Iranian Red Crescent Medical Journal ORIGINAL ARTICLE Assessing Health System Responsiveness: A Household th Survey in 17 District of Tehran A Rashidian1,2,3, Z Kavosi1,4, R Majdzadeh2,5, A Pourreza1*, F Pourmalek 6 , M Arab 1 , K Mohammad5 1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sci- ences, Tehran, Iran 2Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran 3Director, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran 4Department of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran 5Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 6Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA Abstract Background: 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. Methods: World Health Survey (WHS) questionnaire was used to collect data on a two-stage cluster sampling in 17th 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. Result: 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 respon- siveness, 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. Conclusion: 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 pro- cesses may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors. Keywords: Responsiveness; Outpatient services; Inpatient services; WHS; Iran Introduction Health systems are expected to meet their core goals as well as a number of common social goals1 includ- ing respecting patient rights and responding to pa- tients' expectations. These have gained particular em- inence over the past few decades.2,3 For these reasons, *Correspondence: Abolghasem Pourreza, PhD, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-21-88951391, 09123722328,Fax: +98-21-88989129, e-mail: porrezaa@sina.tums.ac.ir Received: August 25, 2010, Revised: November 3, 2010, Accepted: November 10, 2010 World Health Organization developed a framework for health system responsiveness. It was first present- ed in the World Health Report 2000, where it intro- duced responsiveness as one of the three basic goals of health systems (the other two goals were improv- ing health outcomes and fair financial contribution to healthcare).4 Responsiveness is described as fulfillment of peo- ple's non-medical expectations while interacting with health system; including the way individuals are treated and the environment in which they are treat- Iran Red Crescent Med J 2011; 13(5):302-308 ©Iranian Red Crescent Medical Journal