نوع مقاله : مقاله پژوهشی
نویسندگان
1 کارشناس ارشد، مدیریت خدمات بهداشتی درمانی، واحد الکترونیکی، واحد تهران، دانشگاه آزاد اسلامی، تهران، ایران
2 دکتری تخصصی، مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
چکیده
مقدمه: طرح تحول نظام سلامت به شیوه‌های مختلف بر فعالیت بیمارستان‌ها تأثیر می‌گذارد. با توجه به اهمیت کسورات بر درامد بیمارستان، پژوهش حاضر با هدف مقایسه کسورات صورت‌حساب‌های بیمه قبل و بعد از اجرای طرح تحول نظام سلامت در مرکز آموزشی- درمانی الزهرای (س) اصفهان انجام شد.روش بررسی: این مطالعه از نوع توصیفی- تحلیلی بود. داده‌های مربوط به کسورات بیمه‌ای 50288 پرونده بستری سال 1392 و 51699 پرونده بستری سال 1394 تحت پوشش بیمه‌های تأمین اجتماعی و خدمات درمانی مرکز آموزشی- درمانی الزهرا (س) به کمک گزارش‌های کارشناسان واحد فن‌آوری اطلاعات و گزارش‌های مالی سیستم اطلاعات سلامت در قالب فایل‌های الکترونیکی جمع‌آوری گردید و با استفاده از آزمون‌های t و Paired t در سطح معنی‌داری 05/0 مورد تجزیه و تحلیل قرار گرفت.یافته‌ها: نسبت کسورات به درامد بیمارستان در سال 1394 نسبت به سال 1392 کاهش معنی‌داری را نشان داد (010/0 = P). این کاهش در نسبت کسورات به درامد خدمات ویزیت، بیهوشی، جراحی، هزینه تخت و خدمات پاراکلینیک مشاهده شد. حجم خدمات پاراکلینیک، مشاوره، بیهوشی، جراحی و کل خدمات پس از طرح تحول نظام سلامت افزایش معنی‌داری داشت.نتیجه‌گیری: کسورات بیمه‌ای مرکز آموزشی- درمانی الزهرا (س) پس از اجرای طرح تحول نظام سلامت کاهش یافت. بیشترین افزایش کسورات در خدمات پاراکلینیکی بیمه تأمین اجتماعی مشاهده گردید. علت این امر را می‌توان به بالا بودن حجم اسناد این بیمه یا نامساوی بودن مراجعان تحت پوشش بیمه‌ها نسبت داد. با این وجود، بهتر است علل کسورات به تفکیک بیمه‌ها مورد بررسی قرار گیرد و راهکارهایی جهت کاهش کسورات بیمه تأمین اجتماعی ارایه گردد.
کلیدواژه‌ها
عنوان مقاله [English]
Comparison of the Deductions of Insurance Bills in an Education-Treatment Center in Iran before and after Health Care Reform
نویسندگان [English]
- Zahra Rostami 1
- Amir Ashkan Nasiripour 2
1 MSc, Health Services Management, Electronic Campus, Islamic Azad University, Tehran, Iran
2 PhD, Health Services Management, Department of Health Services Management, School of Medical Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, Iran
چکیده [English]
Introduction: Health care reform affects the hospital activities from various ways. According to the important effect of insurance bill deductions on hospitals revenue, this study was aimed to compare the deductions from the insurance bills of Alzahra hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, before and after of health care reform.Methods: This descriptive-analytic study was carried out by examining data about insurance bill deductions among 50288 and 51699 inpatient cases in 2013 and 2015, respectively, in Alzahra hospital covered by Social Security Insurance Organization and Health Services Insurance. To data collection, information technology (IT) staff reports and Health Information System reports were used and exported to electronic files. Data were analyzed using t and paired t tests at a significant level of 0.05.Results: The ratio of deductions to total hospital income significantly reduced in 2015 compared to 2013 (P = 0.010). This significant reduction was seen in visiting, anesthesia, surgery, bed-day costs, and para-clinic services. There was a significant increase in load of para-clinic, consulting, anesthesia, surgery, and total services.Conclusion: Insurance bill deductions in Alzahra hospital decreased after health care reform. The most rate of deductions referred to para-clinic services of Social Security Insurance Organization; that was because of great load of documents of this organization or inequity of patients covered by different insurers. But it is necessary to investigate the causes of insurance bill deductions according to insurance types to find approaches to reduce Social Security Insurance Organization bill deductions.
کلیدواژه‌ها [English]
- Deductions
- Insurance
- Hospitals
- Health Care Reform
- Iran
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