Showing 68 results for Health Insurance
Taher Mohebati,
Volume 1, Issue 1 (7-2018)
Abstract
Morad Nasri, Ali Shojaee,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: The culture of prescribing and drug usage as a strategic commodity, which plays a fundamental role in the economy and health of the family and society, is an important issue that should be addressed by health system policymakers.
Methods: The present study is a cross-sectional prevalence survey of all medical prescriptions of insured persons in a health insurance organization which were accepted and registered in the medical documentation system in the contract pharmacies with health insurance departments in all provinces of the country in the medical records system during 2014 and 2014.
Results: 80% of health insurance expenditures have been consumed by 93.84% in 2014 and 94.88% in 2015 year. An average amount of medicine in 2014, and 2015 years, were respect, 226 and 185 number. In all provinces, 30 to 40 percent of drug costs have been consumed by 30 drugs in each of both years.
Conclusion: Control and monitoring this amount of drug items can optimize 80 percent of pharmaceutical costs in each province and at the level of the health insurance organization. Considering, if each province controls its first 30 medicines, it will lead to optimize about 40% of its pharmaceutical costs.
Ezzatollah Gol-Alizadeh, Amir Pirouzian, Mohammad Reza Jabbari,
Volume 1, Issue 1 (7-2018)
Abstract
The growing diversity of health services, which often costs a lot, and the inability of governments to provide benefits to citizens. in all areas of health, clearly show the need for the presence and development of complementary health insurance in the health market. Private supplementary health insurance is usually provided in bulk, voluntarily, and extendable until the end of life. The purpose of this study was to provide solutions to improve the quality of complementary health insurance services and reduce government dependence. The supplementary health insurance function dedicate the second rank of the nongovernmental insurance market also, with the growth of 34.6% is the second highest growth rate in 2015. The coefficient of damage in this sector with 86.1% indicates its profitability in this year. By reviewing the patterns and models presented in the studies, in order to improve the level of health and complementary insurance, solutions were presented in 20 clauses. According to the present study, it is recommended to offer various insurance packages considering the age, gender, health status of individuals, geographical status, literacy level, income level, employment status etc.
Azam Sadat Rivandi, Ebrahim Jafari Poyan,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: Monitoring the quality of services in the insurance service purchase can be crucial for improving patients' satisfaction, avoiding unnecessary referral to health centers and Subsequent expenditure, and imposing them on insurance. This study aimed to evaluate the quality of public health clinic services.
Methods: This cross-sectional study was performed in Tehran during 2015, 2016 years. The research population consisted of patients referred to general practitioners in Tehran. A multi-stage cluster method was used for sampling. Overall, 394 samples were obtained from patients referred to general practitioners were included in the study. Researcher-made questionnaire was the data collection method. The questionnaire was prepared based on interviews with experts. The collected data were analyzed statistically using SPSS 22 software.
Results: Based on the results of the research, the quality score of the clinics from 125 to 160 defined in the high range and the importance of quality dimensions from the viewpoint of patients from 131 to 160 were placed in the high range as well. Examining the service quality dimensions indicated, access point (85.5%) and then effectiveness (85.3%) were earned the highest score. Moreover, the effectiveness was earned the highest score in terms of importance. The results showed, a significant relationship between income level and questions of importance. It seems that, quality items are considered different for people according to their income.
Conclusions: Findings of this study indicate that, patients referring to general practitioners high-rated the received services' quality. The results of this evaluation can lead to improvement in the quality of services and reduce the burden on visits for insured persons and also reduce charges imposed on duplicate visits. Besides, it can lead to active purchasing for the health insurance organization.
Hamid Ghasemi Barghi, Babak Aali, Farhad Azimi,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: Identifying the extent of misuse of health services in hospitalization is the first step in implementing health control and restriction programs without damage to the quality of these services. This study was carried out in Valiasr Hospital of Meshkin shahr City with the aim of assessing the rate of admission and unnecessary hospitalization of insured persons and the amount of expenses incurred by this phenomenon to the health insurance organization.
Methods: This cross-sectional study was conducted in July 2016 in Valiasr Hospital in Meskine Shahr. The statistical population in this study was composed of all insured persons covered by the health insurance organization from all the funds referred to the hospital at the time of the study. Overall, 330 samples were selected for sampling in this study. An appropriateness Evaluation Protocol (AEP) was used for data collection.
