تحليل ارزش نسبي بين رشته‌هاي تخصصي پزشكي با استفاده از كتاب جديد ارزش‌هاي نسبي خدمات مراقبت سلامت ايران

A cross- specialty analysis of relative values in the new version of Iranian relative values for physician

زمينه و هدف: كتاب جديد ارزش‌هاي نسبي خدمات تشخيصي درماني در سال 1393 و به‌منظور برطرف كردن اشكالات فراوان موجود در كتاب تعرفه پيشين تدوين و ملاك محاسبه قرار گرفت. از جمله اهداف كتاب جديد رعايت بيشتر توازن بين رشته‌اي در محاسبه تعرفه خدمات تشخيصي-درماني و عادلانه‌تر نمودن تعرفه‌ها براي انجام اعمال تخصصي و فوق‌تخصصي بود. هدف مطالعه كنوني تحليل ارزش نسبي بين رشته‌هاي تخصصي پزشكي با استفاده از اين كتاب بود. روش بررسي: اين پژوهش از نوع توصيفي-تحليلي بود كه به تعيين و مقايسه ميانگين ارزش‌هاي نسبي خدمات مراقبت سلامت بين تخصص‌هاي مختلف پزشكي براساس كتاب ارزش نسبي خدمات ‌سلامت ايران از مهر 1396 تا مرداد 1397 در دانشگاه علوم پزشكي اصفهان پرداخت. يافته‌ها: جراحي فك و صورت و جراحي مغز و اعصاب با 62/81 و 60/47 واحد (0/001P<) بالاترين ميانگين و جراحي چشم و جراحي زنان و زايمان با 28/95 و 28/81 واحد (0/001P<) پايين‌ترين ميانگين را به خود اختصاص دادند. از بين فوق تخصص‌ها نيز فوق تخصص جراحي قلب و عروق با 85/25 واحد (0/001P<) بالاترين ميانگين ارزش نسبي و جراحي پلاستيك با 50/51 واحد (0/001P<) پايين‌ترين ميانگين ارزش نسبي را به خود اختصاص دادند. نتيجه‌گيري: نتايج مطالعه نشان داد كه تفاوت معنادار ميان ميانگين ارزش‌هاي نسبي در رشته‌هاي تخصصي و فوق تخصصي وجود دارد. با توجه به اينكه ارزش‌هاي نسبي خدمات با توجه به فاكتورهايي مانند مهارت و تخصص مورد نياز، ريسك عمل جراحي براي پزشك و بيمار، تعيين شده‌اند تفاوت مشاهده‌شده بين رشته‌هاي مختلف توجيه‌پذير به‌نظر مي‌رسد.

Background: The new version of relative values of diagnostic medical services was published in 2014. It was criticized that the previous edition was suffering from an imbalance between relative values related to various specialties and sub-specialties. The main aim of the new edition of the book was to address this problem by providing more balance relative values related to various specialties and sub-specialties. So far, there have not been studies to analyze to what extent the new addition has been succeeded to reach its main goals. The aim of this study was to provide a cross-specialty analysis of the new edition of Iranian relative values for physicians. To our knowledge, this analysis has been performed for the first time in Iran. Methods: Having reviewed description for each relative value, each of them has been assigned to one or more corresponding specialty or subspecialty. Only relative values for surgical operations were considered and finally 3238 procedures have been recognized to be included in the analysis. The latest version of Iranian relative values for physician was considered for this analysis. In order to compare the average relative values among various specialties and subspecialties, analysis of variance (ANOVA) and Tukey's post-hoc test was used. Results: Oral and maxillofacial surgery and neurosurgery get the highest (62.81, 60.47 (P<0.001)) and ophthalmology and obstetrics and gynecology get the lowest (28.95, 28.81 (P<0.001)) average relative value. Cardiovascular surgery and plastic surgery get the highest and the lowest (85.25, 50.51 (P<0.001)) average among subspecialties, respectively. Conclusion: The average relative values are significantly different among specialties and subspecialties. Seeing the difference, itself sounds logical as the job of relative values are to make a difference based on various criteria such as the time and skill needed for each operation, the potential risk for patient and provider it may have, etc. The results of this study provide evidences on how much these differences are. However, if these differences are as there should be needs to be analyzed by further research.