Performing Relative Values Book of Health Services and Its Effects on Deductions of Health Insurance in Bills of Non-Educational Hospitals of University of Medical Sciences of Hormozgan Province in 2014

Mehdi Najafi

Abstract


Introduction:One of reforms performed in health evolution planwas to amend tariff of medical services in the form of presentation of relative values services book. In this study, we discuss effect of the amendments on one of the most important problems of financial structure of health system that is insurance deductions.

Methodology: in analytic-descriptive study which has been performed as occasional, 83413 files sent to Iran’s health insurance from non-educational hospitals (12 hospitals) of Hormozgan medical sciences university have been discussed and 628 files having deductions have been studied. The data has extracted by using checklist which compiled for deductions of outpatient and hospitalization services and then analysed by SPSS software version 22 and square t test.

Results: the results of present study showed that Minab city has high deductions compared other provinces (4/6062*108), also, the results showed that drug deductions, anesthesia and surgery and outpatient services had not significant difference before and after change of tariff. But additional services (p<0/05,t-2/511), diagnostic services (p<0/05, t-2/406), doctors and expert’s services (p<0/05, t-2/402) and hospitalization services (p>0/05, t-1/695) had significant difference before and after change of tariff.

Concluding: total results showed that presentation of relative values book of services had not significant effect on deductions by increment tariff and change of obligations of insurances but in some cases, it increase deductions which shall perform necessary preparation in order to remove this strategy.

 


Keywords


Insurance Deductions, Relative values book of services, Health Evolution Plan, Hospital

Full Text:

pdf

References


Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affairs. 2008;27(3):759-69.

Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. BMC medicine. 2013;11(1):80.

Swayne LE, Duncan WJ, Ginter PM. Strategic management of health care organizations: John Wiley & Sons; 2012.

Asgari R, Dehghan M, Bahrami M, Keshmiri F. The amount and payment of bills covered by the social security records of patients admitted to hospitals in Yazd University of Medical Sciences in the first half of the year. Hospital. 2013;9(4):23-8.

Karimi S, Vesal S, Saeidfar S, Rezayatmand M. The Study Deductions of Insurance Bills and PresentingSuggestions Approaches in Seyed Alshohada Hospital. . Health Information Management 2011;7(6).

Moalemi S, ShamsAbadi A, Moshkani A, Kyani A, Kazemi A. Review and comparison of those admitted insured social security deductions and venerable Bahonar hospital in Kerman. Health Information Management Association. 2011;8(1).

ZaREI J, Azizi AA, Keshavarz K, Siyavoshi E. Deductions imposed by the NHS and social care organizations in the bills sent by hospitals in Ahvaz. Health Inf Manage. 2014;11(1):24-37.

Omrani M, Farajzadeh f, rashidi. The amount of income and deductions of Shaheed Beheshti University hospitals in. Journal of Medical Council of Islamic Republic of Iran. 2011;30(3):265-71.

Safdari R, Sharifian R, GhaziSaeidi M, Azadmanjar Z. The extent and causes of deductions applied to hospital bills Tehran University of Medical Sciences. Payavard Salamat. 2011;5(2).

Health, Services, Insurance, Organization. Deffinition of Insurance Diductions: Health Services Insurance Organization of Iran; 2015. Available from: td.ihio.gov.ir.

Mobasheri M, Mirzaeian R, Shirvani M. The Process of Evolution of Medical Services Tariffs and Reimbursements Based on Diagnosis-Related Groups. J world Applied Sciences. 2014;30(12):1834-8.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.