Results: The results obtained showed that, 56.33% of the insured persons (186 men) and 43.7% of the insured persons were hospitalized (144) were women. From the total of 330 evaluated admissions, 129 cases (39%) were inexpedient, with the highest inexpedient acceptance in the internal ward with 66% and the lowest uncontrolled acceptance was in the surgical ward with a 12% rate. In 2016, the health insurance organization paid 6,133,840,000 Rials for unplanned days of admission in these three parts.
Conclusions: According to the results of this study, the AEP protocol has a good reputation for evaluating of admission and hospitalization days. The health insurance organization and other insurer organizations are essential to reduce and optimize the number of admissions and inexpedient hospitalization days by applying the AEP protocol as a regulatory tool for evaluating hospital admissions documents.
Ali Shojaee, Seyed Mosoud Shajari Pourmosavi, Mohammad Mehdi , Reza Moradi, Sanaz Taghizadeh, Elnaz Kalantari,
Volume 1, Issue 1 (7-2018)
Abstract
Introduction: Health system reforms are designed and implemented according to the situational conditions of each country. Recently health reforms have focused on resources and costs in the health sector for governments; they would be as the tools for making the necessary changes and improvements. Governments have designed and implemented health reforms step by step to completing the coverage of health services in terms of geographic accessibility, service affordability, and avoiding health impoverishments, catastrophic poverty from the use of health services in recent two decades. Objectives other than completing public coverage, improving quality and the quality of health services and care, and the logical reduction in costs and the optimal use of resources. Objectives other than completing public coverage, improving quality The quality of health services and care has not had a reasonable reduction in costs and the optimal use of resources. Comparing the spending costs of hospitalization in the years before and after the Iranian Healthcare Reforms Plan in 2014 has could show that the efficiency and cost of spending. This study seeks to examine the average cost of each hospitalization case in the years before and after the Iranian Healthcare Reforms Plan to compare the impact of the costs on health insurance funds.
Methods: The present study was a cross sectional study. The population of the study has included the sum of the inpatient bed day of health insurers admitted in hospitals of in 31 provinces over the past 5 years from 2010 to 2015. In this study, survey was being conducted, and accessible data resources in the databases were used for data collecting process and analyzing. The analysis has been conducted by using Excel 2010.
Results: The highest of growth rate of the cost of inpatient bed day of health insurers in the first year of the Iranian Healthcare Reform Plan was Included respectively to the rural fund (88.4%), governmental employees fund (75.2%), self-employed fund (73.17%) and other populations fund (73.10%), and the self-employed fund shown third ranking in growth rate, although growth rate of the cost spending in all funds was more than 73%. In the first year of Iranian Healthcare Reform Plan has shown more inpatient costs growth rate than 73 percent’s for all the Iranian Health Insurance Funds.
Conclusion: The average of total inpatient spending cost has increasing trend in all funds of Iran Health Insurance and if there is not be a serious review of the Reform Plan, the health insurance organization may been faced serious financial problems. Therefore, by reviewing the Reform plan, it is possible to improve the plan as well as to ensure health insurance regarding sustainability of financial resources.
Efat Mohamadi, Taraneh Yousefinezhadi, Ali Hassanzadeh, Mojtaba Atri, Mohammadreza Mobinizadeh, Zahra Goudarzi, Sara Mohamadi, Alireza Olyaeemanesh,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: Implementation of the Health Transformation plan (HTP) has had many effects so far. The analysis of these impacts can help policymakers and planners to continuously improve the health system's ultimate goals. Considering that, health financing is one of the most impressive of health system functions from the HTP, the present study examines the effect of the HTP on supplementary health insurance as part of financial providers in the health system in Iran.
Methods: This is a descriptive study carried out using secondary data in 2017. Data were gathered using information systems of health insurance organizations and the statistical yearbook of central insurance of the country. Data analysis was performed using Excel and SPSS software. To analyze and report these data, descriptive statistics and analytical tests were used.
