Volume 28, Issue 111 (11-2019)                   jour guilan uni med sci 2019, 28(111): 45-55 | Back to browse issues page

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GhaedChukamei Z, Golshanei M, Delavari S, Bagheri Tula Rud P. Exploring the Rate and Causes of the Deduction by Health Insurance and Social Security Insurance in an Educational Hospital in Rasht. jour guilan uni med sci. 2019; 28 (111) :45-55
URL: http://journal.gums.ac.ir/article-1-2197-en.html
Abstract:   (552 Views)
Abstract
Introduction: Today, hospitals are faced with severe constraints on financial resources and a large amount of hospital fees are not reimbursed annually by health insurances leading to irreparable financial damages to hospitals. So knowledge of the reasons responsible for such conditions is essential. The purpose of this study was to determine the rate and causes of deductions for social insurance and health insurance applications in a rasht educational hospital.
Objective: Exploring the rate and causes of the deduction by health insurance and social security insurance in an educational hospital in rasht.
Materials and Methods: This study was a cross section one conducted on one of the educational hospitals affiliated with Guilan University of Medical Sciences. Social insurance deductions reported for 2017 were organized by referring to the unit of income with differentiating the type of fraction by determining the minimum and maximum deductions and its relationship with different months of the year as comparative tables The resulting data were analyzed through descriptive statistical methods, using the SPSS software, version 16.
Results: The most deductible applied to social insurance policies with a total of 19,030,679,568 Rials were related to counseling, visit and surgeon, with a total of 38,597,297,828 Rials being related to counseling, visit and pathology in health insurance.
Conclusion: The highest deductions were due to the lack of documentation by personel due to lake of knowledge. Therefore, in order to reduce deductions, the use of a multilateral mechanism, including the formulation of policies on the use of clinical guidelines, the training of doctors and contracting with the doctors who have the most cooperation in this field are recommended.At the same time, continuous explanation and implementation of these activities in the hospital organizing a committee is necessary.
Conflict of interest: non declared
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Received: 2019/11/17 | Accepted: 2019/11/17 | Published: 2019/11/17

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