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.

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.

Introduction: Achieving the universal health coverage in each country is different according to cultural, social, economic conditions, available resources and development infrastructure, which in Iran over the past few decades, several efforts have been made in this field. The aim of this study is to gain successful experiences of countries such as Malaysia, Thailand, Chile, Costa Rica, Cuba, Sweden and some countries in different continents with different health care systems that have achieved universal health coverage.
Methods: This study is a review study. The bulk of the data studied is related documentation, including official published reports, articles, books, regulations, and newsletters that search for keywords such as insurance, universal health coverage, and health. Health, Health System, Financial Resources and Health System Performance in external databases such as Google Scholar, Web of Science and websites such as World Bank, World Health Organization, Also, the use of some internal databases such as Iranmedex and holding meetings with the beneficiaries of the Ministry of Health in Iran has been obtained. All data were analyzed by using content analysis method.
Results: Today, there is no single global model for designing health insurance systems. Countries differ in terms of priorities, population covered, degree of development, type of government system and other factors, and each has its strengths and weaknesses. Countries must evaluate these strengths and weaknesses with their economic, political, and executive priorities, needs, and constraints, and select the best system.
Conclusion: Successful countries in the field of universal health coverage have also benefited from the political and financial commitments of their government and the private sector has acted as a complement to the public sector. Recognizing the health needs for a regular and coordinated referral system is one of the reasons for improving public health coverage. Universal health coverage is a time-consuming process that Iran has come very close to this great goal in the past few years with the implementation of the Health Transformation Plan.

Introduction: Hospital deductions are predominantly costs that are spent by the hospital, but are not funded and reimbursed. The deductions are 10-30% of the hospital income, of which more than 20% of these deductions are applied to the documents through the hospitals themselves. The purposes of this research is to examining the deductions imposed by insurance organization and hospitals, as well as identifies the causes of these deductions and provide practical solutions for reducing deductions.
Methods: The present study is a descriptive-analytic study that was done retrospectively and a combination of quantitative and qualitative methods. The statistical population consisted of a set of hospitals providing health services in the country. The sampled hospitals were 14 units. The number of medical records in order to examine the insurance deductions, using the Cochran method, was estimated at 1715 cases. Data analysis was performed using descriptive and analytical methods in accordance with each of the levels of subtraction. At each end of the analysis, the amount of deduction was extracted from each case.
Results: on average (geometric mean), there is a 87% probability of not registering at least one service in a medical record. The highest financial burden due to the lack of registration of the service at HIS occurs in private hospitals at a rate of 558241 Rials per case. There was a significant correlation between the type of hospital and the set of factors examined about the causes of the deficit in the audit by the hospital income experts (P <0.001). Anesthesiology/ Consultant (15.27%) is the most common cause of the deduction by the insurance companies. The average cost of a deduction applied to a medical record in is 3,873,723 Rials, which accounts for 5.5% of the total cost of each medical record.
Conclusion: Analysis of the findings shows that a high cost of hospital-provided services for patients is not reimbursed to the hospital. This challenge depends on many factors, in which not only insurance organizations, but also hospitals and service providers, who are in charge of the service record and financial statements regulators, are affected.