Results: The effect of the HTP on the share of health care providers has shown that in private financing, the share of households is the highest, and during the period 2002-2004, the average share of households from the total private sector share was 86.5%. During the period of 2002-2003, the share of the domestic government as the public sector was 54% on average. Findings in relation to supplementary health show that the net loss has been ascending and premium rate has been increasing.
Conclusions: The share of households in health expenditures has decreased since the implementation of the HTP, but the average pocket spending in the public and private sector has not decreased by more than 10%. The goal of creating competition and improving the quality of the public sector with the private sector and increasing the incentive for people to go to the public sector has largely been met by changing the frequency of contributions made by the financiers. In the long run, with the continuation of the implementation of the health system reform plan and the elimination of the way in which supplementary health insurers benefit from health subsidies, a high percentage of supplementary health insurance funds in the private sector is consumed, while it is better to adopt measures for the use of this resource in the public sector.
Zhaleh Abdi, Iraj Harirchi, Mahshad Goharimehr, Elham Ahmadnezhad, Rezvaneh Alvandi, Elham Abdalmaleki,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: One of the most important measures to ensure achieving Universal Health Coverage (UHC) is expanding health insurance coverage to all population. Accordingly, the present study was conducted with the aim of investigating the effect of having health insurance on the utilization of outpatient services provided by physicians using the data of the utilization of health services survey (2015).
Methods: This study is a secondary analysis of the utilization of health services survey data that was conducted in two groups of the insured and uninsured to examine the differences between these two groups in outpatient healthcare utilization provided by physicians. The variables were insurance status as an independent variable and the number of physician visit as a dependent variable. This analysis was disaggregated by place of residence and income.
Results: The visit per capita for outpatient services was lower in all uninsured groups. The visit per capita in insured people was almost two times more than that of uninsured individuals, which was 4.25 and 2.61 among insured and uninsured individuals, respectively. Therefore, the lack of basic health insurance decreased the utilization of outpatient services by 50 percent. General physician visits per capita for insured people living in urban and rural areas were 11.2 and 0.35, respectively.
Conclusions: Based on the results of this study, the visit per capita is directly related to the insurance status of the individuals. Therefore, it is necessary to ensure the equity in utilization of outpatient services provided by the physicians among various groups of population.
Ali Akhavan Behbahani, Saeedeh Alidoost, Iravan Masoudi Asl, Maryam Rahbari Bonab,
Volume 1, Issue 3 (12-2018)
Abstract
Introduction: The health insurance organizations in Iran are an important part of the health system. However, they are not conscious to many unnecessary costs incurred by providers and recipients, and the health system suffers from a lack of an efficient health insurance system. Therefore, it is essential to assess the performance of insurers and implement appropriate measures. This study aims to investigate the performance of Iranian health insurance organization and present solutions to the challenges.
Methods: This study employed an explanatory sequential mixed method. The quantitative part of the research is a descriptive cross-sectional study and the qualitative section is conducted through qualitative content analysis. Quantitative data were collected by a researcher-made tool and analyzed based on descriptive statistics. For the qualitative section, the focus group discussion method was used for collecting data.
Results: Quantitative results show an increase in the population covered, especially in Self-employed fund, and increase in the number of contracting providers except physicians and dentists. The analysis of indicators related to utilization of health services indicates that the distribution of health facilities varies in different provinces which Sistan and Baluchestan Province has the lowest ranking. Also, financial indicators show that overhead costs and medical expenses of health insurance organization have been rising significantly since 2014. The analysis of qualitative data led to identification of three themes including: factors affecting budget deficit, suggested solutions for health insurance organization and suggested solutions for the health system. Based on the findings, the increasing of tariffs, population covered and benefit packages coverage are the most important factors in increasing costs, which strategic purchasing and revising of basic benefit package can play a significant role in meeting challenges.
Conclusions: In recent years, the population covered by the health insurance organization and the number of contracting providers have risen, and the utilization of health services has increased. On the other hand, the costs of this organization experiencing a significant increase for various reasons. Therefore, it is vital to design and implement appropriate strategies to manage the costs.
