Factors Affecting Insurance Deductions Before and After the Implementation of Health Reform Plan: A Case Study; [عوامل مؤثر بر کسورات بیمهای؛ قبل و بعد از اجرای طرح تحول سلامت: مطالعه موردی]



Emamgholipour S¹ ; Raadabadi M² ; Zarezadeh M³ Show Affiliations
Source: Journal of Health Administration Published:2019

Abstract

Introduction: Insurance deductions by insurers often lead to financial turmoil in hospitals. With due consideration to lack of hospital resources, hospital deductions double the problems stemming from limited resources, therefore, the investigation of hospital indicators which affect deductions can lead to cost reduction. This study aimed to explore factors affecting insurance deductions in hospitals in Yazd province before and after the implementation of Health Reform Plan. Methods: This analytical-applied study was conducted in 2018. The study population consisted of all hospitals (N=11) affiliated to Yazd University of Medical Sciences. A form was designed by the researcher to collect data which were then analyzed by using descriptive statistics and Pearson correlation test. Results: The comparison of hospital deductions before and after the implementation of Health Reform Plan revealed an increase in deductions in all hospitals. There was also a significant and direct relationship between the number of hospital admissions (P=0.000), bed occupancy coefficient (P=0.034), and the number of active beds (P=0.001) with the amount of hospital deductions. Conclusion: A significant amount of the hospital revenues are wasted due to deductions which can be reduced through analyzing the causes and finding solutions to remove them, training and educating hospital staff and authorities, and implementing effective mitigation strategies. © 2019, Journal of Health Administration. All Rights Reserved.