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Depiction of Health. 2017;8(2): 119-125.
  Abstract View: 972
  PDF Download: 418

Health Care System Management

Original Article

Exploring the Rate and Causes of Inpatient Records Deductions Covered by Iran Health Insurance: The Case of a Public Hospital in Tabriz

Yalda Mousa Zadeh, Morteza Soleymanzadeh, Shirin Nosratnejad*
*Corresponding Author: Email: sh_nosratnejad@yahoo.com

Abstract

Background and Objectives: Today, a major part of health system resources are allocated to hospitals. So, the control of these resources and correct and efficient use of them are the important tasks of management. This study was conducted to determine the deductions of Iran health insurance in the first half of 2014 in a public hospital in Tabriz.

Material and Methods: This was a cross sectional study. The study population included records of patients hospitalized in the first half of 2014. All cases with deduction were selected as sample. Data collection was performed using a researcher-made checklist. Checklist information was collected through records of patients and interview. Then, data were analyzed using Excel software.

Results: Most deductions were related to physician visits (61116000 Rials), laboratory (46881797 Rials) and surgery commission (26114487 Rials), respectively. Most of the deductions were in October (70613244 Rials) and lowest deductions were in February (6838945 Rials). The most important factor of deductions was related to additional request.

Conclusion: According to deduction cases and the most important factor related to it (additional request), It can be concluded that greatest amount of deductions are due to employees' mistakes. In this regard, emphasis on clinical guidelines and physicians’ training is necessary. Negotiations and clarifying the amount of liability of insurance organizations can prevent deductions.

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Submitted: 11 Jun 2017
Accepted: 10 Aug 2017
ePublished: 21 Sep 2017
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