Assessing Trend of Health System Responsiveness in Iran Using Household Survey (Before and After the Implementation of Health Transformation Plan)

Background: One of the 3 main goals of any health system is to meet the non-medical expectations of individuals while interacting with health system. The purpose of this study is to evaluate the health system responsiveness before and after the implementation of the health transformation plan (HTP) in Iran. Methods: In this longitudinal study, a household survey was conducted at the district 17 of Tehran, Iran in 2003, 2008, and 2015. A sample of 600 families was selected using a two-stage cluster sampling approach. Data were collected using a questionnaire and face-to-face interview. Chi square and OneWay Anova were used to analyze the data in the SPSS 16. Results: The importance of all dimensions of responsiveness has decreased compared to previous years in 2015. Dignity (83.46%) had the best performance (high score) and choice (69.23%) had the worst performance (low score) in outpatient services. The best performance score was confidentiality (81.7%) in inpatient services and the worstwas autonomy (67.76%). Private centers performed better than other centers in all dimensions of responsiveness. This difference was statistically significant in outpatient services (P value < 0.05) and was significant in inpatient services only in 2001. Principal component analysis found for out-patient care responsiveness are 2 main factors explaining 69.5% of the variance and for in-patient care responsiveness 1 factor explaining 91.7% of the variance. Overall responsiveness level has increased. Conclusions: Given the increasing level of responsiveness in outpatient and inpatient services after the implementation of the HTP, it can be concluded that this plan has been effective. Interaction of patients and service providers is an issue that should be addressed by health sector reform.