The Impact of Implementing the Self Finance System on Hospital Utilization Indicators in Baghdad City

Abstract

Background: Ministry of Health, since its establishment, adopted the policy of central financing system and free medical services in all health facilities. The sanction and the decline in per capita spending affect the health financing system, thus in 1997 a new financing policy was adopted as pilot in seven specialized hospital called “self–finance” system in which the cost of care was shifted to the patients, i.e. the funds obtained came from user charges at the health facilities. This system was extended (with some modifications) to all hospitals in 1999 and PHC centers in 2001 and implemented until 2003 when it was discontinued.
Materials and Methods: During the second half of 2004, a review of hospital records was performed to compare some hospital utilization indicators for a five months period before and after implementing the Self Finance System (October 1998 – February 1999 and October 1999 – February 2000 respectively). A convenient sample of eleven hospitals from the three Health Directorates in Baghdad city were chosen, excluding seven hospitals in which a special form of self finance system was adopted, and the indictors (Bed Occupancy Rate, Hospital Stay Rate, Inpatient Fatality Rate) among each directorate were measured from the hospitals of each directorate before and after implementing the self finance system.
Results: The study showed that after implementing the self finance system, the Bed Occupancy Rate in the general wards of both the Medical City and AL-Yarmouk Health Directorates were increased, and decreased in the private wards, the opposite was true for Baghdad Health Directorate, where as the Hospital Stay Rate in the private wards of all Health Directorates and the general ward of Baghdad Health Directorate were higher after implementing the self finance system. Inpatient Fatality Rate increased in all Health Directorates.
Conclusions: The implementation of the self finance system affects the utilization of hospitals in many ways, and it has both positive and negative impacts on both the patients and the health professionals.