Effect of "Iran's Health System Evolution" And "Tariff Change" based on relative values book on Performance of Obstetrics and Gynecology Department: A case study in a Big Hospital

Document Type : Original Article


1 Associate Professor, Department of Treatment Health Services Management, Social Determinants of health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

2 MSc. Student, Department of Health Education & Promotion, Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

3 M.Sc. Student, Department of Health Economics and Management Sciences, Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor, Department of Acupuncture and Complementary Medicine, School of Complementary and Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Assistant Professor, Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad, University of Medical Sciences, Mashhad, Iran.

6 Assistant Professor, Department of Health Economics, Social Determinants of health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Health system evolution plan has been of main corrections in in Iran's health system in the last previous years. Due to the importance of these interventions on the economic and performance of the hospital, this study was performed with aim to determine the effect of health system evolution plan and Tariff change based on relative values book on the performance of obstetrics and gynecology department in Imam Reza hospital in Mashhad.
Methods: This cross-sectional descriptive study was conducted by Activity Based Costing in obstetrics and gynecology department of Imam Reza hospital in Mashhad in 2013-2015. For economic-performance analysis of obstetrics and gynecology department, three categories were used including: data related to cost, data related to income, and performance indexes. Data were extracted by data gathering forms and were analyzed using descriptive statistics by Excel Software and statistical descriptive methods (mean, standard deviation, percentage, …).
Results: Total income of this department has increased respectively by 54% and 75% after health system evolution and tariff change. The highest increase of income has related to operating room after tariff change (128%). After both health system evolution and tariff change, total expenditure of this department has increased respectively by 3% and 79%. Cesarean section rate has decreased about 2/3% after evolution.
Conclusion: Evolution plan has positive effect on the performance and financial indicators of obstetrics and gynecology department of Imam Reza hospital. This effect was not equal among revenue and expenditure items.


