هزینه‌های بیمارستانی بیماران بلاصاحب در بیمارستان‌های منتخب شهر شیراز نیمه دوم سال 1393
محورهای موضوعی : -مدارک پزشکیزهرا کاوسی 1 , مرصاد رضائی 2 , علی شجاعی 3 , حمید طالبیان پور 4
1 - دانشیار، گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و اطلاع‌رسانی پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران
2 - دانشجوی کارشناسی مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و اطلاع‌رسانی پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران
3 - کارشناسی‌ارشد MBA، دانشگاه علوم پزشکی شیراز، شیراز، ایران
4 - دانشجوی کارشناسی‌ارشد اقتصاد سلامت، دانشکده مدیریت و اطلاع رسانی پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران
کلید واژه: هزینه جبران نشده, بیمارستان‌ها و نظام سلامت, بیماران بلاصاحب,
چکیده مقاله :
مقدمه: با توجه به هزینه‌هایی که بیماران بلاصاحب بر بودجه‌ی بهداشت و درمان و به تبع آن به بیمارستان‌ها وارد می‌نمایند، این پژوهش با هدف بررسی هزینه‌های بیماران بلا صاحب در بیمارستان‌های منتخب علوم پزشکی شیراز انجام شده است. روش پژوهش: این مطالعه توصیفی - تحلیلی به صورت مقطعی به بررسی هزینه‌های بیماران بلاصاحب در نیمه‌ی دوم سال 1393 در بیمارستان‌های منتخب شیراز پرداخته است. اطلاعات با استفاده از چک لیست محقق ساخته، با مراجعه به پرونده مالی در واحدهای مددکاری بیمارستان‌ها جمع‌آوری گردید. داده‌های جمع‌آوری شده با استفاده از آزمون‌های ANOVAو در نرم‌افزار spss تحلیل شدند. یافته‌ها: یافته‌ها نشان داد که در مدت زمان مطالعه 183 بیمار بلاصاحب در بیمارستان‌های مورد مطالعه بستری و ترخیص شده‌اند؛ بیشتر افراد بلاصاحب مرد (58.6%)، متاهل (52 % )، بومی (77.3 %) و دارای بیمه (61.5 %) بودند. هزینه کل این بیماران 8535929734 ریال برآورد شد که 5184119454 ریال آن توسط بیمه‌ها بازپرداخت گردیده و 3330828022 ریال آن جبران نشده است. میانگین هزینه‌های جبران نشده بر حسب مرجع تحویل دهنده و گیرنده بیمار و نیز در بیمارستان‌های مختلف تفاوت آماری معنی‌داری داشته است. نتیجه‌گیری: با توجه به مشکلات مالی که بیمارستان‌ها با آن مواجه هستند استفاده از هر مداخله‌ایی جهت کاهش هزینه‌های جبران نشده مفید خواهد بود؛ وجود مددکاران خبره جهت ارتباط با سازمان‌های حمایت اجتماعی به بیمارستان‌ها در جبران این هزینه کمک خواهد کرد. افزایش پوشش جمعیتی بیمه‌ها نیز کمک کننده خواهد بود.
Introduction: the guardian less patients are considered as hospital debtors and their financial burden is imposed on hospitals, this research has been conducted to evaluate the expenses of guardian less patients in selected hospitals of Shiraz University Medical Science. Research Method: this cross-sectional study has evaluated the financial burden that guardian less patients imposed on Shiraz selected Hospitals in the second half of the year 1393. The data was gathered through review of patient invoice and medical records using a self-administrated check list. The gathered data was analyzed using, ANOVA Test in SPSS21 software. Results: the findings indicated that 183 guardian less patients were discharged from hospital in the study period. Most of the patients were men (%58/6), married (%52), native (%77/3) and had health insurance (%61/5). The total expenditure of these patients was 8535929734 IRR which 5184119454 IRR was reimbursed by insurance organization. 3330828022 IRR was not compensated. Uncompensated cost was statistically different in different hospital and based on type of who referred patient. Conclusion: Considering financial issues which hospitals face, using various interventions to decreasing uncompensated cost will be useful. Employing social workers who are professional in connecting with social support organizations and also improving population coverage of insurance plan will be helpful.
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2- Gerdtham UG, Søgaard J, Andersson F. Health expenditure growth: reassessing the threat of Ageing. Journal of Health Economic, 1992; 11(1): 63-84.
3- Beygi E, Agrell M, Karlsson P. Johannisson, Signal statistics in fiber-optical channels with polarization multiplexing and self-phase modulation, Journal of Lightw, Technol, 2011; 29(16): 2379–2386.
4- Gruber J, Rodriguez D. How much uncompensated care do doctors provide?, National bureau of economic research; 2007.
5- Hadley J, Zuckerman S, Iezzoni LI. Financial pressure and competition: Changes in hospital efficiency and cost-shifting behavior. Medical Care, 1996; 34(3): 205–219.
6- Ferrier GD, Resko MD, Valdmanis VG. Analysis of uncompensated hospital care using a DEA model of output congestion, Health care manage sci, 2006; 9: 181-188.
