Deductions Applied by Khadamat-e-Darman Insurance Company on Patients' Bills at Teaching Hospitals Affiliated to Isfahan University of Medical Sciences

Document Type : Original Article(s)

Authors
Nahid Tavakoli 1
Sakineh Saghaeyannejad 2
Mohammadreza Rezayatmand 3
Farhad Moshaveri 4
Iraj Ghaderi 5
1 . Lecturer of Medical Records in Isfahan University of Medical Sciences, Isfahan, Iran
2 Lecturer of Medical Records in Isfahan University of Medical Sciences, Isfahan, Iran
3 Head of the Department of Medical Records in General Healthcare Insurance Office in Isfahan, Iran
4 Healthcare Assistant Manager in General Healthcare Insurance Office in Isfahan, Iran
5 Insurance Documents officer in General Healthcare Insurance Office in Isfahan
Abstract
Introduction: Hospital managers are always concerned about provision and careful control of financial resources. In this study the deductions applied by Khadamat-e-Darman insurance company on patients' bills at university hospitals affiliated to Isfahan University of Medical Sciences were investigated.
Methods: In this cross–sectional study, data were collected in a checklist consisting of nine parts and 39 questions. The checklist was checked for validity and reliability and was handed over in ten university hospitals in Isfahan. Data were analyzed with SPSS.
Results: The obtained findings suggested that the highest deductions pertained to Feiz hospital (18.5%) while the lowest came from Imam Mosa Kazem hospital (10.4%).
The most frequent cause of deductions related to medication costs (40%) whereas the least frequent cause pertained to consultation fees (10.6%).
Conclusion: On average, each case record covered by Khadamat-e-Darman Insurance Company had 330,000 Rials deduction.
The main cause of deduction seems to be incomplete and inaccurate documenting of hospitalized patients' records by care providers.
Keywords: Health Insurance; Medical Records; Documentation
Health Information Management
Volume 3, Issue 2 - Serial Number 6
September 2006
Pages 53-61