Jahan Ara Mamikhani, Seyed Moosa Tabatabaie, Marziyeh Zangeneh,
Volume 2, Issue 3 (12-2019)
Abstract
Introduction: Health insurance organizations are the main purchasers in Iran health system. Ordinarily, financial documents are delivered to the health insurers by the hospitals. It is possible there be other processes according to circumstances. Both these offices protect their own organizations' benefits, so there may occur some conflicts, which may harm patients. This study was conducted with a systemic approach employing organizational ecosystem technique for demonstrating the space of decisions and behaviors much better, in order to achieve better management in the interaction between hospitals and insurers.
Methods: This is a model building study, conducted in four phases. Initially a literature review study was performed for gathering higher national and institutional level documents, and for situational analysis of processes and functions. Then an FGD was performed according to Harris framework of ecosystems, the elements were identified under four domains, i.e. community, public policy, organizational, and interpersonal. In the third phase employing tables of program evaluation model of CDC, revealed the key stakeholders of the interaction, continued by explaining their functions and roles in the interaction. In the last phase, graphical model showing the direct effects among the elements of interaction was depicted and in the last step finalized by the experts in an FGD.
Results: In the insurer-hospital interaction ecosystem there were 30 elements identified in domains of community, public policy, organizational, and interpersonal; containing 11, 8, 4 and 7 elements respectively. The key stakeholder analysis for the interaction program, revealed the number of stakeholders which were dropped in these distinctive groups: who are affected by the program, who perform the program, and who benefit the results of the program, 2, 6, and 7 respectively. The graphical model was drawn using these findings.
Conclusion: In the organizational ecosystem of insurer-hospital interaction more than 63 percent of elements belong to community and public policy domains; less than 23 percent are related to organizational and interpersonal domains. This emphasizes that insurer-hospital interaction is more affected by community and public policy rather internal factors of insure organizations and hospitals.
Javad Sajjadi Khasraghi, Mahmoud Salesi, Mohammad Meskarpour Amiri, Mohammad Mohammadian, Javad Khosmanzar, Manaf Abdi,
Volume 5, Issue 3 (10-2022)
Abstract
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.
Javad Sajjadi Khasraghi, Mahmood Salesi, Mohammad Meskarpour Amiri,
Volume 5, Issue 4 (12-2022)
Abstract
Background: The outbreak of the Covid-19 pandemic has had a devastating effect on the provision and receipt of health services around the world. The present study was conducted with the aim of investigating the effects of this disease on referrals and services of one of the hospitals in Tehran.
Methods: In this historical cohort study, the number of referrals and services in 26 hospital departments in the first 6 months of 2018 and the first 6 months of 2018 were investigated and analyzed. The data in the form of a pre-designed Excel form received from the statistics unit and quality improvement unit of the hospital were entered into SPSS software version 26 and analyzed using non-parametric Wilcoxon test.
Results: The load of referrals and services of the studied hospital was reduced by 30 percent during the Covid-19 epidemic. The highest rate of decrease was related to clinics and clinics (55/07 percent) and the lowest rate of decrease was related to emergency services (7/67 percent). CT scan services and referrals increased by 84/5 percent on average. These changes were statistically significant.
Conclusion: The reduction of the burden of referrals and services of the studied hospital is evaluated as medium to high. Healthcare providers should monitor hospital activity and develop strategies to mitigate the indirect effects of the COVID-19 pandemic resulting from reduced overall hospital activity
