Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Pattern of Costs by the Health Insurance Organization for the People in Urban Areas with Population under Twenty Thousands and Nomads in Isfahan Province, Iran, 2009-2013

Document Type : Original Article (s)

Authors
Reza Khadivi 1
Ahmad Saebian 2
Mahdi Khosravi 3
Reyhaneh Nasehi 4
1 Associate Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Practitioner, Isfahan Health Insurance Organization, Isfahan, Iran
3 Network Development and Health Promotion Unit, Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran
4 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Family physician program, through the expansion of insurance coverage for all, had been performed in Iran since 2005. This study aimed to survey the pattern of costs by the Health Insurance Organization, for the people covered by family physician program in Isfahan Province during 2009-2013.Methods: In a cross-sectional study in 2014, documents of the current final costs of the Health Insurance Organization and the Deputy of Health, Isfahan University of Medical Sciences, in the family physician program in the rural areas, urban areas with population under twenty thousands and nomads in Isfahan province during 5 years, from 2009 until 2013, were studied. The collected and analyzed data on the current costs of health care in the outpatient departments consisted of two parts: the cost of outpatient visits (including general practitioners and specialists) and all the costs of medical, laboratory and radiology applied, as well as all hospital costs of people covered by family physician.Findings: The referral load to specialists and subspecialists decreased from 0.46 times per person in 2009 to 0.39 in 2013 in the covered population. The trend of inpatient admissions decreased from 63.09 times per thousand in 2009 to 53.99 in 2013 in the covered population, too.Conclusion: Referring to specialists and subspecialists and inpatient care decreased after applying of family physician program.
Keywords
Health sector reform
Family physician program
Cost of health insurance coverage
Iran
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Journal of Isfahan Medical School
Volume 33, Issue 366 - Serial Number 366
November and December 2016
Pages 2341-2350

  • Receive Date 31 May 2015
  • Accept Date 06 April 2022