Volume 3, Issue 2 (8-2020)
Iran J Health Insur 2020, 3(2): 138-144 |
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Rahmani K, Riaziat A, Farshid A, Rezayatmand R. Cost Control Solutions in the Most Expensive Laboratory Services of the Health Insurance Organization. Iran J Health Insur 2020; 3 (2) :138-144
URL: http://journal.ihio.gov.ir/article-1-128-en.html
URL: http://journal.ihio.gov.ir/article-1-128-en.html
1- Student Research Committee, Faculty of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2- National Center for Health Insurance research, Tehran Iran
3- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
4- Health Management and Economic research center, Isfahan University of Medical Sciences, Isfahan, Iran ,r.rezayatmand@mng.mui.ac.ir
2- National Center for Health Insurance research, Tehran Iran
3- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
4- Health Management and Economic research center, Isfahan University of Medical Sciences, Isfahan, Iran ,
Abstract: (4384 Views)
Introduction: The increasing demand for health services has made the health system constantly faced with inconsistent challenges of improving performance and cost control. The prerequisite for taking appropriate cost control measures is a detailed description of the situation. The aim of this paper is to identify the most expensive outpatient laboratory services covered by the Health Insurance Organization and cost control strategies.
Methods: This study was a cross-sectional descriptive study that was done in 2017 based on data from 2015. Laboratory cost data were obtained from the Medical Records System of the Provincial Health Insurance Offices of the whole country and analyzed using Excel 2013 software. Chiefs of provincial Medical Records Bureau and responsible experts were asked to propose cost-cutting interventions pertaining to identified the costliest services. Suggested interventions were reviewed and after excluding duplicates, they were categorized as specific interventions for each service and non-specific interventions.
Results: The most costly outpatient laboratory services accounted for approximately half of the costs of the Iranian Health Insurance Organization. TSH measurement tests, blood cholesterol, CBC and vitamin D levels are at the top of the costly lab services. The most important cost control interventions include family physician and referral system implementation, monitoring of physicians and Para clinical centers, insurance aggregation, observing costly centers, preparing performance reports to physicians, empowering insureds and creating electronic health records.
Conclusion: It is suggested that appropriate policies regarding the strategies proposed here by insurance organizations and the Ministry of Health and Medical Education need be taken into consideration in order to more effectively control and manage the rising costs of health services.
Methods: This study was a cross-sectional descriptive study that was done in 2017 based on data from 2015. Laboratory cost data were obtained from the Medical Records System of the Provincial Health Insurance Offices of the whole country and analyzed using Excel 2013 software. Chiefs of provincial Medical Records Bureau and responsible experts were asked to propose cost-cutting interventions pertaining to identified the costliest services. Suggested interventions were reviewed and after excluding duplicates, they were categorized as specific interventions for each service and non-specific interventions.
Results: The most costly outpatient laboratory services accounted for approximately half of the costs of the Iranian Health Insurance Organization. TSH measurement tests, blood cholesterol, CBC and vitamin D levels are at the top of the costly lab services. The most important cost control interventions include family physician and referral system implementation, monitoring of physicians and Para clinical centers, insurance aggregation, observing costly centers, preparing performance reports to physicians, empowering insureds and creating electronic health records.
Conclusion: It is suggested that appropriate policies regarding the strategies proposed here by insurance organizations and the Ministry of Health and Medical Education need be taken into consideration in order to more effectively control and manage the rising costs of health services.
Type of Study: Research |
Subject:
Special
Received: 2020/02/20 | Revised: 2020/09/19 | Accepted: 2020/08/31 | ePublished: 2020/09/19
Received: 2020/02/20 | Revised: 2020/09/19 | Accepted: 2020/08/31 | ePublished: 2020/09/19
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