Mohammadreza Rezaee, Saeid Daei Karimzadeh, Mehdi Fadaei, Akbar Etebarian,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: The Iran Health Insurance Organization (IHIO) was established to develop the Iran Health Insurance Sector. Currently, this organization lacks the adequate funding and faces challenges in providing the required resources due to the imposed unilateral sanctions; therefore, it is necessary that this organization take proper measures within the framework of state policies regarding the resilience economy in order to finance itself and cover more population in accordance with the Iranian operating laws. The objective of the present study was to propose a financing model for the IHIO based on the resilience economy.
Methods: This was a qualitative study based on the Grounded Theory (GT), and the data were collected from framework documents, open and in-depth interviews, and a review of the lectures given by 31 experts. The validity was first examined by the interviewees and then approved by the experienced professors. The reliability was determined to be 73% via process auditing. The data were analyzed through a GT-based methodology and constant comparison over three stages of open, axial, and selective codings.
Results: The examination of the qualitative date revealed that there are many factors in action in the IHIO’s financing process and this organization needs to review and revise its structure and methodology. Taking into consideration the current sanctions and lack of funds, the IHIO should change the following seven components within the framework of notified resilience economy policies: organizational management, financial management, research, structural change, cultural revision, and regulatory procedures.
Conculsions: There has been a remarkable increase in the IHIO’s insured parties recently, and more people have been receiving healthcare services. Thus, it is highly essential to propose a model to change the IHIO’s approach towards commercialization and make it produce more revenues and finance in accordance with the current economic situation in Iran.
Masoud Kavosi, Seyed Jamaledin Tabibi, Mahmoud Mahmoudi Majdabadi Farahani, Kamran Hajinabi,
Volume 1, Issue 4 (2-2019)
Abstract
Introduction: The boundaries of providing heath care to patients have become so widespread that provide all these services in the form of health insurance at least not economically feasible. In many countries, supplementary insurance is used to provide health care. This research has been conducted to determine the effective factors on organizations supporting the supplementary health insurance system in selected countries and Iran.
Methods: The present study is a descriptive-analytic, cross-sectional and applied study. The data of this study were collected through a questionnaire by checking texts and field studies. Reliability of the questions was confirmed by experts and limited content validity method. The data were entered into SPSS software version 25 for the purpose of calculating descriptive and inferential statistics. Then, the exploratory factor analysis was confirmed through the AMOS software program.
Results: The present study showed that men with a postgraduate degree and 17 years of service experience have contributed to this research. In this regard, supportive organizations such as the Ministry of Health and Medical Education, and the subsidy targeting organization, have the least impact on supplementary care insurance had.
Conclusions: The results of this research indicate that the Ministry of Health and Medical Education has played a significant role in optimal utilization of supplementary health insurance and improved patient satisfaction as well as improved community health.
Elham Shami, Shirin Nosratnejad, Alireza Pirestani,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: Getting and receiving health care services is called health care utilization. Health system management depends on decisions that are right and conscious, Utilizing knowledge of health services and studies in this area is mandatory for allocating financial resources and health planning. Access has an important role in the utilization and use of health services. One of the most important factors in increasing access to services is the people’s insurance coverage. The aim of this study was determine health care utilization among new insured people of the Iranian health insurance plan after the implementation of Health Care Improvement Plan.
Methods: The present study is a cross-sectional study with a sample size of 400 households from Tabriz with random sampling. The study was conducted using a telephone conversation (retrospective information) questionnaire on the rate of utilization of outpatient and inpatient care services among the Iranian health insurers of Tabriz during one-year period. Data were analyzed using descriptive and analytical statistics and analyzed using STATA 11 and EXCEL software.
Results: The relative frequency of outpatient and inpatient services were 98.49, 98.75%, respectively. Also, access to services in the use of outpatient and inpatient services was 93% and 90%, respectively. Satisfaction rate for outpatient services was 51%. Satisfaction rate for receiving hospital services was 56%.
Conclusions: Health insurance in Iran has led to the benefit of people without health insurance, which is higher in inpatient services. Moving toward universal health coverage can be a better way to cover people uninsured and the community.
Mohammadreza Rezaee, Said Daei-Karimzadeh, Mehdi Fadaei, Akbar Etbarian, Hamid Bahrami,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: The family physician program and the referral system in health insurance of Iranian villagers and nomads were implemented in 2005 by the Iran Health Insurance Organization, after being approved by the Islamic Consultative Assembly. Financial resources and other physical and legal infrastructures as well as human resources are the essential requirements for implementing this program. The present study aimed at examining the factors contributing to the success of this national program in the described areas, considering their ease, accessibility, and role in the success of the family physician program and the referral system in health insurance of Iranian villagers and nomads in 2017.
