Volume 28, Issue 3 (Iran South Med J 2025)
Iran South Med J 2025, 28(3): 688-713 |
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Omranikhoo H, Shahbazifard M, Ardaneh M, Rezaee M. Retrospective or Prospective Reimbursement Systems: Evaluating the Efficiency of the Global Payment System in Public Hospitals in Bushehr Province. Iran South Med J 2025; 28 (3) :688-713
URL: http://ismj.bpums.ac.ir/article-1-2343-en.html
URL: http://ismj.bpums.ac.ir/article-1-2343-en.html
1- Department of Management, Economics and Health Policy, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
2- Epidemiology Department, School of Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Biostatistics and Epidemiology, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
3- Department of Management, Economics and Health Policy, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran ,m.rezaee8666@yahoo.com
2- Epidemiology Department, School of Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Biostatistics and Epidemiology, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
3- Department of Management, Economics and Health Policy, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran ,
Abstract: (229 Views)
Background: Reimbursement systems play an important role in controlling costs and improving hospital efficiency. This study aimed to compare the billing costs of procedures subject to global tariffs with the notified tariffs for the same procedures to determine the efficiency of the global reimbursement method in hospitals affiliated with Bushehr University of Medical Sciences.
Materials and Methods: This cross-sectional descriptive-analytical study examines data related to 12,527 procedures covered by the global tariff in 2022 in eight government hospitals in Bushehr Province, Iran. The required information was obtained through the Hospital Information System (HIS) and then analyzed using SPSS version 26 software.
Results: The results showed that the global payment system (prospective) was able to cover 93% of hospital billing costs compared to fee-for-service (retrospective). Hospital profits were significant for part-time doctors, male doctors, male patients, and in services such as neurosurgery and ophthalmology. Meanwhile, the largest losses imposed on hospitals were دrelated to the obstetrics and gynecology department. Also, profitable patients usually had shorter hospital stays and imposed lower costs on the hospital for medication, paraclinical services and accommodations.
Conclusion: Global payment system can effectively reduce hospital costs and increase productivity. In addition, it seems that in some cases global tariffs are not able to cover real costs and these tariffs should be revised. The findings can be used as a basis for decision-making by health policy-makers.
Materials and Methods: This cross-sectional descriptive-analytical study examines data related to 12,527 procedures covered by the global tariff in 2022 in eight government hospitals in Bushehr Province, Iran. The required information was obtained through the Hospital Information System (HIS) and then analyzed using SPSS version 26 software.
Results: The results showed that the global payment system (prospective) was able to cover 93% of hospital billing costs compared to fee-for-service (retrospective). Hospital profits were significant for part-time doctors, male doctors, male patients, and in services such as neurosurgery and ophthalmology. Meanwhile, the largest losses imposed on hospitals were دrelated to the obstetrics and gynecology department. Also, profitable patients usually had shorter hospital stays and imposed lower costs on the hospital for medication, paraclinical services and accommodations.
Conclusion: Global payment system can effectively reduce hospital costs and increase productivity. In addition, it seems that in some cases global tariffs are not able to cover real costs and these tariffs should be revised. The findings can be used as a basis for decision-making by health policy-makers.
Keywords: Reimbursement mechanisms, Fees and charges, Surgical procedures, Operative, Efficiency, Healthcare systems
Type of Study: Original |
Subject:
Healthcare management
Received: 2025/08/2 | Accepted: 2025/10/27 | Published: 2025/12/27
Received: 2025/08/2 | Accepted: 2025/10/27 | Published: 2025/12/27
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