بررسي روند شاخص‌هاي عملكردي - اقتصادي يك بيمارستان بزرگ: مقايسه قبل و بعد از اجراي طرح تحول، تعرفه‌ گذاري بر اساس كتاب ارزش‌ هاي نسبي و اجراي دستورالعمل پرداخت مبتني بر عملكرد

Survey on Economic and Performance Indicators of a Big Tertiary Hospital: Before and After Health Care Evolution Plan, Tariff Change and Pay for Performance Instruction Implementation

مقدمه: پژوهش حاضر با هدف تعيين تأثير طرح تحول نظام سلامت و تعرفه‌گذاري بر اساس كتاب ارزش‌هاي نسبي بر شاخص‌هاي مالي و عملكردي بيمارستان امام رضا (ع) مشهد انجام شده است. روش كار: اين مطالعه توصيفي- مقطعي در بيمارستان امام رضا (ع) به روش هزينه‌يابي مبتني بر فعاليت در چهار دوره زماني: قبل و بعد از اجراي طرح تحول نظام سلامت، بعد از ابلاغ كتاب ارزش‌هاي نسبي و يك سال بعد از اجراي طرح تحول در سال 1394 انجام شد. داده‌هاي درآمدي، هزينه‌اي و عملكردي به كمك نرم‌افزار اكسل 2013 تحليل شدند. نتيجه‌گيري: طرح تحول بر شاخصهاي مالي و عملكردي بيمارستان امام رضا (ع) مشهد تأثير مثبت داشته است. اين تأثير در بين اقلام درآمدي و هزينههاي مختلف، به صورت يكسان نبوده است.

Introduction: The aim of this study was to determine the effect of Iran’s health system evolution plan, tariffs change on performance, revenue, and expenditure of a big tertiary hospital in Iran in 2015. Methods: This cross-sectional descriptive study was conducted in a big tertiary hospital, (Imam Reza), in 1394 using activity based costing in four time spans: before and after health system evolution, after tariff change, and one year after the inauguration of the evolution. Data relating performance, revenue, and expenditure were gathered and analyzed using descriptive statistics by Excel 2013 Software. Results: Cost, revenue, and profit of hospital were increased by 31%, 82%, and 4.6% after health system evolution and by 42%, 38%, and 1.7% after tariff change, respectively. Hospital encountered with 17% loss one year after the inauguration of the evolution, however, cost and revenue of hospital were increased 23% and 3%, respectively. The highest change in physician and personnel income with 103% and 91% rise was related to after tariff change. After health system evolution and tariff change, operating room income was increased 33% and 124%, respectively. One year after the inauguration of the evolution, the operating room income didn’t change and the amount of surgeries decreased by 9%. Conclusions: Performance and financial indicators of Imam Reza hospital have been affected substantially by health system evolution; however, it has not equally affected all revenue and expenditure items.