Document Type : Original Article
Authors
1 Assistant Professor, Health Services Management, Health Management & Economic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2 BSc, Health Services Management, Isfahan University of Medical Sciences. Isfahan, Iran. (Corresponding Author) Email: vesal.sahar@yahoo.com
3 BSc, Health Services Management, Isfahan University of Medical Sciences. Isfahan, Iran.
4 MD, Medicine, General Healthcare Insurance Office in Isfahan. Isfahan, Iran.
Abstract
Introduction: Insurance considered as the main financial resource of hospitalsBut hospitals have disagreement with insuring organizations in some financial cases and usually they do not received all their insurance claims. The aim of current research was to review the causes of deductions in insurance bills in Seyed Alshahada hospital and suggest some suitable approaches.Methods: In this descriptive cross-sectional retrospective study, prescription information and records of patients referred to Seyed Alshahada Hospital (AS) in the second six months of 2007 were studied and information of patients with special diseases was extracted from. Sampling method was census records and during the study 4983 clinical prescriptions, 27238 paraclinical prescriptions and 3392 hospitalized case were investigated. Data was collected using a checklist which validity was confirmed by insurance experts and management specialists and analyzed by statistical and descriptive scales.Results: The highest prevalence and causes of deductions in clinical prescriptions was related to insurance organizations Komite Emdad (62%) due to confounding date. Next Rankings were Nirouhaye Mosalah, Tamin Ejtemaei and Khadamat Darmani insurances. The highest prevalence and causes of deductions in paraclinical prescriptions was related to insurance organizations Komite Emdad (45.3%) due to lack of prescriptions. Next Rankings were Nirouhaye Mosalah, Tamin Ejtemaei and Khadamat Darmani insurances.The highest prevalence and causes of hospitalization records deductions was related to Tamin Ejtemaei (74.4%) due to lock exorbitant. Next rankings were Khadamat Darmani insurance, Komite Emdad insurance and Nirouhaye Mosalah insurance.Conclusion: Most causes of outpatient deductions had direct correlation with organizational mistakes derived from hospital staff. In this field, educating physicians, nurses and other staff holding up in patients bill procedure seems to be necessary. On the other hand, the main cause for inpatient files as it was mentioned was due to extra demands, which did not count resources lose. Transparency of the deductions would reduce the disagreement between hospital and insurance organizations.Keywords: Insurance; Hospitals; Files; Inpatients; Hospital Records.
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