The Effects of Iran Health Transformation Plan on the "End Of Life" Care in Acute Hospital Setting: Perspectives of Patients and Families

Introduction: End of life (EOL) care is a set of medical care services provided both as therapeutic and palliative measures, to patients with terminal diseases. EOL care has been implemented in health care services in multiple industrial countries, but is still not provided systematically in many developing countries, such as Iran. The Health Transformation Plan (HTP) was the last major policy reform put forward in Iran to increase the quality of care and provide financial protection against catastrophic health expenditure. In this study we aim to assess how HTP has affected the patients receiving EOL care in Iran.Material and Methods: The present qualitative study was performed in the East Azerbaijan province, Northwest of Iran. The samples of this study were individuals who were receiving EOL care because of debilitating conditions such as cancer and progressive neurological disease and their families. All of the subjects were entered into a structured interview and themes and subthemes were extracted. Interviews were done before and after of HTP implementation.Results: Before the implementation of the HTP, the main concerns of patients receiving EOL care was financial challenges, hurdles in receiving health services and psychological support. After the HTP the main challenge facing patients were provision of medical services and the increasing bureaucracy involved in receiving health care.Conclusion: HTP increased the steps necessary to receive care for terminally ill cancer patients. The financial protection of patients is not enough to compensate for the increasing cost of medical services. After the HTP implementation, increase in the demand of medical services in public health centers has caused the exhaustion of health care resources

Keywords:

End of life care , Health Transformation , Elder