ABSTRACT
Responsiveness is an indicator by WHO to evaluate the performance of health systems on non-medical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system. World Health Survey [WHS] questionnaire was used to collect data on a two-stage cluster sampling in 17[th] District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire. More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. [Prompt attention] and [quality of basic amenities] received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully. Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors
ABSTRACT
To determine the appropriateness of admission and hospitalization of patients in two major teaching hospitals of Tehran University of Medical Sciences [TUMS]. Appropriateness Evaluation Protocol was employed to evaluate 1732 days of hospital stay and 258 patient admissions. Findings indicated that 22.8% of admissions were inappropriate and length of stay for patients who had inappropriate admissions was significantly shorter than those who had appropriate admission. Statistical tests demonstrated a significant difference between hospital wards in terms of inappropriate admission [p < 0.0001]. On average 8.6% of patient days were inappropriate and it is significantly different between two hospitals. It was also found that the more patient length of stay, the more inappropriate patient day. Delay in discharge process was the most frequent reason indicated for inappropriate hospital stay. A substantial proportion of hospital admissions and stays were found to be inappropriate due to management procedures and more likely lack of health care services in lower level of health system