[Home ] [Archive]   [ فارسی ]  
:: About :: Current Issue :: Archive :: Search :: Submit :: Contact ::
:: Volume 3, Issue 2 (Summer 2017) ::
hbrj 2017, 3(2): 141-150 Back to browse issues page
Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study
Neda Vali pour , Seyed masud Mosavi negad , Zahra Meshkani
Abstract:   (399 Views)
Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study
 
Vali-pour Neda1, Mosavi-nejad Seyed Masoud2, Meshkani Zahra3*
 
1. Msc, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2. Medical Doctor, AJA University of Medical Sciences, The Boss of Hospital, Tehran, Iran
3. PhD Student, Health Management and Economic Research Center, Iran University of Medical Sciences, Faculty of Management and Medical Information, Tehran, Iran
*Correspondence: Health Management and Economic Research Center, Faculty of Management and Medical Information, In Front of Khatam-Ol-Anbiya Hospital, Yasemi st, after Mirdamad Blv, Valiasr st, Vanak square, Tehran, Iran.
Tel: 021-88671615                                                                                     Email: z_moshkani@yahoo.com
Abstract:
Background & Objectives:
Deductions applied by insurance companies on sent bills affect the income of hospitals. If hospitals do not pay attention to this issue, it is probable that they do not receive the costs that they have paid even for the provided services.
Methods: In this retrospective descriptive study conducted in one of the armed forces hospitals in Tehran in 2015, 6717 medical files belonged to the admitted cases were investigated. The list of reported deductions for admitted cases was prepared using a self-made form that included deduction topics (surgery, anesthesia, services, imaging, laboratory, supplies and equipment, beds, visit and counseling).
Results: The highest rate of deduction was due to the additional request for surgery and anesthesia (30% of total deduction). The highest rates of return were respectively related to request lower than tariff rate (78%) and absence of recording services related to surgical activities (17%) and operating room and anesthesia (5%). After identifying these cases, a total of 3270 million Rial was returned to the financial resources of hospital.   
Conclusion: Some strategies for reducing deductions are transferring affairs related to the registration and identification of outpatient services to the authorities of the units, establishing a system for collecting the experience of personnel and transferring them to the insurance organizations, creating a system for receiving the suggestions and ideas of employees, establishing interactions with the authorities of the contracting  insurance companies, having physicians to record  correct codes of surgery and services as well as establishing deduction committees.
 
Key­words: Deduction, Insurance, Armed Forces, Hospital
 
­Citation: Vali-pour N, Mosavi-nejad SM, Meshkani Z. Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study. Journal of Health Based Research 2017; 3(2): 141-150.

Keywords: Deduction, Insurance, Armed Forces, Hospital
Full-Text [PDF 891 kb]   (123 Downloads)    
Type of Study: Applicable | Subject: Special
Send email to the article author

Add your comments about this article
Your username or Email:

Write the security code in the box >


XML   Persian Abstract   Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

vali pour N, mosavi negad S M, meshkani Z. Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study. hbrj. 2017; 3 (2) :141-150
URL: http://hbrj.kmu.ac.ir/article-1-173-en.html


Volume 3, Issue 2 (Summer 2017) Back to browse issues page
نشریه پژوهش های سلامت محور Journal of Health Based Research
Persian site map - English site map - Created in 0.05 seconds with 31 queries by YEKTAWEB 3701