Medical Journal of the Islamic Republic Of Iran
مجله پزشکی جمهوری اسلامی ایران
Med J Islam Repub Iran
Medical Sciences
http://mjiri.iums.ac.ir
2
journal2
1016-1430
2251-6840
8
10.18869/mjiri
14
8888
13
en
jalali
1398
11
1
gregorian
2020
2
1
34
1
online
1
fulltext
en
Health insurance deductions in Iranian public hospitals before and after the health transformation plan
Health Management and Economics
Health Management and Economics
Original Research
Original Research
<strong>Background: </strong>Developing countries, such as Iran, have been struggling with high rates of insurance deduction. As part of the Health Transformation Plan (HTP) in Iran, a new reference book was introduced to update the medical tariffs. This study aimed to compare the rates and extent of insurance deductions before and after HTP in Iran’s public hospitals.<br>
<strong>Methods:</strong> This was a quasi-experimental study. Overall, 400 medical bills were selected from Iran’s national Health Information System using multilevel random sampling before and after HTP implementation (2014 and 2017). Insurance deductions were divided into 5 groups: (1) diagnostic procedures, (2) medication and medical appliances, (3) accommodation and human capital provision, (4) surgery, and (5) other services. Using STATA Version 14.0, independent t test and Fisher’s exact test were used for data analysis. Significance level was set at 0.5.<br>
<strong>Results: </strong>There was a significant decrease in insurance deductions among Iran’s Health Insurance (HI) and Social Security Insurance (SSI). Accordingly, before HTP, the average amount of insurance deductions was 58.9% and 71.3% in HI and SSI, respectively. Moreover, there was a significant decline in all 5 groups between the pre- and postimplementation of HTP (p<0.05). Based on the results, hospitalization time (OR=2.31, 95% CI=1.9-3.2), patients in general hospitals (OR=1.49, 95% CI=1.4-2.7), coverage by SSI (OR=2.54, 95% CI=1.8-5.6), and having surgery (OR=3.5, 95% CI=2.0-7.3) increase the chance of insurance deduction significantly (p<0.05).<br>
<strong>Conclusion:</strong> Findings of this study showed that after HTP, insurance deductions were decreased significantly. The causes of this decline may be due to the range of services covered by public insurances, increase in insurance coverage, and improvement in health providers-insurance companies communication.
Insurance deduction, Relative value unit, Health transformation plan, Hospitals
157
163
http://mjiri.iums.ac.ir/browse.php?a_code=A-10-4908-1&slc_lang=en&sid=1
Alireza
Mazdaki
mazdakiii@yahoo.com
200319475328460063824
200319475328460063824
No
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
Hamed
Zandian
zandian.hamed899@gmail.com
200319475328460063825
200319475328460063825
No
Social Determinants of Health Research Center, & Department of Community Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
Aein
Zarrin
azarrin@edu.uwaterloo.ca
200319475328460063826
200319475328460063826
No
School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
Telma
Zahirian Moghadam
t.zahirian@arums.ac.ir
200319475328460063827
200319475328460063827
Yes
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, & Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran