Rāhburdhā-yi Mudīriyyat dar Niẓām-i Salāmat (Mar 2018)
Investigating the Effectiveness of the Health Services Relative Value Implementation on Out of Pocket Payment of Insured People Covered by the Health Insurance Organization in Selected Hospitals of Bushehr Province in 2014
Abstract
Background: Most of the reforms that have taken place in world health systems are aimed at increasing the efficiency, quality, and control of costs. By implementing the health system reform plan, the actual plan of medical services tariffs by communicating the relative value of health services instruction on October 2014 was started. One of the most important goals of the reform plan was to reduce out of pocket payment. This study was conducted to determine the amount of out of pocket payment of insured people covered by the health insurance organization in the selected hospitals in Bushehr province. Methods: The present analytical study was conducted on insured people hospitalization cases of health insurance organization in selected hospitals affiliated to Bushehr University of Medical Sciences (Persian Gulf Martyrs Hospital, Shahid Ganji Hospital) in July, August, January, and February 2014 as the statistical population and the most common services used as the statistical sample. The data were collected using a researcher-made checklist and investigating the hospital records coded and analyzed by SPSS 20 software. Results: According to the results of the study, the average cost of the patient's share was 1050835 Rials in July, August to 611631 Rials in January, and February, which decreased by 42.00 %. The results of the study show that by implementing the relative value of services instruction, the share of the health insurance organization increased from 79.00 % to 84.00 % and the share of the patient's payments decreased from 8.00 % to 4.00 %. Conclusion: The results of the study show that the government has been able to achieve one of the goals of the health reform plan, which is reducing the out of pocket payment, by increasing health resources.
