Volume 3, Issue 4 (12-2020)
Iran J Health Insur 2020, 3(4): 254-263 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Kavian Telouri F, Heidari A, Abbasi A, Kabir M J, Badakhshan A, Khatirnamani Z. Investigation the Referral Burden and Costs of Hospitalization Patients Covered by the Rural Insurance Fund Before and After the Implementation of the Referral System Program. Iran J Health Insur 2020; 3 (4) :254-263
URL: http://journal.ihio.gov.ir/article-1-161-en.html
URL: http://journal.ihio.gov.ir/article-1-161-en.html
Fatemeh Kavian Telouri1 
, Alireza Heidari * 2, Anis Abbasi1 , Mohammad Javad Kabir1 , Abbas Badakhshan1 , Zahra Khatirnamani1
, Alireza Heidari * 2, Anis Abbasi1 , Mohammad Javad Kabir1 , Abbas Badakhshan1 , Zahra Khatirnamani1
1- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
2- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran , alirezaheidari7@gmail.com
2- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran , alirezaheidari7@gmail.com
Abstract: (3036 Views)
Introduction: Measuring and monitoring health costs will help health system policy makers choose appropriate policies to protect patients. The purpose of this study was to investigate the referral burden and cost of hospitalized patients covered by the Rural Insurance Fund before and after the implementation of the referral system program in Golestan province, Iran..
Methods: A cross-sectional descriptive study was performed based on the information of the first six months of 2017 and 2018 of all patients admitted to health insurance in all hospitals of Golestan province. The information systems and existing documents of the General Directorate of Health Insurance were used to collect data.
Results: Compared to 2017, the number of hospitalizations of health insurance policyholders in the public sector in 2018 in total funds and rural funds decreased by 13 and 10 percent, respectively, and in the private sector, in all funds and rural funds decreased by 39 and 98 percent, respectively. The cost of hospitalization of health insurance policyholders in the public sector in total funds and rural funds decreased by 13 and 12 percent, respectively, and in the private sector by 24 and 99 percent, respectively. This reduction in referral burden and hospitalization costs in the public and private sectors in rural and public funds and in all funds has been significant (P <0.05).
Conclusion: According to the findings, in order to reduce the demand for hospitalization, it is recommended that the guidelines of the rural family physician program and the referral system at level one be fully implemented. By increasing the facilities and physical capacity of services in level one and providing comprehensive and timely services that continue in level two, the induced demand created in patients' hospitalization should be prevented.
Methods: A cross-sectional descriptive study was performed based on the information of the first six months of 2017 and 2018 of all patients admitted to health insurance in all hospitals of Golestan province. The information systems and existing documents of the General Directorate of Health Insurance were used to collect data.
Results: Compared to 2017, the number of hospitalizations of health insurance policyholders in the public sector in 2018 in total funds and rural funds decreased by 13 and 10 percent, respectively, and in the private sector, in all funds and rural funds decreased by 39 and 98 percent, respectively. The cost of hospitalization of health insurance policyholders in the public sector in total funds and rural funds decreased by 13 and 12 percent, respectively, and in the private sector by 24 and 99 percent, respectively. This reduction in referral burden and hospitalization costs in the public and private sectors in rural and public funds and in all funds has been significant (P <0.05).
Conclusion: According to the findings, in order to reduce the demand for hospitalization, it is recommended that the guidelines of the rural family physician program and the referral system at level one be fully implemented. By increasing the facilities and physical capacity of services in level one and providing comprehensive and timely services that continue in level two, the induced demand created in patients' hospitalization should be prevented.
Keywords: Referral, Referral Burden, Inpatients, Hospitalization Costs, Health Insurance Organization, Rural Insurance Fund
Type of Study: Research |
Subject:
Special
Received: 2020/10/9 | Revised: 2021/04/20 | Accepted: 2021/02/5 | ePublished: 2021/03/3
Received: 2020/10/9 | Revised: 2021/04/20 | Accepted: 2021/02/5 | ePublished: 2021/03/3
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
