Comparison of the Deductions of Insurance Bills in an Education-Treatment Center in Iran before and after Health Care Reform

• Main Authors: Zahra Rostami, Amir Ashkan Nasiripour
• Format: Article
• Language: fas
• Published: Vesnu Publications 2019-02-01
• Series: مدیریت اطلاعات سلامت
• Subjects: Deductions; Insurance; Hospitals; Health Care Reform; Iran
• Online Access: http://him.mui.ac.ir/index.php/him/article/view/3790

Introduction: Health care reform affects the hospital activities from various ways. According to the important effect of insurance bill deductions on hospitals revenue, this study was aimed to compare the deductions from the insurance bills of Alzahra hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, before and after of health care reform. Methods: This descriptive-analytic study was carried out by examining data about insurance bill deductions among 50288 and 51699 inpatient cases in 2013 and 2015, respectively, in Alzahra hospital covered by Social Security Insurance Organization and Health Services Insurance. To data collection, information technology (IT) staff reports and Health Information System reports were used and exported to electronic files. Data were analyzed using t and paired t tests at a significant level of 0.05. Results: The ratio of deductions to total hospital income significantly reduced in 2015 compared to 2013 (P = 0.010). This significant reduction was seen in visiting, anesthesia, surgery, bed-day costs, and para-clinic services. There was a significant increase in load of para-clinic, consulting, anesthesia, surgery, and total services. Conclusion: Insurance bill deductions in Alzahra hospital decreased after health care reform. The most rate of deductions referred to para-clinic services of Social Security Insurance Organization; that was because of great load of documents of this organization or inequity of patients covered by different insurers. But it is necessary to investigate the causes of insurance bill deductions according to insurance types to find approaches to reduce Social Security Insurance Organization bill deductions.