Volume 26, Issue 2 (6-2023)
jha 2023, 26(2): 84-97 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rezaee M, Effatpanah M, Ghamkhar M, Namazi shabestari A, Ghamkhar L. Comparing the Billing Cost of Global Childbirth Surgeries (Natural, Cesarean Section) with the Tariff Approved by the Supreme Insurance Council: A Descriptive Study. jha 2023; 26 (2) :84-97
URL: http://jha.iums.ac.ir/article-1-4346-en.html
URL: http://jha.iums.ac.ir/article-1-4346-en.html
Mehdi Rezaee1 
, Mohammad Effatpanah2 , Maryam Ghamkhar3 , Alireza Namazi shabestari4 , Leila Ghamkhar 5
, Mohammad Effatpanah2 , Maryam Ghamkhar3 , Alireza Namazi shabestari4 , Leila Ghamkhar 5
1- M.D, department of orthopedics, school of medicine, Tehran university of medical sciences, Tehran
2- MD & MPH, Professor of child and adolescent psychiatry, pediatric department, school of medicine, Imam Khomeini hospital, Tehran university ofmedical sciences, Tehran
3- M.Sc., Midwifery, Islamic Azad university branch Challus, Challus, Mazandaran
4- MD, PhD, Associated professor of geriatric medicine, department of geriatric medicine, school of medicine, Tehran university of medical sciences, Tehran
5- PhD, Physical Therapy, national center for health insurance research, Tehran ,lghamkhar@yahoo.com
2- MD & MPH, Professor of child and adolescent psychiatry, pediatric department, school of medicine, Imam Khomeini hospital, Tehran university ofmedical sciences, Tehran
3- M.Sc., Midwifery, Islamic Azad university branch Challus, Challus, Mazandaran
4- MD, PhD, Associated professor of geriatric medicine, department of geriatric medicine, school of medicine, Tehran university of medical sciences, Tehran
5- PhD, Physical Therapy, national center for health insurance research, Tehran ,
Abstract: (394 Views)
Introduction: Global reimbursement is a hospital payment method. In some global surgeries, the billing cost of treatment differs from the tariff set by the Supreme Council of Insurance, leading to financial losses for hospitals or insurance companies. This study compares the billing costs of childbirth services with the approved tariffs.
Methods: This descriptive-analytical study examined the billing costs of all childbirth cases (natural and cesarean section) covered by health insurance at three specialized maternity hospitals (A, B, C) in Tehran province in 1400. Data were sourced from health insurance company dashboards, compiled in Excel, and analyzed using SPSS software.
Results: The study evaluated 3,742 childbirth cases, with 35% being natural births and 65% cesarean sections. The comparison between billing costs and approved tariffs showed that Hospital A's costs for both natural and cesarean childbirths exceeded the set tariffs. However, the billing costs in the other two hospitals were below the approved tariffs. Additionally, the actual hospitalization days for cesarean sections were shorter than those covered by the tariff in all three hospitals.
Conclusion: This study highlights variations in childbirth billing costs compared to the approved global tariffs across different hospitals. These findings underline the necessity of cost control in hospitals and suggest a need to revise the approved tariffs to align with the actual hospitalization duration for patients.
Methods: This descriptive-analytical study examined the billing costs of all childbirth cases (natural and cesarean section) covered by health insurance at three specialized maternity hospitals (A, B, C) in Tehran province in 1400. Data were sourced from health insurance company dashboards, compiled in Excel, and analyzed using SPSS software.
Results: The study evaluated 3,742 childbirth cases, with 35% being natural births and 65% cesarean sections. The comparison between billing costs and approved tariffs showed that Hospital A's costs for both natural and cesarean childbirths exceeded the set tariffs. However, the billing costs in the other two hospitals were below the approved tariffs. Additionally, the actual hospitalization days for cesarean sections were shorter than those covered by the tariff in all three hospitals.
