The effect of Iran's health transformation plan on utilization of specialized outpatient visit services: An interrupted time series

Background: Health Transformation Plan (HTP) has been one of the biggest reforms in Iran's health system over the past 3 decades. The plan has been implemented since May 2014 and includes several packages that can affect the utilization of health care services. We aimed to assess the effect of implementation of HTP on utilization of specialist outpatient visit rate in clinics affiliated to university hospitals. Methods: We chose Kurdistan province to collect monthly specialist outpatient visit data for 50 months because this province was not a patient referral hub. An interrupted time series (ITS) analysis and segmented regression analysis were used to evaluate the effects of HTP on specialist outpatient visit rates. Statistical analyses were conducted using STATA version 13. Results: A significant increase was observed in the specialist outpatient visit rate (12.1 outpatient visit per 1000 population) in the first month after the implementation of HTP (p= 0.000, 95% CI= 6.36-17.83). Also, after the implementation of HTP, a significant increase was observed in the monthly trend of specialist outpatient visit rate equivalent to about 0.53 every month per 1000 population compared to the monthly trend in specialist outpatient visit rate before the intervention (p= 0.033, 95% CI= 0.04-1.01). Conclusion: HTP has significantly increased the specialist outpatient visit rate in clinics affiliated to university hospitals in Kurdistan province. Thus, it is necessary to perform some comprehensive studies on all public, private, and semi-private sectors in different parts of the country to provide a better and more comprehensive picture of the effects of HTP on utilization of specialist outpatient visit services.