بررسی مقایسه‌ای هزینه خدمات بستری بیماران قلبی، قبل و بعد از اجرای طرح تحول سلامت (مورد مطالعه بیمارستان قلب الزهرا (س) شیراز)
محورهای موضوعی : -مدارک پزشکیحمیدرضا مهارلو 1 , امید براتی 2 , محمد هادی ماهر 3
1 - دانشجوی کارشناسی‌ارشد مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و اطلاع رسانی، دانشگاه علوم پزشکی شیراز، شیراز، ایران
2 - استادیار گروه مدیریت خدمات بهداشتی درمانی، دانشکده مدیریت و اطلاع رسانی، دانشگاه علوم پزشکی شیراز، شیراز، ایران
3 - کارشناسی‌ارشد حسابداری، دانشکده مدیریت و اطلاع رسانی، دانشگاه علوم پزشکی شیراز، شیراز، ایران
کلید واژه: طرح تحول نظام سلامت, هزینه, منابع تامین مالی, بیماران قلبی عروقی,
چکیده مقاله :
مقدمه: هزینه بالای خدمات بستری بیماران سبب شد تا وزارت بهداشت درمان و آموزش پزشکی برای کاهش پرداخت از جیب بیماران طرح تحول نظام سلامت را در کشور اجرا نماید. شیوع بالای بیماری‌های قلبی عروقی و هزینه بالای خدمات سهم قابل توجهی بر افزایش هزینه‌های نظام سلامت و پرداختی بیماران دارد. هدف مطالعه حاضر بررسی سهم منابع تامین کننده هزینه خدمات بستری ارایه شده به بیماران قلبی عروقی شش ماهه قبل و بعد از اجرای طرح تحول نظام سلامت می‌باشد. روش پژوهش: پژوهش حاضر از لحاظ هدف کاربردی و روش مورد استفاده توصیفی- تحلیلی است برای حصول به اهداف این مطالعه و تدوین متون و ادبیات پژوهش از مطالعات کتابخانه‌ای و روش اسنادی استفاده شده است. اطلاعات مورد نیاز پژوهش از صورت‌حساب 601 بیمار قلبی عروقی ،مراجعه کننده به بیمارستان قلب الزهرا (س) شیراز، قبل و بعد از اجرای طرح تحول نظام سلامت می‌باشد. داده‌ها در چک لیست‌های آماری ثبت گردید. سپس در نرم‌افزارexcel جهت تحلیل آماری وارد شده است، تجزیه و تحلیل اطلاعات با استفاده از نرم‌افزار آماری SPSS و آزمون مانند من‌ویتنی صورت پذیرفت. یافته‌ها: میانگین کل پرداخت از جیب بیمار بعد از اجرای طرح تحول جهت بای‌پس عروق کرونر با اختلافی معنی‌دار از 10649295 ریال به 6971268 ریال کاهش یافت (001/0P<). میانگین سهم بیمه‌های پایه از کل هزینه یک واحد عمل جراحی بای‌پس عروق کرونری، از 41847802 ریال در قبل از اجرای طرح به 94782096 ریال بعد از اجراح طرح تحول نظام سلامت افزایش معنی‌داری نشان داد (001/0P<). نتیجه‌گیری: هم زمان با اجرای طرح تحول سلامت و کاهش پرداخت هزینه از جیب بیمار به منظور تامین هزینه‌های اعمال جراحی، درصد قابل توجهی از کل هزینه‌های پرداختی توسط سازمان‌های بیمه‌گر پوشش داده می‌‌شود.
Introduction: High level of cost for inpatient services made a reasonable reason for Iranian Ministry of Health and Medical Education in order to implement a reform called: “Health transformation plan”; it has been aimed to decrease patient out of pocket. High prevalence of cardiovascular disease and high level of cost for these services have significant contribution to increase health system expenses and patients payments. This study is aimed to investigate and compare the portion of cost payers’ contribution for inpatient services provided to cardiovascular patients before and after health system reform. Methods: This descriptive- analytical study was conducted on 601 CABG patients referred to Al-Zahra Heart hospital in Shirazbefore and after Iranian Health transformation plan implementation. Required data gathered by hospital bills. data were recorded in the data sheet then entered excel software for statistical analysis, and they were analyzed by SPSS software and Mann-Whitney U statistical test for non-parametric situation. Results: The mean of patients out of pocket after “Health transformation plan” implementation for CABG cases decreased significantly (p<0.001) from 10,649,295 to 6,971,268Rials. There was a significant increase for mean of basis insurance share from total cost of a unit CABG (p<0.001) as it rose from 41,847,802 to 94,782,096Rials. Conclusion: Having implemented the “Health System reform” in Iran leading to decrease patient out of pocket for operations significantly, there is a massive payments and costs must be covered by Iran Ministry of Health which imply huge costs and duties to this organization.