Methods: In the current study, the variables involved in the physical and legal infrastructures, manpower, and provision of financial resources were first examined using Delphi method according to the experts' opinion including practitioners involved in the rural programs, inspectors, and supervisors of health insurance plan as well as experts and managers of Khuzestan, Isfahan, Lorestan, Ilam, Kermanshah, Chaharmahal va Bakhtiari, and Kohgiluyeh va Boyer-Ahmad provinces selected based on the purposive and chain sampling methods. Student t-test was then used to compare the responses with standard tables.
Results: In the provision of financial resources, physical and legal infrastructure and manpower after several years of implementating the program were approved by the indices such as the timely allocation of funds and provision of service packages, the determination of the actual per capita and the payment of services per capita, approval of referral system law and upstream laws, the payment of franchises at levels 2 and 3, and the number of specialists in the villages, their appropriate distribution on the basis of population density and the expansion of health centers based on this density, appropriate training, and long-term contracts, which create a sense of usefulness and ease of using services in insures and has a significant relationship with changing the family physician program and the success of the project.
Conclusions: After several years of implementing rural family physician program, the project has a relatively appropriate performance in terms of financing and other infrastructures. However, the referral system is still not implemented properly and feedbacks from specialized physicians are not sent to family physicians.
Mahdi Shahraki,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: The increasing variety and costs of health services, the high share of out of pocket, and the quantity and quality of services covered by basic insurances increased the demand for supplemental health insurance. Considering the importance and necessity of supplementary health insurance, its demand growth and its impact on improving the quality of life, the present study amed at investigating the demand of supplementary health insurance in the urban household of Iran.
Methods: The present descriptive-analytical and applied study with cross sectional design was conducted in 2016 employing the probit econometric model with sample selection and maximum likelihood method. The sample size was 18,809 urban households in Iran's provinces selected via the three-stage sampling method on a systematically randomized basis by the Statistical Center of Iran. Data were extracted from the cost-income questionnaire of urban households and the coefficients of the model were estimated with Stata 14 software.
Results: The results showed that the increase in age, education, the level of literacy, and the marital status of the head of the household increased the probability of demanding for the supplementary health insurance by 0.6%, 0.17%, 6.6%, and 5.3%, respectively. Also, the number of family supporters, having a child under seven years old, and owning a private house increased this probability by 16%, 3.7%, and 0.85%, respectively. The increase in health and medical expenses, as well as income and educational expenditures had a negligible positive effect, while the squared index of the age and education of the head of the household had a negative impact on the demand for supplementary health insurance.
Conclusions: Marital status, age, education level of the head of the household, the number of family supporters, increased health costs per capita, increased education expenditures and the per capita income had a positive impact on the demand for supplementary health insurance by households. Among these variables, the number of family supporters, marital status, and the age of the head of the household had the highest impact and per capita income and education expenditures of the family members had the lowest effect on the demand for supplementary health insurance. Also, the demand for supplementary health insurance by Iranian urban households was a quadratic concave function of the age and education level of the head of the household. Thus, it is recommended to identify and classify households based on the factors affecting their demand and determine the appropriate conditions for the health services coverage corresponding to each class of household. It is particularly necessary to support the elderly in the treatment costs.
Morad Nasri,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: Human growth begins since the formation of the embryo and ends with death. Growth hormone is secreted from the pituitary gland and involved in the growth process. 11 to 28 percent of short stature in Iran and about 10 percent in the world is related to growth hormone deficiency. In this article, the status of prescribing growth hormone for those under the coverage of Iranian Health Insurance was investigated in Ilam province during 2007-2017.
Methods: This was a cross-sectional descriptive and retrospective study and conducted according to the available documents in the General Directorate of Iranian Health Insurance. The statistical population of the study included all medical prescriptions of growth hormone to those under the coverage of the Iranian Health Insurance during 2007-2017 sent by pharmacies to the general directorate of Ilam Health Insurance. Using the records in the database and the health insurance processor, and by census method, the data entered Excel 2007 and analyzed using SPSS version 21.
