Aboutorabi Ali, Radinmanesh Maryam, Rezapour Aziz, Afshari Mahnaz, Taheri Ghasem
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cost Eff Resour Alloc. 2020 Sep 29;18:38. doi: 10.1186/s12962-020-00232-w. eCollection 2020.
the health service tariff is an appropriate policymaking tool and the financial leverage of the health system control which affects quality, availability, cost, efficiency, equity and accountability of health services. Global surgeries include 91 common cases of general and specialized surgeries in hospitals; fixed tariffs are annually defined for these surgeries, and insurance companies must pay medical centers based on these tariffs. The aim of this study was to examine and compare hospital bills with global surgery tariffs at Hazrate Rasoole Akram Educational and Medical Center in 2017.
This descriptive-analytic study was conducted retrospectively and compared the global and actual costs of global surgeries performed in the third quarter of the year 2017 at Hazrate Rasoole Akram Educational and Medical Center. Required data on the actual costs of surgeries was collected through the Hospital Information System (HIS) and patients' records. Information on the global costs was obtained from the Annual Circulars of Insurance Council for the studied period about the cost of global surgeries. Linear regression (STATA13 software) was used to investigate the effect of items on tariff and invoice differences; concerning other calculations, EXCEL software was used.
The highest frequency of global surgeries was related to ophthalmic surgery which accounted for approximately half of total surgeries performed at Hazrate Rasoole Akram Hospital. The most significant difference between global tariff and invoice was also related to ophthalmic surgery (188709.3 Dollar a year).Overall, the actual hospital bills were much higher than the tariffs approved for global surgeries, and the total difference was 461805.5 Dollar. The results revealed that there was a significant relationship between some of the items such as the cost of operating rooms, anesthesia and other services.
Referral hospitals which are at the level three of referral networks usually treat more complex patients; this should be taken into account when defining surgery tariffs of these centers. On the other hand, hospitals need to control the costs and reduce the end cost of these surgeries by improving clinical management and cost management. In addition, prospective and case-based payment methods can control health costs.
医疗服务收费标准是一种合适的政策制定工具，也是卫生系统控制的财务杠杆，会影响医疗服务的质量、可及性、成本、效率、公平性和问责制。全球手术包括医院中91种常见的普通外科和专科手术病例；每年都会为这些手术确定固定的收费标准，保险公司必须根据这些标准向医疗中心支付费用。本研究的目的是在2017年检查和比较哈兹拉特·拉苏勒·阿克拉姆教育与医疗中心的医院账单与全球手术收费标准。
本描述性分析研究采用回顾性研究方法，比较了2017年第三季度在哈兹拉特·拉苏勒·阿克拉姆教育与医疗中心进行的全球手术的全球成本和实际成本。通过医院信息系统（HIS）和患者记录收集手术实际成本的所需数据。关于全球成本的信息从保险理事会在研究期间发布的关于全球手术成本的年度通知中获取。使用线性回归（STATA13软件）研究各项对收费标准和发票差异的影响；其他计算使用EXCEL软件。
全球手术频率最高的是眼科手术，约占哈兹拉特·拉苏勒·阿克拉姆医院进行的手术总数的一半。全球收费标准与发票之间最显著的差异也与眼科手术有关（每年188709.3美元）。总体而言，医院实际账单远高于全球手术批准的收费标准，总差异为461805.5美元。结果显示，手术室成本、麻醉和其他服务等一些项目之间存在显著关系。
处于转诊网络三级的转诊医院通常治疗更复杂的患者；在确定这些中心的手术收费标准时应考虑到这一点。另一方面，医院需要通过改善临床管理和成本管理来控制成本并降低这些手术的最终成本。此外，前瞻性和基于病例的支付方式可以控制医疗成本。
