پديد آورندگان :
پيروزي، بختيار نويسنده Ph.D Student in Health Policy, Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran Piroozi, Bakhtiar , مرادي، قباد نويسنده Social Determinants of Health Research Center, Assistant Professor, Dept. of Statistics and Epidemiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj Moradi, Ghobad , اسماعيل‌نسب، نادر نويسنده Social Determinants of Health Research Center, Professor, Dept. of Statistics and Epidemiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj Esmail Nasab, Nader , قصري، هومن نويسنده Internist, Deputy of Treatment, Kurdistan University of Medical Sciences, Sanandaj Ghasri, Hooman , فرشادي، صلاح‌الدين نويسنده MSc. in Executive Management, Dept. of Health Economic, Deputy of Treatment, Kurdistan University of Medical Sciences, Sanandaj Farshadi, Salahadin , فرهادي‌فر، فريبا نويسنده Associate Professor, Dept. of Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj Farhadifar, Fariba
كليدواژه :
سزارين , Cesarean , Out of Pocket Payment , Health System Reforms , اصلاحات نظام سلامت , زايمان , پرداخت از جيب بيمار , childbirth
چكيده فارسي :
زمينه و هدف: ميزان سزارين در دو دهه اخير در ايران روند رو به رشدي داشته است. برنامه «ترويج زايمان طبيعي» در قالب طرح تحول نظام سلامت در كشور به منظور افزايش زايمان طبيعي اجرايي شده است. هدف پژوهش حاضر تعيين تأثير طرح تحول نظام سلامت بر ميزان سزارين و هزينه پرداخت شده توسط مادران بستري در بيمارستان‌هاي استان كردستان است.
روش بررسي: اين مطالعه توصيفي به صورت طولي و گذشته‌نگر انجام گرفته است. ميزان سزارين در همه بيمارستان‌هاي استان كردستان براي سال 1392 و طي يك سال بعد از اجراي طرح تحول نظام سلامت و همچنين داده‌هاي مربوط به درصد پرداخت از جيب در يكي از بيمارستان‌هاي دانشگاه علوم پزشكي كردستان كه به صورت تصادفي انتخاب شد، مورد بررسي قرار گرفت. داده‌ها در نرم‌افزار SPSS v.20 تحليل شد.
يافته‌ها: ميزان سزارين در استان كردستان طي يك سال بعد از اجراي طرح تحول نظام سلامت، نسبت به ميزان پايه خود در سال 1392، كاهشي 02/14 درصدي داشته است (001/0p<). ميانگين درصد پرداخت صورت حساب بيمارستان از جيب قبل از اجراي طرح تحول نظام سلامت 05/16% بوده است. اين درصد بعد از اجراي مرحله اول و سوم طرح به 30/4% و 5/2% كاهش پيدا كرده است.
نتيجه‌گيري: برنامه ترويج زايمان طبيعي، به هدف از پيش تعيين شده خود، يعني كاهش 10 درصدي ميزان سزارين طي يك سال بعد از اجراي طرح تحول نظام سلامت نسبت به ميزان پايه، دست يافته و درصد هزينه پرداخت شده از جيب در صورت حساب بيمارستان كاهش چشم‌گيري داشته است.
چكيده لاتين :
Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.
Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.
Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.
Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures.
Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.
Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.
Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.
Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures by mothers.