Results: The number of prescribed hormone in 2007 was 1858 which increased to 4485 in 2017, showing a 2.82 folds increase. Also, the number of prescriptions in 2007 was 66 totally, which increased by 78.7 times to 513 prescriptions. The average cost of each version containing the growth hormone in Ilam province was 3,699.606 Rials in 2007 that increased to 14.972.125 Rials in 2017.
Conclusions: Growth hormone is one of the expensive drugs in the health insurance organization. The drug in the studied years of 2007-2017 has always been at the top ranks with a significant role in medical expenses of Ilam health insurance, and has been one of the top 20 costing items in the province. Also, over time, its cost ranking increased and reached to the first in 2016-2017. More control and supervision on how to prescribe would be effective in optimizing the pharmaceutical costs of the general directorate of health insurance of Ilam province.
Masoumeh Esmaeeli, Ali Askari, Zein-Al-Abedin Amini Sabegh, Ehsan Sadeh,
Volume 2, Issue 1 (6-2019)
Abstract
Introduction: Improving level of health and increasing life expectancy of people requires investment on health through use of health products. Since the health products benefits need to be financed, it can be said that health expenditure is necessary for a healthy society. Therefore, the purpose of this study was to investigate factors affecting on entry of households in the health market and their health expenditures.
Methods: This study considering the health expenditures characteristics of urban and rural households living in Tehran province and neighboring provinces, to identify the factors influencing entry of households in the health market and their health expenditures has been used sample selection model and Hackman's two-step estimation method. It is worth noting that given difficulty in choosing a sample, it is necessary to use sample selection models to obtain reliable estimates.
Results: The results show that gender, health insurance services, tobacco costs, head of household status, education, number of children, youth and elderly and urbanization are among most important factors affecting on entry of households in the health market and their health expenditures; but education cannot affect decision of these households to enter the health market.
Conclusions: According to the current situation, for households with low income, households with more members, older households and households with a predominant gender (women) should be considered special support schemes.
Peyman Rezaei, Afsoon Asadzadeh,
Volume 2, Issue 2 (9-2019)
Abstract
Introduction: The use of appropriate health payment system is one of the priorities for all countries. The aim of this study was to survey the features of diagnosis related groups (DRGs) and ambulatory payment classifications (APCs) in order to provide a framework for calculating inpatient and outpatient care costs in Iranian hospitals.
Methods: This review article conducted by searching bibliographic databases including PubMed،Science direct, SID and Cochrane library. Google scholar and other relevant websites were also searched. Studies restricted to English and Persian language. There was no study design and date limitation.
Results: Of all retrieved studies, 108 studies were selected. Seven DRGs systems have been developed primarily for inpatient services that had various elements for determining payment and were made to address particular limitations in the original DRGs. Different countries often have used their native inputs such as ICD clinical codes. DRGs approaches are converted the clinical code to the financial for determining costs. Finally, Payments for each condition or diseases are estimated based on Adjustment factors, Expenditure ceiling, and Cost weights set. In the APC system would be assigned specific current procedure terminology and ICD clinical codes for each patient who visited the physician and had procedures perform. The APCs approaches are converted the clinical code to the financial for determining costs. Finally, Payments for each condition or diseases are estimated based on Adjustment factors, Expenditure ceiling, and Cost weights set.
Conclusions: Using well-defined prospective payment systems such as native DRG and APC which cover inpatient and outpatient service costs are considered as an effective step in reforming Payments in Iran health care system
Morad Nasri, Younes Soheylizad,
Volume 2, Issue 2 (9-2019)
Abstract
Introduction: According to the law costs associated with disasters and accidents, it is the responsibility of the Ministry of Health and Medical Education for up to two months after discharge. But because there is no specific mechanism to identify the outpatient costs of these patients, these costs are imposed on the health insurance organization. The purpose of the study is to determine that; how the referral times and outpatient costs of the insured by the health insurance organization caused by driving accidents during the essential visits period in Ilam province.
Methods: The study was conducted retrospectively and descriptively. The statistical population includes insured that referred to Imam Khomeini Hospital in Ilam city during the first quarter of 2018 caused by accidents driving. The referral times and outpatient costs of 454 insured covered by health insurance were reviewed and recorded, coded and entered into the computer by census. Data were analyzed by SPSS 21 software and the tables and graphs were designed and extracted by central tendency indicators and data descriptions were performed.