Introduction: Introduction: The implementation of Health Transformation Plan (HTP) with the aim of expanding the quality of inpatient services and financial protection of inpatients in order to reduce out-of-pocket payments and provide the services required by inpatients by the hospital has increased hospitalization rate and costs in hospitals. The purpose of this study was to investigate the impact of the implementation of this program on the service costs, hospitalization of the insured of Iran Health Insurance Organization (IHIO).
Methods: This cross-sectional study was conducted to investigate the hospitalization rate and cost of the insured of IHIO by implementing HTP in the period of April 2012 to March 2016. The data sources were gathered from the books of performance report of the IHIO from 2012-2016. Data was categorized using Excel software version 2013. Then Data was analyzed by SPSS software version 21 and E-Views version 8 using the Interrupted Time Series (ITS) model.
Results: The results of ITS showed a significant increase in hospitalization rate per capita after 4 months of the implementation of HTP. So that every month, on average, for every one million people insured, 156 people werr added to the number of hospitalized referrals of the insured of this organization. Also, the implementation of the HTP has increased the per capita fixed cost of service hospitalization of the insured insurance in the country.
The increase in the per capita fixed cost of hospitalization after 4 months from the beginning of the Health Transformation Program and at the same time with the start of the third phase of the program has been the reason for reviewing the book Relative Values of Health Services.
The Findings showed that the implementation of the program, on average per month, for each insured person, the amount of 1,544.8 Rials has been added to the cost of each hospital service.
Conclusion: The implementation of the HTP has increased the hospitalization rate and cost of per- insured of the IHIO.
Also, the implementation of this program has increased the per capita cost of proving the hospitalization of the insured of the organization. Due to the limited financial resources of the organization, in order to control and manage financial resources, policies such as referral system and creating a waiting list for hospital services in the treatment of non-emergency diseases should be adopted immediately.

Introduction: Identifying factors affecting the financial aspects of hospital is an important step for its strategic control. Therefore, this study aimed to assessment the trend and determinants of inpatient and outpatient revenue in a COVID-19 patient s’ treatment center.
Methods: The present study was a descriptive-analytical research by applying time series analysis. Raw data on the hospital income (by inpatient and outpatient) and the potential factors were gathered monthly by referring to the administrative departments of the hospital, during 2015-2020. Dickey-fuller unit root test was used to measure stationary trend of the variables. The auto-regression distributed lagged model (ARDL) was used to study the effect of independent variables on hospital income. All analyzes were performed in Eviews software.
Results: During the study period, on average 73.65% of hospital revenues were related to inpatient income and the rest were outpatient income. The total revenue trend of the hospital at the current price has increased significantly from April 2015 to august 2020
(P<0.0001), while this at the fixed price has decreased significantly (P<0.0001). At the beginning of the admission of a Covid-19 patient (February 2020), the hospital income has decreased significantly and after three months in May 2020, it has returned to its long-term trend. The results showed that inpatient and outpatient income was significantly affected by the variables of quantity of service, quality of care and hospital performance indicators (P<0.05).
Conclusion: Hospital revenue was significantly declined at the commence of Covid-19 pandemic. Increasing the capacity of intensive care beds, raising hotel service tariffs, changing insurance policies and supporting upstream organizations can be effective strategies to control the economic consequences of the Covid-19 epidemic on hospitals.

Introduction: Awareness of benefiting from health services and its determinants is important for health care planning. In Andersen’s behavioral model, predisposing and enabling factors and factors related to need explain the use of health services. The purpose of this study is to identify the factors related to the use of inpatient services in Iran based on the mentioned model.
Methods: The present study is a secondary analysis study that was conducted based on the data of the national survey of the use of health services in 2008 and 2015. The number of sampled people was 8326 in 2008 and 5684 in 2015. Logit regression was used to examine the factors related to the use of health services.
Results: Female patients (OR=1.48, P<0.01), older patients (OR=0.01, P<0.05), patients whose needs were diagnosed by doctors or medical personnel (OR=1.98, P<0.01), patients whose head of household had higher than diploma education (OR=1.65, P<0.01), and residents of disadvantaged areas of the country (OR=1.42, P<0.05) were more likely to benefit from inpatient services. The chance of benefiting from inpatient services was higher in 2015 than in 2008 (OR=2.15, P<0.01).
Conclusion: Andersen’s Behavioral Model of Health Services can be a suitable the theoretical framework to explain the determinants of the use of inpatient health services in Iran. It is suggested that the 3 categories of factors constituting this behavioral model should be continuously considered in policies related to the use of inpatient services.