  1. Rezapour A, Ebadi Fard Azar F, Arabloo J. Cost analysis of healthcare services of a teaching hospital of Qazvin university of medical sciences. Teb Va Tazkiey 2012; 21(2):31-9. (Persian).
  2. Report of Challenges for Developing Country in Health Sector. Ministry of health. Tehran, Iran: Research Center of Parliament; 2008.
  3. Dargahi H, Masoori N, Safdari R, Fazaeli S, Yousefi M. Investigating productivity changes in medical records departments of Tehran university of medical sciences hospitals using malmquist index. Director General 2011; 8(3):395-404.
  4. Rezapour A, Arabloo J, Soleimani MJ, Ebadi Fard Azar F, Safari H. Microeconomic Analysis of healthcare services in Bou Ali Sina University hospital. Int J Hospital Res 2012; 1(1):41-51.
  5. Bayrami R, Taghipour A, Ebrahimipour H. Experience of unplanned pregnancy in women attending to health centers of Mashhad, Iran: a phenomenological study. Iran J Obstet Gynecol Infertil 2014; 16(87):15-23. (Persian).
  6. Keshavarz Z, Ghazanfarian A, Simbar M, Shakeri N. Effect of educational intervention based on theory of planned behavior (TPB) in selecting mode of delivery. Iran J Obstet Gynecol Infertil 2016; 19(27):1-7. (Persian).
  7. Grytten J, Monkerud L, Hagen TP, Sørensen R, Eskild A, Skau I. The impact of hospital revenue on the increase in caesarean sections in Norway. a panel data analysis of hospitals 1976-2005. BMC Health Serv Res 2011; 11(1):267.
  8. Seidali A, Namazi N. Study of antagonistic properties of lactobacilli isolated from healthy baby stools on growth of Acinetobacter baumannii and Pseudomonas aeruginosa of nosocomial origin. Pajoohandeh J 2016; 20(6):315-9. (Persian).
  9. Charoenboon C, Srisupundit K, Tongsong T. Rise in cesarean section rate over a 20-year period in a public sector hospital in northern Thailand. Arch Gynecol Obstet 2013; 287(1):47-52.
  10. Stivanello E, Rucci P, Lenzi J, Fantini MP. Determinants of cesarean delivery: a classification tree analysis. BMC Pregnancy Childbirth 2014; 14(1):215.
  11. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One 2016; 11(2):e0148343.
  12. Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends 2011; 5(4):139-50.
  13. Faridfar N, Alimohammadzadeh K, Seyedin SH. The impact of health system reform on clinical, paraclinical and surgical indicators as well as patients' satisfaction in Rasoul-e-Akram hospital in 2013 to 2014. Razi J Med Sci 2016; 22(140):92-9. (Persian).
  14. Rezaei S, Arab M. Effects of the new health reform plan on the performance indicators of Hamedan university hospitals. J Sch Public Health Instit Public Health Res 2016; 14(2):51-60. (Persian).
  15. Bayrami R, Taghipour A, Ebrahimipour H. Challenges of providing cervical cancer prevention programs in Iran: a qualitative study. Asian Pac J Cancer Prev 2014; 15(23):10071-7.
  16. Bayrami R, Taghipour A, Ebrahimipour H. Personal and socio-cultural barriers to cervical cancer screening in Iran, patient and provider perceptions: a qualitative study. Asian Pac J Cancer Prev 2015; 16(9):3729-34.
  17. Vahdat S, Heydarian N. The impact of implantation of health care reform plan in patients pay out of pocket in selected public hospitals in Isfahan. J Med Council Iran 2015; 33(3):187-94. (Persian).
  18. Arrieta A. Health reform and cesarean sections in the private sector: the experience of Peru. Health Policy 2011; 99(2):124-30.
  19. Parkhurst JO, Rahman SA. Life saving or money wasting? Perceptions of caesarean sections among users of services in rural Bangladesh. Health Policy 2007; 80(3):392-401.
  20. Godarzi L, Khayeri F, Meshkini A, Khaki A. The transformation of the health system with emphasis on the promotion of natural childbirth in hospitals affiliated with medical universities of the country. Criticism Government Health XI 2015; 14(2):51-60. (Persian).
  21. Babaei F. Policy analysis to promote natural childbirth in hospitals in Iran. Criticism Government Health XI 2015; 14:17. (Persian).
  22. Office of Technology Assessment. Method of calculating the price of services in health sector. Tehran: Ministry of Health and Medical Education; 2016.
  23. Cohen S, Kaimenaki E. Cost accounting systems structure and information quality properties: an empirical analysis. J Appl Acco Res 2011; 12(1):5-25.
  24. Chan YC. Improving hospital cost accounting with activity-based costing. Health Care Manag Rev 1993; 18(1):71-7.
  25. Shepard DS, Hodgkin D, Anthony YE. Analysis of hospital costs: a manual for managers. Geneva: World Health Organization; 2000.
  26. Tabibi J, Maleki MR, Nourozi T. Computation cost price of clinical laboratories services in valiasr hospitals in Tehran in 2009 by using of ABC model. J Hospital 2010; 8(3):5-17.
  27. Ebrahimipour H, Rezazadeh A, Olyani S, Khorsand VZ, Fazaeli S, Jafari M, et al. A survey on the effect of "Iran's health system evolution" and "Tariff change" on cardiovascular ward performance of a big tertiary hospital. Payesh 2017; 16(2):150-8. (Persian).
  28. Zhang H, Hu H, Wu C, Yu H, Dong H. Impact of China's Public hospital reform on healthcare expenditures and utilization: a case study in ZJ province. PLoS One 2015; 10(11):e0143130.
  29. Zhao LP, Yu GP, Liu H, Ma XM, Wang J, Kong GL, et al. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China. PLoS One 2013; 8(8):e72166.
  30. Sulku SN. The health sector reforms and the efficiency of public hospitals in Turkey: provincial markets. Eur J Public Health 2012; 22(5):634-8.
  31. Shweta K, Kumar S, Gupta AK, Jindal SK, Kumar A. Economic analysis of costs associated with a respiratory intensive care unit in a tertiary care teaching hospital in Northern India. Indian J Crit Care Med 2013; 17(2):76-81.
  32. Geitona M, Androutsou L, Theodoratou D. Cost estimation of patients admitted to the intensive care unit: a case study of the teaching university hospital of Thessaly. J Medical Econ 2010; 13(2):179-84.
  33. Haque A, Siddiqui NU, Kumar R, Hoda M, Lakahni G, Hooda K. Cost of care in a paediatric intensive care unit of a tertiary-care university hospital of Pakistan. J Pak Med Assoc 2015; 65(6):651-4.
  34. Talebi M. Increase in the rate of natural childbirth and decrease in caesarean sections in Mashhad University of Medical Sciences. Available from:URL:http://webda.mums.ac.ir/index.php?option=com_content&view= article&id=9811: 2015 May 7.

Larrañaga O. Health sector reforms in Chile. Lancet 1997; 349:189-225