7- Hadley J, Holahan J. How much medical care do the uninsured use, and who pays for it? Health Affairs (Millwood), Supplemental Web Exclusives, 2003; 3: 66-81.
8- Xiong J, Hipgrave D, Myklebust K. Child health security in China: a survey of child health insurance coverage in diverse areas of the country. Social Science & Medicine, 2013; 97: 15–19.
9- Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M. Tackling the challenges to health equity in China Lancet, 2008; 372: 1493–501.
10- Reiter KL, Harless DW, Pink GH .the Effect of Minimum Nurse Staffing Legislation On Uncompensated Care Provided By California Hospital, Medical Care Research And Review, 2010; 1-20.
11- Zhang W, Wang X. uncompensated care for children without insurance or from low-income families in a chinese childrens hospital, Medical science monitor; 2014: 1162–1167.
12- Holahan J, Garrett B. The Cost of Uncompensated Care with and without health reform. timely analysis of immediate health Policy issues, 2010.
13- Holahan, John, Bowen Garrett, Irene Headen, and Aaron Lucas. Health Reform: The Cost of Failure. Washington DC: The Urban Institute, 2009.
14- Fishman LE, Bentley JD. The evolution of support for safety-net hospitals. Health Affairs, 1997; 16(4): 30–47.
15- Graves JA. Medicaid Expansion Opt-Outs-and uncompensated care, The New England Journal of Medicine; 2012: 20.
16- Bosco G, Cigliutti R, Nespola A, et al. Experimental Investigation of Non-Linear Interference Accumulation in Uncompensated Links, Politecnico di Torino Porto Institutional Repository, June, 2012.
17- Friedman L, Baker GR, Carpenter C, Greene B, Kurz RS, Laditka SB, et al. Understanding health care financial management. Chicago, Health Administration Press; 2006: 115-153.
18- Veach MS, What’s On Your Plate?, Ten Top Issues for 2006, Healthcare Financial Management: Journal of the Healthcare Financial Management Association, 2006; 60 (1): 72-6.
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1- Di Matteo L. The determinants of the public– private mix in Canadian healthcare expenditures: 1975–1996. Health Policy, 2000; 52(2): 87-11.
2- Gerdtham UG, Søgaard J, Andersson F. Health expenditure growth: reassessing the threat of Ageing. Journal of Health Economic, 1992; 11(1): 63-84.
3- Beygi E, Agrell M, Karlsson P. Johannisson, Signal statistics in fiber-optical channels with polarization multiplexing and self-phase modulation, Journal of Lightw, Technol, 2011; 29(16): 2379–2386.
4- Gruber J, Rodriguez D. How much uncompensated care do doctors provide?, National bureau of economic research; 2007.
5- Hadley J, Zuckerman S, Iezzoni LI. Financial pressure and competition: Changes in hospital efficiency and cost-shifting behavior. Medical Care, 1996; 34(3): 205–219.
6- Ferrier GD, Resko MD, Valdmanis VG. Analysis of uncompensated hospital care using a DEA model of output congestion, Health care manage sci, 2006; 9: 181-188.
7- Hadley J, Holahan J. How much medical care do the uninsured use, and who pays for it? Health Affairs (Millwood), Supplemental Web Exclusives, 2003; 3: 66-81.
8- Xiong J, Hipgrave D, Myklebust K. Child health security in China: a survey of child health insurance coverage in diverse areas of the country. Social Science & Medicine, 2013; 97: 15–19.
9- Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M. Tackling the challenges to health equity in China Lancet, 2008; 372: 1493–501.
10- Reiter KL, Harless DW, Pink GH .the Effect of Minimum Nurse Staffing Legislation On Uncompensated Care Provided By California Hospital, Medical Care Research And Review, 2010; 1-20.
11- Zhang W, Wang X. uncompensated care for children without insurance or from low-income families in a chinese childrens hospital, Medical science monitor; 2014: 1162–1167.
12- Holahan J, Garrett B. The Cost of Uncompensated Care with and without health reform. timely analysis of immediate health Policy issues, 2010.
13- Holahan, John, Bowen Garrett, Irene Headen, and Aaron Lucas. Health Reform: The Cost of Failure. Washington DC: The Urban Institute, 2009.
14- Fishman LE, Bentley JD. The evolution of support for safety-net hospitals. Health Affairs, 1997; 16(4): 30–47.
15- Graves JA. Medicaid Expansion Opt-Outs-and uncompensated care, The New England Journal of Medicine; 2012: 20.
16- Bosco G, Cigliutti R, Nespola A, et al. Experimental Investigation of Non-Linear Interference Accumulation in Uncompensated Links, Politecnico di Torino Porto Institutional Repository, June, 2012.
17- Friedman L, Baker GR, Carpenter C, Greene B, Kurz RS, Laditka SB, et al. Understanding health care financial management. Chicago, Health Administration Press; 2006: 115-153.
18- Veach MS, What’s On Your Plate?, Ten Top Issues for 2006, Healthcare Financial Management: Journal of the Healthcare Financial Management Association, 2006; 60 (1): 72-6.