The impact of health sector evolution plan on hospitalization and cesarean section rates in Iran: an interrupted time series analysis

Abstract

Objective

To investigate the effect of the health sector evolution plan (HSEP) on hospitalization and cesarean section (C-section) rates in Kermanshah province in the western region of Iran.

Design

Interrupted time series analysis.

Setting

Hospital care system in Kermanshah province.

Study Participants

Fifteen hospitals affiliated to Ministry of Health and Medical Education (MoHME) in Kermanshah province.

Intervention(s)

Health sector evolution plan.

Main Outcome Measures

Hospitalization rate and C-section rate.

Results

We observed a statistically significant increase in the hospitalization rate (12.9 hospitalizations per 10 000 population, P < 0.001) in the first month after the implementation of the HSEP. Compared with the monthly trend in hospitalization rate before the intervention, we found a significant increase of 0.70 hospitalizations per 10 000 population (P < 0.001) in monthly trend in hospitalization rate after the HSEP. Although the proportion of C-section from total deliveries decreased by 11% (P = 0.044) in the first month after the implementation of the HSEP, the proportion of C-section from total deliveries increased at the rate of 0.0017% (P = 0.001) per month during post-intervention period.

Conclusion

We found an increase in the hospitalization rate after the intervention of HSEP. Although the C-section rate in the first month after the HSEP decreased, we observed an increasing trend in C-section rate over the study period; this implies that the HSEP did not promote vaginal delivery in Iran, which is outlined as one of the objectives of the intervention.

health sector evolution plan, hospitalization rate, cesarean section, interrupted time series, Iran