Assessing issues and problems in relatioship between basic insurance organizations and university hospitals: a qualitative research

Abstract

Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals. Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data. Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.

Keywords

• university hospitals
• basic insurer organizations
• deductions
• qualitative research