Introduction:Implementation of performance-based payment system is considered as an important and effective factor in improving work productivity, which will increase organizational satisfaction and justice. Performance-based payments actually link material rewards to individual, group, or organizational performance, or a combination of the three. The aim was to explain and prioritize the challenges and solutions of the performance-based payment system to the staff of hospitals.
Methods: This study is a qualitative study that was conducted with content analysis approach in 2020 in teaching hospitals of Lorestan. The statistical population was 14 medical and staff members using purposive sampling. The sampling method was purposeful and sampling continued until data saturation. Data analysis was performed using conventional content analysis.
Results: After the process of continuous comparison of data and open, pivotal and selective coding, in 2 main dimensions (organizational factors, individual and internal factors) and 6 sub-dimensions (fair payment system; work quantity; work quality; work based payment And effort; motivation and interest; commitment and commitment) were organized.
Conclusion: Considering the effectiveness of the implementation of performance-based payment plan on the income of hospitals, it can be stated that this plan has a positive effect on the performance of hospital staff and causes them to be more active in hospitals, provide better services and Total improved effectiveness. Therefore, the officials and implementers of the performance-based payment plan in the Ministry of Health and Medical Education are suggested to follow its implementation more widely in other provinces.

Introduction: One of the most important factors that indicate hospital performance are hospital indicators. One of the fundamental developments and changes in the health system of Iran is the health system transformation plan, the effects of which should be examined from different aspects. The purpose of this research is to determine the performance indicators of hospitals affiliated to Zahedan University of Medical Sciences, Zahedan, Iran and compare them with the standards of the Ministry of Health and Medicine. Medical education was in 2018.
Methods: This cross-sectional descriptive study was conducted in 2018 in public hospitals covered by Zahedan University of Medical Sciences, Zahedan, Iran. In this study, the most important performance indicators of the hospital from 2015 to 2018 were investigated in a targeted manner. The entry criterion was the completeness of the indicator's information. In this study, to obtain accurate and reliable information, input data and output data were used as performance indicators. The data was analyzed using EXCEL software and descriptive.
Result: In the present study, a total of 6 hospitals of Zahedan city under the coverage of Zahedan University of Medical Sciences were investigated. On average, 11,200 people were hospitalized and 11,003 people were discharged, which decreased to 11,086 people hospitalized and 10,450 people discharged after the transformation plan. The average number of emergency and outpatients was 71,600 and 124,571 respectively.
Conclusion: To evaluate the hospital, the use of performance indicators as a criterion can guide managers in understanding the current situation of their center as well as in planning and management decisions. The findings of the study showed that in terms of bed occupancy rate, the hospitals were in an average and poor condition compared to the standards of the Ministry of Health. But in terms of the average days of hospitalization, they were in an unfavorable situation.

Introduction: The COVID-19 caused many changes in the performance and productivity of health service providers. The purpose of this study was to investigate the effects of the COVID-19 pandemic on the financial and performance indicators of one of the hospitals in Tehran.
Methods: This historical cohort study was conducted in the first 6 months of 2018 as the pre-pandemic period and the first 6 months of 2019 as the post-pandemic period. 13 performance indicators of inpatient departments; 9 operational indicators of the whole hospital and 3 financial indicators were included in the study. The data were received in a pre-designed Excel form from the statistics unit and quality improvement unit of the hospital, and after entering SPSS and checking their normality, they were analyzed with Wilcoxon's non-parametric test.
Results: Average indices of bed circulation (P=0.028), discharged patients (P=0.028) and hospitalized patients (P=0.046) were significantly reduced. The index of death before 24 hours (P=0.027) and after 24 hours (P=0.028) and ED discharge (P=0.028) also increased significantly. The average profit of the hospital at the current price and the actual price had increased significantly (P=0.028). Total current income increased, but real income decreased, which were not significant. Current and real costs were also reduced, only the real cost reduction was significant (P=0.028).
Conclusion: The COVID-19 had a significant impact on the hospital's financial and performance indicators. It’s necessary for hospital managers to have an appropriate model for the development of services and the sustainability of resources during a crisis.