Study of Cost-effectiveness of Strategic purchasing of environmental halth services in Tabriz Health complexes

Abstract

Introduction: In most countries, especially developing countries, primary health care is provided by the public sector as a result of resource constraints, high costs, low quality of services provided, governments and health policy makers forced to evolve and initiate reforms, including outsourcing. . Strategic purchase of services or the transfer of some internal activities and the right of an organization to make a decision outside its organization on a contractual basis. Health complexes can be mentioned here. The main purpose of the present study is to study the cost-effectiveness of strategic acquisition of environmental health services in Tabriz health complexes. Materials and Methods: This is a descriptive study and a cross-sectional study on health system (HSR) on 20% of total complexes (public and private managed) in Tabriz in year 4. Work status, available equipment and facilities, results of activities and activities of all EHS staff as well as costs of selected complexes were collected using various forms (13 series forms). These forms collect various information including surveys for complex designation, benchmarking effectiveness, collaboration consent, general specifications of complexes and their covered centers, personal and public information of complex health personnel, costs Monthly staff, auto and equipment, supplies and equipment consumed and received. One or more of the actions taken by the staff are carried out using a survey as a criterion of comparison of the selected effectiveness and cost of each service provided in the selected complexes, and then a cost-effectiveness comparison between the public and private complexes. Results: Results show that government complexes are better than private ones regarding number of educated people, number of referrals to courts, total visits, number of closed centers and places, number and percentage of sanitation and improvement of drinking water chlorination sites. . According to the calculated cost effectiveness information of each health card issuance service, public health certification, health improvement and sanitation, cost of training to individuals, offending to judicial centers, total number of visits, closed locations, sampling As for food, drinking water chlorination is much lower in private health complexes than in public ones. The service is not intended for public and private complexes and vehicles to visit places in government complexes and one of the private complexes. Discussion: The average salary of an environmental health inspector in a private complex is less than half the salary of a public complex employee. The total annual cost of publicly-owned Wakim Private Branches and the cost of consumables and the cost of equipment for the Piladrudi State Complex are higher than other complexes. The cost of environmental health unit of Chamran private complex is higher than other complexes regardless of staff salaries. The highest cost of environmental health units in complexes is related to staff salaries. The salaries of the employees of the private complex are not based on an agreed price for each service, but are at least the minimum wage. Paying low salaries to the employees of private complexes has improved their cost effectiveness index, and if the salaries are actually paid based on the agreed purchase price due to the low performance results, we will see a change in the cost effectiveness index.