Examining the Impact of Health Transformation Plan Financing Policies on the Use of Common Healthcare Services by the Elderly: An Interrupted Time Series Analysis

Abstract

Background: Significant changes in Iran's social structures — economic, cultural, and political — have led to major changes in demographic processes. One of the most significant of these changes, which has a profound impact on the social structure, is the decline in fertility rates. These changes, along with the ongoing aging of the population and increasing healthcare costs, have created serious challenges for the country's healthcare system. Objectives: This study aimed to investigate the impact of the health transformation plan (HTP) on the use of healthcare services among the elderly in Tabriz city over a decade, covering the years 2009 to 2018, comparing five years before and after the implementation of the plan. Methods: This quasi-experimental interrupted time series study comprised 120 monthly data points spanning from 2009 to 2018. Segmented regression analysis was employed to evaluate the impact of the HTP on healthcare service use among the elderly in Tabriz city. Results: Analysis revealed significant cost savings related to circulatory diseases, injuries, musculoskeletal disorders, and reproductive conditions, which were associated with corresponding changes in healthcare utilization patterns. The study also found that the intervention did not have statistically significant effects on consultation frequency for most disease groups, although significant changes were observed in the impact on healthcare utilization trends for genitourinary diseases and factors influencing health status. Although the results demonstrated significant cost savings associated with certain disease groups such as circulatory diseases and musculoskeletal disorders, the overall impact of the HTP on the visit burden was relatively small for most diseases. This discrepancy can be explained by the fact that cost savings may stem from improved efficiency in service delivery, reductions in the cost per visit, or changes in treatment approaches, rather than a substantial decrease in the number of healthcare visits. Therefore, while the plan succeeded in reducing healthcare expenses in some areas, it did not significantly reduce the frequency of consultations for the majority of disease groups. Conclusions: The HTP had a small impact on visit burden for most diseases, with temporal factors such as population growth and seasonal changes, as shown by our analysis. In some cases, the intervention had temporary effects, but visit burden increased again over time. Future evaluations should focus on modifying the intervention and examining other external factors.