Volume 80, Issue 4 (July 2022)
Tehran Univ Med J 2022, 80(4): 300-312 |
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Saeedpour J, Rezaei M, Ekhteyar S, Akhavan Rezayat S, Damiri S, Fartaj F et al . Costs of services covered by the global payment system
in Tehran University of Medical Sciences. Tehran Univ Med J 2022; 80 (4) :300-312
URL: http://tumj.tums.ac.ir/article-1-11812-en.html
URL: http://tumj.tums.ac.ir/article-1-11812-en.html
Jalal Saeedpour1 
, Mehdi Rezaei2 , Shamsi Ekhteyar3 , Sara Akhavan Rezayat4 , Soheila Damiri4 , Faezeh Fartaj3 , Maryam Radin Manesh * 5
, Mehdi Rezaei2 , Shamsi Ekhteyar3 , Sara Akhavan Rezayat4 , Soheila Damiri4 , Faezeh Fartaj3 , Maryam Radin Manesh * 5
1- Health Information Managment Research Center, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Orthopedic Surgery, School of Medicien, Tehran University of Medical Sciences, Tehran, Iran.
3- Vice-Chancellor for Treatment Affairs, Tehran University of Medical Sciences, Tehran, Iran.
4- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
5- Vice-Chancellor for Treatment Affairs, Tehran University of Medical Sciences, Tehran, Iran.| Department of Health Economics, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran. ,maryam.radinmanesh@yahoo.com
2- Department of Orthopedic Surgery, School of Medicien, Tehran University of Medical Sciences, Tehran, Iran.
3- Vice-Chancellor for Treatment Affairs, Tehran University of Medical Sciences, Tehran, Iran.
4- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
5- Vice-Chancellor for Treatment Affairs, Tehran University of Medical Sciences, Tehran, Iran.| Department of Health Economics, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran. ,
Abstract: (1172 Views)
Background: In Iran, a combination of three methods of budget payment, fee for service and case-based payment (known as the global payment system) is used to reimburse the cost of hospital services. The aim of this study was to investigate the costs of 90 services of the Global Hospital Reimbursement System at Tehran University of Medical Sciences.
Methods: This descriptive cross-sectional applied study was performed from March 2017 to March 2019 in the hospitals of Tehran University of Medical Sciences. The billing and record data of all patients whose services were reimbursed on a global payment system basis were extracted from hospital information systems. Data were analyzed using descriptive statistics (frequency mean. std deviation, maximum & minimum) in SPSS 21 and Excel 2016.
Results: During two years in TUMS, the costs of services provided to 143,866 patients have been reimbursed based on the global payment system., which had a cost of 2300 billion rials. 80% of the total services and costs were related to 10 services. 78.46% of the cases were related to two specialized groups of ophthalmology and obstetrics and gynecology. 83.17% of the total costs of services reimbursed globally at the TUMS were related to these two specialized groups. The average cost per service was about 16 million Rials, but varied greatly for different services, ranging from about 1.8 million Rials to 67 million Rials. On average, for a global service, the share of each of the cost subgroups of diagnostic services, hoteling and nursing services, medicine and consumables, operating room and surgery, physician's visit and consultation, respectively 3.1%, 11.6%, 21.4%, 49.9% and 13.9%.
Methods: This descriptive cross-sectional applied study was performed from March 2017 to March 2019 in the hospitals of Tehran University of Medical Sciences. The billing and record data of all patients whose services were reimbursed on a global payment system basis were extracted from hospital information systems. Data were analyzed using descriptive statistics (frequency mean. std deviation, maximum & minimum) in SPSS 21 and Excel 2016.
Results: During two years in TUMS, the costs of services provided to 143,866 patients have been reimbursed based on the global payment system., which had a cost of 2300 billion rials. 80% of the total services and costs were related to 10 services. 78.46% of the cases were related to two specialized groups of ophthalmology and obstetrics and gynecology. 83.17% of the total costs of services reimbursed globally at the TUMS were related to these two specialized groups. The average cost per service was about 16 million Rials, but varied greatly for different services, ranging from about 1.8 million Rials to 67 million Rials. On average, for a global service, the share of each of the cost subgroups of diagnostic services, hoteling and nursing services, medicine and consumables, operating room and surgery, physician's visit and consultation, respectively 3.1%, 11.6%, 21.4%, 49.9% and 13.9%.
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Conclusion: Managers need to focus on high-frequency and high-cost services to reduce the cost and financial losses for services that are under the global payment system. Depending on the specific cost pattern of each service, the strategies adopted to control the costs of that service should also be different.
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Keywords: healthcare costs, medical care cost, prospective payment system, rate setting and review, reimbursement mechanisms.
Type of Study: Original Article |
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