family Characteristics ; Financial Statements ; Health Care Reform ; Health Equity ; Health Expenditures ; Health Services ; Humans ; Incidence ; Inpatients ; Iran ; Outpatients ; Propensity Score

OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.
Catastrophic Illness ; Confounding Factors (Epidemiology) ; Family Characteristics* ; Financial Statements ; Health Care Reform ; Health Equity ; Health Expenditures ; Health Services ; Humans ; Incidence ; Inpatients ; Iran* ; Outpatients ; Propensity Score

PURPOSEPediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score (ISS), new injury severity score (NISS) and revised trauma score (RTS) on children's mortality, hospitalization and need for surgery.

METHODSIn this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest.

RESULTSThere were 588 records in hospital registry system. The mean age of the patients was (7.3 ± 3.8) years, and 62.1% (n = 365) of patients were male. RTS was the more ability score to predict mortality with an area under curve (AUC) of 0.99 (95% CI, 0.99-1). In the hospital length of stay (LOS), ISS was best predictor for both the hospital LOS with AUC of 0.72 (95% CI, 0.67-0.76) and need for surgical surgery with AUC of 0.94 (95% CI, 0.90-0.98).

CONCLUSIONRTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes.