Showing 8 results for Insurance
Roohollah Askari, Hamid Reza Dehghan, Mohammad Amin Bahrami, Fatemeh Keshmiri,
Volume 9, Issue 3 (2-2011)
Abstract
Background: The hospitals are the most significant providers of health care services. According to more health funds spending by hospitals, economic management in hospitals is necessary. Determining the causes and rates of insurance under reimbursement bills was the objective of this study.
Materials and Methods: This research is a descriptive cross-sectional survey was done in 2008. The samples of study were the al records' patients who undertaken of social security insurance system in the teaching hospitals of Shahid Sadoughi University of Medical Science. The data complied in SPSS 16 software and then analyzed.
Results: In this study, 9.8% cases of all hospitalization bills were deducted. The highest rates of under reimbursement bills was in Afshar hospital (12.7%), followed by burn hospital (12.5% ), Shahid Sadoughi hospital (10%), and Shahid Rahnemoon hospital (8.2%). The highest rates of under reimbursement bills imposed to the surgeon fees (28.4%), treatment fees (15.06%), and medicine (14.3%) costs. However assistant surgeon fees had no under reimbursement. The most important causes of under reimbursement were defects in the insurance records of patients and noncompliance with insurance organization regulations.
Conclusion: Training of human resources and optimized use of hospital information systems could be helpful to hospitals for reducing insurance reimbursement to ultimately improve hospitals to financial statements.
M Soofi, M Bazyar, A Rashidian,
Volume 11, Issue 3 (10-2012)
Abstract
Background: Insurance coverage has a tendency to alter the consumer and provider's behavior. Moral hazard is a serious problem in all risk pooling systems, such as insurance and taxes-based financial systems that cause negative consequences as increased costs in the health system. Therefore we decide, at this review article, to discuss about moral hazard, in different classifications and effects on the insurance marketing and health system.
Materials & Methods: This is a review article. Relevant materials selected from published articles, studies, and sites. The databases of Medline, Web of Science, Science Direct, Google Scholar, and Springer were explored to use the key words of moral hazard and health insurance.
Results: Insurance covered individuals, knowing that their health expenditures will be reimbursed by insurance in the time of illness, and their demand medical services are more than un insurance covered individuals. On the other hand the providers have financial incentive to provide unnecessary and excess medical services. Different types of moral hazard like as ex ante and ex post moral hazard hidden information and hidden action moral hazard provider and consumer moral hazard may arise due to insurance coverage. These lead to negative consequences such as consumption of unnecessary care services, alteration of consumption pattern for inefficient use of resources, welfare loss, and an increase in the health expenditures.
Conclusion: Studying and controlling the effects of moral hazards seems necessary to prevent unwelcome outcomes as well as misallocation of financial resources.
F Ebadifard Azar, A Rezapour, A Rahbar, P Abbasi Broujeni,
Volume 11, Issue 3 (10-2012)
Abstract
Background: Increasing the receivables collection period make problems in the payment of personal salaries, medicine fees & facilities under surveillance centers. It finally has negative effects on delivered services. At present economic circumstances, paying attention to liquidity and its present value is very important to doing economic activities and to decreasing receivables collection period. The aim of the study was calculating the receivables collection and turnover period in selected hospital of the Qom University of Medical Sciences.
Materials & Methods: This is a descriptive research that conducted in the selected hospital of Qom university of medical sciences during the fourth national development program (2005-2009). Data was Collected from information based on the financial documents of the kamkar hospital and registered into information sheets and analyzed by excel software.
Results: Results show that during the fourth national development program , Receivables turnover has gradually decreased and unlike thereceivables collection period increased. Both of these relations showed an undesirable circumstances and graving with the contracting insurance companies in the payment of their obligation with the hospital.
Conclusion: Findings indicated that the receivables collection period of insurance companies takes Long and taken a long way from its normal .It needs a serious monitoring & intervention in the large scale decision making, except by using the power of law during the fourth development national program which it hasn 't a good impact in repayment approach of the policy makers in this issue that expected all of the general managers in the giving of services.
Sh Nosratnejad , A Purreza , M Moieni , H Heydari ,
Volume 13, Issue 2 (8-2014)
Abstract
Background: Nowadays Social health insurance does not cover all health expenditures because of increasing cost of diagnosis and treatment services which results in private insurer entry to health market. This study is aimed to determine key indicators which have important effect on the demand for private health. This identification of indicators leads to better planning for prospering private health insurance.
Material & Method: This is a a descriptive and analytical study. The data were collected by questionnaires which has been filled by a sample of 950 households .The samples had been chosen by three-stage cluster sampling. The model had been estimated by econometric methods based on models of Probit and extreme value distribution..
