1- National Center for Health Insurance Research, Tehran, Iran , mr.rezaei@ihio.gov.ir
2- National Center for Health Insurance Research, Tehran, Iran
3- Department of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2- National Center for Health Insurance Research, Tehran, Iran
3- Department of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract: (40 Views)
Introduction: The implementation of nursing tariffs in Iran began in 2022 as a major health policy reform aimed at enhancing the professional status of nurses and improving payment equity. However, the extent to which this policy has been accompanied by fundamental changes in emergency department triage patterns, temporary admissions, and overall cost structure has not been systematically examined.
Methods: This descriptive–analytical study was conducted using secondary data extracted from the Iranian Health Insurance Organization database, covering the period from 2021 (1400) to 2024 (1403). The study population included all insured emergency department cases nationwide. Key variables comprised the number of temporary emergency department admissions (observation cases), the number of patients triaged at Emergency Severity Index (ESI) levels 1 and 2, and nursing tariff–related costs. Changes in these indicators before and after the policy implementation were analyzed, and cost figures were adjusted for health-sector inflation. Statistical analyses were performed using SPSS version 26.
Results: At the national level, the number of patients triaged at ESI levels 1 and 2 showed a dramatic increase, rising from 55,816 cases in 2021 to 544,289 cases in 2024, representing an approximately 9.75-fold increase. Concurrently, observation cases also increased substantially, from 1,765,742 to 2,728,398, a 1.5-fold rise. Paradoxically, after adjusting for inflation and expected cost growth, the average cost per case showed a reduction of up to 40%. Furthermore, a significant negative correlation was found between the density of emergency medicine specialists and the growth rate of ESI 1 and 2 cases across provinces.
Conclusion: The policy implementation, while addressing payment equity, has fundamentally shifted the registration pattern towards higher-acuity triage and observation cases. The simultaneous surge in case volume and the reduction in real average cost per case suggest that the policy influenced recording behavior without necessarily increasing the true financial burden proportionally. Strengthening oversight mechanisms and emphasizing specialized clinical supervision are crucial to mitigate unintended consequences and ensure the integrity of triage practices following this policy reform.
Methods: This descriptive–analytical study was conducted using secondary data extracted from the Iranian Health Insurance Organization database, covering the period from 2021 (1400) to 2024 (1403). The study population included all insured emergency department cases nationwide. Key variables comprised the number of temporary emergency department admissions (observation cases), the number of patients triaged at Emergency Severity Index (ESI) levels 1 and 2, and nursing tariff–related costs. Changes in these indicators before and after the policy implementation were analyzed, and cost figures were adjusted for health-sector inflation. Statistical analyses were performed using SPSS version 26.
Results: At the national level, the number of patients triaged at ESI levels 1 and 2 showed a dramatic increase, rising from 55,816 cases in 2021 to 544,289 cases in 2024, representing an approximately 9.75-fold increase. Concurrently, observation cases also increased substantially, from 1,765,742 to 2,728,398, a 1.5-fold rise. Paradoxically, after adjusting for inflation and expected cost growth, the average cost per case showed a reduction of up to 40%. Furthermore, a significant negative correlation was found between the density of emergency medicine specialists and the growth rate of ESI 1 and 2 cases across provinces.
Conclusion: The policy implementation, while addressing payment equity, has fundamentally shifted the registration pattern towards higher-acuity triage and observation cases. The simultaneous surge in case volume and the reduction in real average cost per case suggest that the policy influenced recording behavior without necessarily increasing the true financial burden proportionally. Strengthening oversight mechanisms and emphasizing specialized clinical supervision are crucial to mitigate unintended consequences and ensure the integrity of triage practices following this policy reform.
Type of Study: Short Communication |
Subject:
Special
Received: 2025/09/16 | Revised: 2026/06/6 | Accepted: 2026/05/31
Received: 2025/09/16 | Revised: 2026/06/6 | Accepted: 2026/05/31
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