Tehran University Medical Journal

Background: Tariff setting in healthcare is an important control knob affecting the quality, access and cost of services. As part of Iran Health Transformation Plan (HTP) in 2014, the relative value of health care and services was increased to motivate healthcare providers to deliver high quality services. This study aimed to examine the impact of HTP on health services tariffs.
Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared.
Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average.
Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.

Background: The new version of relative values of diagnostic medical services was published in 2014. It was criticized that the previous edition was suffering from an imbalance between relative values related to various specialties and sub-specialties. The main aim of the new edition of the book was to address this problem by providing more balance relative values related to various specialties and sub-specialties. So far, there have not been studies to analyze to what extent the new addition has been succeeded to reach its main goals. The aim of this study was to provide a cross-specialty analysis of the new edition of Iranian relative values for physicians. To our knowledge, this analysis has been performed for the first time in Iran.
Methods: Having reviewed description for each relative value, each of them has been assigned to one or more corresponding specialty or subspecialty. Only relative values for surgical operations were considered and finally 3238 procedures have been recognized to be included in the analysis. The latest version of Iranian relative values for physician was considered for this analysis. In order to compare the average relative values among various specialties and subspecialties, analysis of variance (ANOVA) and Tukey's post-hoc test was used.
Results: Oral and maxillofacial surgery and neurosurgery get the highest (62.81, 60.47 (P<0.001)) and ophthalmology and obstetrics and gynecology get the lowest (28.95, 28.81 (P<0.001)) average relative value. Cardiovascular surgery and plastic surgery get the highest and the lowest (85.25, 50.51 (P<0.001)) average among subspecialties, respectively.
Conclusion: The average relative values are significantly different among specialties and subspecialties. Seeing the difference, itself sounds logical as the job of relative values are to make a difference based on various criteria such as the time and skill needed for each operation, the potential risk for patient and provider it may have, etc. The results of this study provide evidences on how much these differences are. However, if these differences are as there should be needs to be analyzed by further research.