The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis

BACKGROUND: Healthcare policy- and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms. In May 2014, the Iranian Ministry of Health and Medical Education has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP). This study aimed to determine the effect of the HTP on hospitalization rate in Iranian public hospitals affiliated to the Ministry of Health and Medical Education. METHODS: This study was designed as a quasi-experimental, counterfactual study utilizing the interrupted time series analysis (ITSA), comparing the trend of hospitalization rate before and after the HTP implementation in 16 hospitals in the Lorestan province. Data was collected from March 2012 to February 2019. RESULTS: In the first month of the HTP implementation, an increase of 2.627 [95% CI: 1.62–3.63] was noted (P < 0.001). Hospitalization rate increased by 0.68 [95% CI: 0.32–0.85] after the HTP implementation compared to the first month after the launch of the HTP (P < 0.001). After the HTP implementation, monthly hospitalization rate per 1000 persons significantly increased by 0.049 [95% CI: 0.023–0.076] (P < 0.001). CONCLUSIONS: The HTP implementation has resulted in an increased hospitalization rate. Health planners should continue to further improve this service. ITSA can play a role in evaluating the impact of a given health policy.