Goudari Faranak Behzadi, Rashidian Arash, Arab Mohammad, Mahmoudi Mahmood, Jaafaripooyan Ebrahim
Assistant Professor of Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Ph.D. of Health Policy, Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Electron Physician. 2018 Mar 25;10(3):6506-6515. doi: 10.19082/6506. eCollection 2018 Mar.
Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran.
The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations.
In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005-2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed.
Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p<0.05) and N32, N43, N81 and N90 showed a significant downward trend (p<0.05). Similarly, all H Codes except for H18 had a significant upward trend (p<0.000). As such, K Codes including K45, K56 and K81 had an increasing movement. S Codes also experienced both increasing and decreasing trends. However, none of the O Codes changed according to time. Other global surgical codes like C61, E07, M51, L60, J98 (p<0.000), I84 (p<0.031) and I86 (p<0.000) shown upward and downward trends. Total global surgeries trend was significantly upwards (B=24.26109, p<0.000).
The varying trend of global surgeries can partly reflect the behavior of service providers in order to increase their profits and minimize their costs.
全球支付系统是按病例支付系统的首个范例，该系统包含60种常用外科手术，其支付依据是伊朗每例手术的平均成本。
本研究旨在确定全球手术趋势的减少、增加或无变化情况。
在这项回顾性纵向研究中，分别从德黑兰健康保险组织收集了2005年至2015年十年期间每月的60个主要全球手术代码数据。在60个手术代码中，根据医疗中心发送的保险文件，只有46个代码的可接受数据可用。使用STATA软件v.11通过回归分析模型对时间序列进行了定量分析。
一些全球手术代码呈上升趋势，一些呈下降趋势。在N代码中，N83、N20、N28、N63和N93呈上升趋势（p<0.05），N32、N43、N81和N90呈显著下降趋势（p<0.05）。同样，除H18外的所有H代码都有显著上升趋势（p<0.000）。因此，包括K45、K56和K81在内的K代码呈上升趋势。S代码也经历了上升和下降趋势。然而，没有一个O代码随时间变化。其他全球手术代码如C61、E07、M51、L60、J98（p<0.000）、I84（p<0.031）和I86（p<0.000）呈现出上升和下降趋势。全球手术总数趋势显著上升（B=24.26109，p<0.000）。
全球手术趋势的变化可以部分反映服务提供者为增加利润和降低成本而采取的行为。
