Showing 2 results for Insurer Organizations
N Nasiriad, A Rashidian, H Joodaki , F Akbari Haghighi, M Arab,
Volume 9, Issue 1 (9-2010)
Abstract
Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals.
Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data.
Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.
Saeide Alidoost, Dr Aziz Rezapour, Rahim Sohrabi, Roghayeh Mohammadibakhsh, Dr Ali Sarabi-Asiabar, Narges Rafiei,
Volume 18, Issue 1 (5-2019)
Abstract
Background: The hospitals' reliance on insurer organizations' resources is increasing due to the growing number of insured persons. However, a relatively large share of these revenues cannot be collected for various reasons and is considered as hospital deductions from revenue. Hence, this study aimed to investigate the causes of hospital deductions from revenue and strategies to reduce them in hospitals affiliated to Iran University of Medical Sciences.
Materials and Methods: This qualitative study was conducted based on the phenomenological approach in 2017. Data was collected through semi-structured interviews consisting 17 finance experts in hospitals. Data analysis was performed using MAXQDA version10 and analytical framework of Gale et al. (2013).
Results: Based on the framework analysis, two themes were identified as the underlying causes of hospital revenue deduction including direct causes and root causes of revenue deduction. Also, in order to reduce revenue deduction strategies, eight themes were recognized including interaction with insurance organizations; analysis, assessment, and feedback on revenue deficit; coordination and empowerment of employees; proper organization of human resources; strengthening regulatory system, motivational strategies; good planning and creating an organizational structure.
Conclusion: The revenue deductions occur in all stages of converting services into income and the most important factor is lack of staff awareness and incentive to control deductions. Contributions of all process owners in the hospital and insurers and in particular the commitment of hospital’s senior managers are necessary to control the deductions.
