Department of Health Service Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2024 Oct 1;27(10):580-587. doi: 10.34172/aim.31106.
Iran's healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran's public hospitals.
This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP's actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap.
The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B=1.05, 95% CI: 0.76-1.35, <0.001), females (B=26.7, 95% CI: 15.5-37.9, <0.001), patients with a longer stay (B=81.2, 95% CI: 77.5-84.8, <0.001), and procedures performed by full-time surgeons (B=67.3, 95% CI: 56.9-77.5, <0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B=346.9, 95% CI: 214.3-479.5, <0.001).
Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs.
伊朗的医疗保健系统在国家关税和全球手术程序（GSPs）成本之间存在显著差异。本研究旨在比较伊朗公立医院 GSP 的实际成本与国家关税。
这是一项 2017 年进行的回顾性横断面研究。本研究使用普查法调查了三家公立医院的 6126 例 GSP。此外，还获得了最高健康保险委员会的国家关税。关税-成本差距是 GSP 的实际成本与关税之间的差异。多元线性回归分析确定了影响关税-成本差距的因素。
GSP 的平均实际成本为 637 美元，而平均关税为 495 美元。报销仅覆盖了 78%的成本。年龄较大（B=1.05，95%CI：0.76-1.35，<0.001）、女性（B=26.7，95%CI：15.5-37.9，<0.001）、住院时间较长（B=81.2，95%CI：77.5-84.8，<0.001）和全职外科医生进行的手术（B=67.3，95%CI：56.9-77.5，<0.001）的患者差距更大。此外，神经外科在预测外科专业中实际成本与关税之间的差距方面具有最大的影响（B=346.9，95%CI：214.3-479.5，<0.001）。
由于许多 GSP 的国家关税未能覆盖其实际成本，公立医院因此遭受了巨大的财务损失。建议对能够承担更高成本的特定客户群体提高关税，并调整全球关税以匹配实际服务提供成本。
