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

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

References

  1. Roberts M, Hsiao W, Berman P, Reich M. Getting health reform right: A guide to improving performance and equity. Oxford, UK: Oxford University Press; 2008.
  2. 4th Five Year Social, Cultural and Economical Developmental Plans of the Islamic Republic of Iran 2005-2009 [Online]. [cited 2012 Aug 10]; Available from: http://rc.majlis.ir/fa/law/show/94202. [In Persian].
  3. Gressani D, Saba J, Fetini H, Rutkowski M, Maeda A, Langenbrunner J. Islamic Republic of Iran health sector review. vol. 1: Main report. The World Bank Group Human Development Sector Middle East and North Africa [Online]; [cited 2007 Jun]; Available from: URL:medolympiad.behdasht.gov.ir/uploads/280_954_First_Modiriat3.pdf
  4. Ministry of Health and Medical Education, Center for Network Development and Health Promotion operational guide for family physician and rural insurance project implementation. Version 10 (Revised). Tehran, Iran: Ministry of Health and Medical Education: 2009. p. 5-31. [In Persian].
  5. Odeyemi IA, Nixon J. Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis. Int J Equity Health 2013; 12: 9.
  6. Kazemian M, Aljunid S. Iran's National Health Accounts: Years 1971-2001, Analytical Framework and Methodological Issues. Malaysian Journal of Public Health Medicine 2005; 5(Suppl 2): 13.
  7. Golalizade E, Moosazade M. The Impact of the Family Medicine Program on the number of outpatient visits in Mazandaran University of Medical Sciences health centers. J Med Counc I.R. Iran 2013; 31(1): 9-14. [In Persian].
  8. Khadivi R, Yarahmadi A, Eslamieh R, Khosravinejad M. The drug prescription patterns and utilization after family physician program implementation in rural health centers of Isfahan District, Iran. J Isfahan Med Sch 2014; 31(271): 2403-11. [In Persian].
  9. Takian A, Rashidian A, Kabir MJ. Expediency and coincidence in re-engineering a health system: an interpretive approach to formation of family medicine in Iran. Health Policy Plan 2011; 26(2): 163-73.
  10. Khadivi R, Kheyri M, Davari M, Nourbakhsh SMK. Does family physician programme in iran improve financial contribution of patients. International Journal of Current Life Sciences 2014; 4(8): 4383-7.
  11. Hasan O, Meltzer DO, Shaykevich SA, Bell CM, Kaboli PJ, Auerbach AD, et al. Hospital readmission in general medicine patients: a prediction model. J Gen Intern Med 2010; 25(3): 211-9.
  12. Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA 2011; 305(7): 675-81.
  13. Lasser KE, Hanchate AD, McCormick D, Manze MG, Chu C, Kressin NR. The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics. BMJ 2014; 348: g2329.
  14. Chua KP, Sommers BD. Changes in health and medical spending among young adults under health reform. JAMA 2014; 311(23): 2437-9.
  15. Simonet D. Cost reduction strategies for emergency services: insurance role, practice changes and patients accountability. Health Care Anal 2009; 17(1): 1-19.
  16. World Health Organization. The World Health report 2008 - primary health care (now more than ever). Geneva, Switzerland: WHO; 2008.
  17. Bodenheimer T, Grumbach K. Understanding health policy: a clinical approach. 5th ed. New York, NY: McGraw-Hill; 2009. p. 163-783
  18. Rashidian A, Joudaki H, Khodayari-Moez E, Omranikhoo H, Geraili B, Arab M. The impact of rural health system reform on hospitalization rates in the Islamic Republic of Iran: an interrupted time series. Bull World Health Organ 2013; 91(12): 942-9.
  19. Fu R, Wang Y, Bao H, Wang Z, Li Y, Su S, et al. Trend of urban-rural disparities in hospital admissions and medical expenditure in China from 2003 to 2011. PLoS One 2014; 9(9): e108571.
  20. Arredondo A, Zuniga A, Parada I. Health care costs and financial consequences of epidemiological changes in chronic diseases in Latin America: evidence from Mexico. Public Health 2005; 119(8): 711-20.
  21. Knaul FM, Gonzalez-Pier E, Gomez-Dantes O, Garcia-Junco D, Arreola-Ornelas H, Barraza-Llorens M, et al. The quest for universal health coverage: achieving social protection for all in Mexico. Lancet 2012; 380(9849): 1259-79.
  22. Jamshidi HR, Farzadfar F, Naghavi M, Rahbar MR, Jafari N, Khosravi A, et al. Utilization of health service In Islamic Republic of Iran in 2002. Tehran, Iran: Tandis Publications; 2005. p. 154-64. [In Persian].
  23. McWhinney IR, Freeman T. Textbook of family medicine. 3rd ed. Oxford, UK: Oxford University Press; 2009.
Journal of Isfahan Medical School
Volume 33, Issue 366 - Serial Number 366
November and December 2016
Pages 2341-2350

Files

History

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

Share

How to cite

Statistics