Hospitalization and cost trends during Iranian health system reforms over two decades: a time series analysis

Health Sector Reform (HSR) in Iran was implemented in two phases, in 2005 and 2014, financed through a governmental health insurance model managed by the Iranian Health Insurance Organization (IHIO). This study mainly aimed to evaluate the outcomes of HSR by analyzing trends in hospitalization rates and associated expenditures among the insured population covered by the IHIO over the past 20 years as well as forecasting for future based on the observed time series trend.

This observational longitudinal study assessed key indicators, including hospitalization rates, average per capita inpatient costs, and the inflation rate of inpatient expenditures, from 2001 to 2021, for populations covered by both rural and non-rural insurance funds of the IHIO. Data were analyzed across three distinct periods: pre-HSR, between the two HSR phases, and post-second-phase implementation. Time series analyses were conducted using autoregressive integrated moving average (ARIMA) and exponential smoothing models to forecast trends through 2027.

Projections suggest that by 2027, the hospitalization rate for citizens covered by both rural and non-rural funds will likely reach 101 per 1,000 insured individuals. Over the study period, per capita hospitalization costs remained stable across both funds with no significant differences. However, the mean annual increase in per capita hospitalization costs is expected to continue rising between 2021 and 2027, reaching 54.90% in non-rural funds and 48.67% in rural funds.

HSR appears to have achieved health equity in hospitalization rates between rural and urban populations. While per capita inpatient costs have shown parity between rural and non-rural funds.