Results: During the essential visits period the insured of health insurance that have been injured due to driving accidents during the first quarter of 2018, a total they had 888 visits times and had cost 7,979,319,264 Rials. Each study sample had 1.96 times outpatient visits at the time of the study and has produced a cost of 2,082,582 Rials for the Health Insurance Organization.
Conclusions: The results of the study per year show that on average the 3216 times visit an amount of 1,057,278,832 Rials will be imposed to the Health Insurance Organization. It is suggested that the Health Insurance Organization adopts a method that this costs to be covered by the Ministry of Health and from the sources from the 10% third party premiums from the paragraph B of Article 37 of the Fifth Plan law.
Ahmadreza Riaziat, Keyvan Rahmani, Alireza Farshid, Reza Rezayatmand,
Volume 2, Issue 2 (9-2019)
Abstract
Introduction: As the pharmaceuticals play a decisive role in promoting health of the community, its consumption and cost puts the burden on society. Regarding the role of insurance organizations in health system financing and the lack of a description of the costly services of the health insurance organization in Iran, the present study aims to identify the most costly pharmaceutical items of the health insurance organization and provide solutions to reduce the consumption of identified items.
Methods: The present study was a descriptive cross-sectional study conducted in 2017 based on 2015 data. Information was obtained from the medical documentation software of the provincial health insurance offices throughout the country. In order to improve the accuracy of the information and the accuracy of the selection of the most costly services, duplications were identified and corrected. Data analysis was done using Excel 2013 software. The initial questionnaire containing 20 costly services identified at the previous stage was completed by the chief of provincial health insurance offices and relevant responsible experts. The proposed interventions were reviewed and, after removing duplicates, were classified as special interventions for each service and non-specific interventions for all of them.
Results: The cost of 20 items of costly pharmaceuticals has accounted for 35% of total pharmaceuticals costs of health insurance organization in 2015. Among the most important non-specific interventions identified, recording drug prescription (more monitoring of drug use), proper education of rational drug prescription, the presence of a trusted physician to approve drugs, staggered franchising, the pharmaceuticals cost-effectiveness studies and culture empowerment in Prescribing and consumption of medication (increasing general information).
Conclusions: With the knowledge of costly services, in order to balance the costs of the health insurance organization, it is necessary that various policies be put in place by the health insurance organization in order to control costs.
Jafar Yahyavi Dizaj, Jalal Saeidpour, Faroogh Na'emani, Kamran Irandoust,
Volume 2, Issue 2 (9-2019)
Abstract
Introduction: Inequalities in the health system that are defined as the differences between individuals in the enjoyment of health and its facilities, is one of the determinants of health among individuals and groups. The purpose of this study was evaluate the inequality in payment of health insurance in Iran during 2011 to 2017.
Methods: The present descriptive-analytical study was designed and conducted as cross-sectional study in 2018 year, using the National Household Expenditure Survey data which is done annually by the Iranian Statistics Center. In the present study, inequality in payment of Iranian health insurance during 2011-2017 was measured. For this purpose, the average household expenditures for health insurance and average household expenditures were calculated, and by the Lorenz curves, the Gini coefficient of these expenditures was calculated. Then, in order to assess the fairness of insurance payments, the Kakwani index was calculated.
Results: The average Gini index for health insurance payments between urban and rural households during the whole study period was 0.34 and 0.47, respectively. Kakwani index values were always positive for rural areas throughout the study period, while urban areas were negative for 2012-2014. In addition, the trend of average changes in the Kakwani index across the country declined from 2011 to 2013, indicating an uneven trend in insurance payments in those years. But in the years 2014-2016 the trend of these changes was incremental.
Conclusions: The findings of the present study showed that the equity status of Iranian households' insurance payments was not favorable especially in urban areas; and it is necessary to achieve equity in the payments of family health insurance, planners and policymakers while reviewing the redistribution of resources in the country's insurance sector by redistributing resources in urban areas, along with improving the quality of covered health services. Proper insurance provides adequate financial protection for Iranian households.