Conclusion: This study highlights variations in childbirth billing costs compared to the approved global tariffs across different hospitals. These findings underline the necessity of cost control in hospitals and suggest a need to revise the approved tariffs to align with the actual hospitalization duration for patients.
Type of Study: Research |
Subject:
Health Economics
Received: 2023/03/25 | Accepted: 2023/06/21 | Published: 2023/12/31
Received: 2023/03/25 | Accepted: 2023/06/21 | Published: 2023/12/31
References
1. Brakebill A, Fendrick AM, Kullgren JT. How Might Patients and Physicians Use Transparent Health Care Prices to Guide Decisions and Improve Health Care Affordability? AMA J Ethics. 2022;24(11):E1034-1039. [DOI:10.1001/amajethics.2022.1034]
2. Rahmany K, Barati M, Ferdosi M, Rakhshan A, Nemati A. Strategies for reducing expenditures in Iran's health transformation plan: A qualitative study. Med J Islam Repub Iran. 2018;32:102-107. [DOI:10.14196/mjiri.32.102]
3. Than TM, Saw YM, Khaing M, Win EM, Cho SM, Kariya T, Yamamoto E, Hamajima N. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting? BMC Health Serv Res. 2017;17(1):669. [DOI:10.1186/s12913-017-2619-z]
4. Lotfi F, Lohivash S, Kavosi Z, Owjimehr S, Bayati M. The impact of Health Transformation Plan on natural vaginal delivery and cesarean section frequency in Iran: an interrupted time series analysis. BMC Res Notes. 2021;14(1):257. [DOI:10.1186/s13104-021-05677-7]
5. Aboutorabi A, Radinmanesh M, Rezapour A, Afshari M, Taheri G. A comparison of global surgery tariffs and the actual cost of bills at Hazrate Rasoole Akram educational and medical center. Cost Eff Resour Alloc. 2020;18:38-44. [DOI:10.1186/s12962-020-00232-w]
6. Askari AZ, Mirmohammadkhani M, Shahab MR, AliEbrahimian A. Designing and validating the cost management model of inpatient records in the global system: A Case study in Niknafas Obstetrics and Gynecology Hospital in Rafsanjan. J Tolooebehdasht. 2022;21(2):17-30. [In Persian]. [DOI:10.18502/tbj.v21i2.10338]
7. Chatruz A, Javadinasab H, Amini MK, Biglar M, Goudarzi N, Javad J. A comparison of the cost of global surgery bills with approved tariffs in hospitals affiliated to Tehran University of Medical Sciences. Payavard Salamat. 2015;9(1):67-80. [In Persian].
8. Mirzaei A, Gomar A, Ebrahimi G, Tafazoli M, Soltani L, Fekri Z, Borna L. Investigate the Relationship Run System Payments DRG and Reduce the Cost of Therapy. 2020;21(6):53-59. [In Persian].
9. Hosseini Ashpala R, Khorami F, Bani Asadi T, N A. Comparing the cost of hospitalized cases in the global system with the retrospective repayment system of a case study in Iran. J Mod Med Inform. 2015;1(1):65-74. [In Persian].
10. Madani S, Taji M. Calculate the cost of selected global surgical operations and comparison with the approved tariffs in Amin hospital in Isfahan. Homa-ye-Salamat. 2010;7(3):6-9. [In Persian].
11. Askari Zare A, Mir Mohammadkhani M, Shahab M, Ebrahimian A. Comparison of Global Inpatient Services Costs with Approved Tariffs in Niknafs Obstetrics and Gynecology Hospital in Rafsanjan in 2019: A Descriptive Study. J Rafsanjan Univ Med Sci Health Serv. 2022;20(10):1117-1128. [In Persian]. [DOI:10.52547/jrums.20.10.1117]
12. Sabermahani A, Sirizi MJ, Zolala F, Nazari S. Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients. Value Health Reg Issues. 2021;24:141-144. [DOI:10.1016/j.vhri.2020.05.004]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Site Keywords
Health, Administration, Scientific Article, Iran University of Medical Sciences,