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2- vahidi R, saadati M. Determining the distribution of effective factors on out of pocket payment (formal and informal) in hospitalized cardiac patients of Shahid Madani hospital and its side effects on the patient or companions–Iran-Tabriz 2010. Bimarestan, 2013; 11(4): 45-52. [Persian]
3- Ghiasvand H, Hadian M, Maleki M, Shabaninejad H. Determinants of Catastrophic Medical Payments in Hospitals Affiliated to Iran University of Medical Sciences; 2009. Hakim Research Journal. 2010; 13(3): 145-54. [Persian]
4- Karami M, Mobasheri F, Khosravi Shadmani F. tential Impact Fraction of modifying selected risk factors on burden of cardiovascular disease in Iran: comparative risk assessment. Razi journal of medical sciences. 2013; 20(109): 62-71. [Persian]
5- Talebizadeh N, Haghdoost A-A, Mirzazadeh A. Age at natural menopause, An epidemiological model (Markov Chain) of cardiovascular disease in Iran. payesh, 2009; 8(2): 163-70. [Persian]
6- Haji Nabi k, Mahnazar S. The relationship of health insurance funds with heart disease hospitalization costs covered by health insurance in Karaj. Journal of Research and Health, 1391; 2(2): 207-13. [Persian]
7- Health IMo. Iran reform of health system 2015 [11/9/2015]. Available from: tahavol.behdasht.gov.ir. [Persian]
8- Dabagh A, Sarafzadegan N, Banifatemi V, Habibi H, Rafie M. Cost of therapeutic modalities of cardiovascular patient in Isfahan University hospitals. Hakim Research Journal, 2004; 6(2): 19-25. [Persian]
9- Hassan Nejad N. Determining the Methods of Financing Health care Costs among Hospitalized Diabetic Patients in Different Types of Insurances. Hospital, 2013; 12(3): 83-90. [Persian]
10- Maher A, ahmadi M, Jamnani A. Identify the method of financing the health system selected countries between the years 20004 see the works of a new generation of financial resources in the health system in Iran. pajohesh eghtesadi, 2008; 8(1): 115-49. [Persian]
11- Hosseiny nasab E, Varharami V. Factors affecting the cost of health care for families in Yazd. Health Administration, 2010; 13(40): 73-80. [Persian]
12- Afana M, Brinjikji W, Cloft H, Salka S. Hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention in the united states are substantially higher than medicare payments. Clinical Cardiology, 2015; 38(1): 13-9.
13- Sadeghi N, Zaree H. The impact of the funding on improving hospital performance. Quarterly monitoring of 0, 1388; 16: 145-135. [Persian]
14- Mosadegh Rad A. To what extent health reform plan economically for the benefit of the state and the people? Revised on 5 November 2014, the http://tums.isna.ir/Default.aspex?NSID=5&SSLID=46&NID=15676; 2014.[Persian]
15- Azami A, Akbarzade K. Patient satisfaction in hospitals of Ilam. J Ilam Univ Med Sci, 2004; 45(12): 10-16. [Persian]
16- Boerma T, Eozenou P, Evans D, Evans T, Kieny MP, Wag staff A. Monitoring progress towards universal health coverage at country and global levels. Plops Med. 2014; 11(9): e1001731. doi: 10.1371/journal.pmed.
17- Gunther M, Alligood MR. A disciplinespecific determination of high quality nursing care. J Adv Nurs, 2002; 38(4): 353-359.
