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Title: The relative efficiency of public and non-public health centres in Iran
Author: Otaghsara, Samad Rouhani.
ISNI:       0000 0001 3460 9533
Awarding Body: University of Keele
Current Institution: Keele University
Date of Award: 2006
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Given the focus of Iran's government on primary health care (PHC) in recent decades in order to address the public health of the entire population, it has been said that the country's primary health network has achieved much in this period so that it is now one of the best PHC systems in the region as well as in the developing countries. Nevertheless, this publicly funded and provided PHC system is currently faced with many problems particularly financial restrictions, inefficiency, under utilisation and low motivated staff. Market based reform has been used to address these issues. Privatisation is such a use of marketisation, which has been used, in the whole public sector in Iran in recent years. Currently, market based reform is the approach of the government in order to use the opportunities of private sector in the health care delivery as well as in PHC services and its expansion. The policy reform agenda, contracting with the private-for-profit sector is one of the strategies of reform in the PHC sector to expand the PHC network, started in 1999 in East Azerbaijan Province (EAP) and followed in other provinces later. In the EAP initiative, there are nine non-public urban health centres providing the defined package of PHC for about 140,000 urban population in the three different cities. All these health centres with a matched group of nine public health centres were compared in this study. The comparison has focused on the economic performance of the health centres including technical input efficiency, input allocative efficiency (cost efficiency and the efficient mix of inputs) and overall input economic efficiency as a combination of `technical input' and `input allocative' efficiency. There is a broad definition for the term efficiency, which includes customer satisfaction as an outcome indicator and were measured among a sample of attendants in each group.As cost effectiveness, linking between cost and consequenceso f health care, of public and non-public health centres in the delivery of primary health care was part of this investigation, that required justifying the comparability of outcomes of provided care by the health centres of two groups. The justification was given about the comparability of outcomes of preventive care in both sectors given the characteristics of their services. However, for curative care and as a tracer condition, the health status change measurement among a sample of follow up patients visited by the GPs in each group was measured by using EQ-5D questionnaire, to justify the comparability of outcomes of curative care between the two groups of study. To triangulate i. e. complementation and confirmation of the results of efficiency and outcome measurement, a sample of key health staff and experts as well as all managers of study health centres was approached to reveal their viewpoints about the different aspects of such interventions. This could indicate the extent to which the viewpoints and realities are or are not consistent and can potentially bring some issues that probably were omitted in the other parts of this research but are initially important to these key health experts. The result of this study has revealed that the non-public sector in all dimensions of economic indicators in terms of technical input efficiency, input allocative efficiency (both cost efficiency and efficient mix of inputs) and then overall input economic efficiency had significantly (P value S 0.05) higher scores than the public sector. Also, the result of customer satisfaction survey has shown that a significantly (P value S 0.05) higher level of customers in the non-public sector are satisfied with the performance of health centres than the customers in the public sector; however, the level of customer satisfaction in both groups was high. The result of health status change measurement did not reveal any significant differences between the two groups in terms of the impact of provided curative care. This, together with the given justification about the comparability of preventive care in the two sectors, provided the basis for the cost effectiveness comparison in the delivery of PIIC between the groups of study. The result of cost effectiveness comparison has indicated that, given the comparability of the outputs and the costs attached to the production, the non-public sector was significantly (P value :50.05) more cost effective in the provision of PHC than the public sector. Furthermore, the viewpoints of key health staff and experts as well as the managers of study health centres were in line with the above realities. The above findings have provided the evidence supporting the possibility of using existing private sector opportunities in the provision and expansion of PHC in the urban area in Iran and were interpreted as a possibility in Pareto improvement in the status quo of primary health care delivery in this country. Given the financial limitation facing the current PHC network in this country, it is concluded that public-private mix i. e. contracting with the private sector such as that experienced in the EAP is a way forward to support PHC provision for the urban area in Iran.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available