Result: The result indicated that having basic health insurance, doing exercise each day routinely, having regular medical checks, being landlord and being retired raised the probability of demand for private health insurance. On the other hand, demanding private health insurance is less common among older adults and people who use to wear seat belts.
Conclusion: Identification of important factors which influence the demand for private health insurance would assist policy makers to provide essential structures for expanding private health insurance coverage.
Mohammad Javad Kabir , Nahid Jafari , Mohammad Nahimi Tabihi, Ebrahim Mikaniki , Hasan Ashrafian Amir, Seiyed Davoud Nasrollahpour Shirvani, Araslan Dadashi , Ghasem Oveis ,
Volume 14, Issue 2 (8-2015)
Abstract
Background: One of the key duties of family physician is to form health records and provided recording services. This study conducted to form health records and aevaluate health records in family physician program in Northern Province of Iran.
Materials and Methods: This cross-sectional study was carried out in second half 2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected using systematic random sampling, and assessed performance recording of all family physicians. A self- designed questionnaire was used which the validity and reliability of were confirmed. Data were analyzed by SPSS18 at the significant level of p<0.05.
Results: Out of the 189 assessed family physicians, the profile of patients referred to the second level and its results were recorded in referral record forms by 43 physicians. Out of 1890 studied families, 1559 families had health record which had filled 892(57%) health record completely. Out of 5869 assessed family members, 4229 patients were examined periodically by their family physician at least once and 1919(46%) results filled entirely. during 559 were reported with health records, among which 892 were filled out completely. There was a significant difference between referral record rates to registered specialist between the Northern Province of Iran (P=0.001).
Conclusion: The quantity and quality of health record formation was not in the expectation level as well and appropriate interventions are needed.
Dr Alimohammad Mosadeghrad, Mahnaz Afshari, Rahman Nasrolahi, Sareh Daneshgar, Rasoul Corani Bahador ,
Volume 17, Issue 2 (9-2018)
Abstract
Background: Insurance companies sometimes do not reimburse hospitals completely. Reducing the amount of deduction of bills increases hospital’s income and efficiency. This study compares the deductions imposed by social insurance organization on Imam Khomeini hospital’s bills before and after the implementation of health transformation plan.
Material and Methods: Data of this descriptive-descriptive study calculated from the deductions applied to the hospital of outpatient and inpatient bills of social insurance organization in second six months of 2013 (before implementation of health transformation plan) and the same time of 2014 (after implementation of of health transformation plan). This quasi experimental study was conducted using the data. Data was analyzed by SPSS software using paired t test.
Results: The bill deductions in the second six months of 2013 compare to the same time in 2014 were 2.9 and 11.1 percent, respectively. Hospital bill deductions increased 282.8 percent after the health transformation plan implementation. The deductions on inpatients and outpatients records increased 6 and 12 times, respectively. Most deduction was imposed on surgical and laboratory bills in 2013 and on radiotherapy, chemotherapy and hoteling bills in 2014.
Conclusion: Deductions of hospital bills extremely increased from social insurance organization after implementation of health transformation plan. In order to identify deductions causes, providing related education to staff and physicians and relative process improvement are necessary.
Ebrahim Jaafaripooyan, Batoul Ahmadi, Baheshte Ebrahimi,
Volume 20, Issue 3 (12-2021)
Abstract
Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.
Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.
Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.
Conclusion: The abuse in the health service provision is a high risk for health care managers in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.
Ebrahim Hasanzadeh, Hasan Aboulghasem Gorji, Aziz Rezapour, Mani Yousef Vand,
Volume 22, Issue 2 (9-2023)
Abstract
Background and purpose: Supplementary health insurance plays a pivotal role in the health economy and individual payments, enhancing access to health services and improving individual quality of life. This study aims to explore the challenges and strategies for developing supplementary health insurance.
Methods: This systematic review examined research related to the challenges and strategies for the development of supplementary health insurance in various countries, focusing on articles published in the last five years in both domestic and international databases. For each article, a data extraction form was completed, and the data were subsequently classified, summarized, and analyzed.
Results: Seventeen articles met the study's inclusion and exclusion criteria and were analyzed. The main challenges and strategies for developing supplementary health insurance were identified across seven primary themes: premium and financing, electronic infrastructure, quality improvement, moral hazards and adverse selection, cost-effectiveness and efficiency, evidence-based decision-making, and effective awareness and advertising.
Conclusion: Considering the numerous identified challenges and barriers in the development of supplementary health insurance, it is recommended to focus on creating electronic infrastructures and necessary platforms to enhance and develop policies in supplementary health insurance, particularly in the dimensions of service packages, cost-effectiveness, and efficiency