18- Akhondzade R. Health system transformation project, an opportunity or a threat for doctors (Editorial). Journal of Anesthesiology and Pain (JAP), 2014; 5(1): 1-2. [Persian]
19- Sang S, Wang Z, Yu C. Evaluation of Health Care System Reform in Hubei Province, China. Int J Environ Res Public Health, 2014; 11: 2262-77.
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1-Ebadifard Azar F, Rezapour A. Health care economics. First ed. Tehran: Ebadifard; 2012. [Persian]
2- vahidi R, saadati M. Determining the distribution of effective factors on out of pocket payment (formal and informal) in hospitalized cardiac patients of Shahid Madani hospital and its side effects on the patient or companions–Iran-Tabriz 2010. Bimarestan, 2013; 11(4): 45-52. [Persian]
3- Ghiasvand H, Hadian M, Maleki M, Shabaninejad H. Determinants of Catastrophic Medical Payments in Hospitals Affiliated to Iran University of Medical Sciences; 2009. Hakim Research Journal. 2010; 13(3): 145-54. [Persian]
4- Karami M, Mobasheri F, Khosravi Shadmani F. tential Impact Fraction of modifying selected risk factors on burden of cardiovascular disease in Iran: comparative risk assessment. Razi journal of medical sciences. 2013; 20(109): 62-71. [Persian]
5- Talebizadeh N, Haghdoost A-A, Mirzazadeh A. Age at natural menopause, An epidemiological model (Markov Chain) of cardiovascular disease in Iran. payesh, 2009; 8(2): 163-70. [Persian]
6- Haji Nabi k, Mahnazar S. The relationship of health insurance funds with heart disease hospitalization costs covered by health insurance in Karaj. Journal of Research and Health, 1391; 2(2): 207-13. [Persian]
7- Health IMo. Iran reform of health system 2015 [11/9/2015]. Available from: tahavol.behdasht.gov.ir. [Persian]
8- Dabagh A, Sarafzadegan N, Banifatemi V, Habibi H, Rafie M. Cost of therapeutic modalities of cardiovascular patient in Isfahan University hospitals. Hakim Research Journal, 2004; 6(2): 19-25. [Persian]
9- Hassan Nejad N. Determining the Methods of Financing Health care Costs among Hospitalized Diabetic Patients in Different Types of Insurances. Hospital, 2013; 12(3): 83-90. [Persian]
10- Maher A, ahmadi M, Jamnani A. Identify the method of financing the health system selected countries between the years 20004 see the works of a new generation of financial resources in the health system in Iran. pajohesh eghtesadi, 2008; 8(1): 115-49. [Persian]
11- Hosseiny nasab E, Varharami V. Factors affecting the cost of health care for families in Yazd. Health Administration, 2010; 13(40): 73-80. [Persian]
12- Afana M, Brinjikji W, Cloft H, Salka S. Hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention in the united states are substantially higher than medicare payments. Clinical Cardiology, 2015; 38(1): 13-9.
13- Sadeghi N, Zaree H. The impact of the funding on improving hospital performance. Quarterly monitoring of 0, 1388; 16: 145-135. [Persian]
14- Mosadegh Rad A. To what extent health reform plan economically for the benefit of the state and the people? Revised on 5 November 2014, the http://tums.isna.ir/Default.aspex?NSID=5&SSLID=46&NID=15676; 2014.[Persian]
15- Azami A, Akbarzade K. Patient satisfaction in hospitals of Ilam. J Ilam Univ Med Sci, 2004; 45(12): 10-16. [Persian]
16- Boerma T, Eozenou P, Evans D, Evans T, Kieny MP, Wag staff A. Monitoring progress towards universal health coverage at country and global levels. Plops Med. 2014; 11(9): e1001731. doi: 10.1371/journal.pmed.
17- Gunther M, Alligood MR. A disciplinespecific determination of high quality nursing care. J Adv Nurs, 2002; 38(4): 353-359.
18- Akhondzade R. Health system transformation project, an opportunity or a threat for doctors (Editorial). Journal of Anesthesiology and Pain (JAP), 2014; 5(1): 1-2. [Persian]
19- Sang S, Wang Z, Yu C. Evaluation of Health Care System Reform in Hubei Province, China. Int J Environ Res Public Health, 2014; 11: 2262-77.