تأثير طرح تحول سلامت بر تعرفه خدمات سلامت: گزارش كوتاه

The impact of health transformation plan on health services fees: brief report

زمينه و هدف: تعرفه‌گذاري خدمات سلامت يكي از اهرم‌هاي كنترل نظام سلامت است كه بر كيفيت، دسترسي و هزينه خدمات سلامت تأثير دارد. اين پژوهش با هدف بررسي تأثير طرح تحول سلامت بر تعرفه خدمات سلامت انجام شد. روش بررسي: اين پژوهش توصيفي و مقطعي به مقايسه تعرفه خدمات سلامت بر اساس كتاب تعرفه كاليفرنيا (پيش از اجراي طرح‌ تحول سلامت) و كتاب ارزش‌هاي نسبي خدمات و مراقبت سلامت ايران (پس از اجراي طرح ‌تحول سلامت) پرداخت. يافته‌ها: كتاب كاليفرنيا و كتاب ارزش‌هاي نسبي جديد در 13 گروه تخصصي به‌ترتيب شامل 5281 و 3448 كد خدمت بودند (كاهش 34/7 درصدي). كتاب كاليفرنيا و كتاب ارزش‌هاي نسبي جديد به ترتيب تعداد 64985/9 و 125133/6 K جراحي (افزايش 92/6 درصدي) و 25976 و 22307 K بيهوشي (كاهش 14/1 درصدي) در تمامي 13 گروه تخصصي در نظر گرفته بودند. ارزش نسبي خدمات به طور ميانگين 1/9 برابر شد. نتيجه‌گيري: اجراي طرح تحول سلامت منجر به افزايش حدود دو برابري تعرفه‌هاي خدمات و مراقبت‌هاي سلامت شد كه بار مالي زيادي بر سازمان‌هاي بيمه سلامت وارد ساخت.

Background: Tariff setting in healthcare is an important control knob affecting the quality, access and cost of services. As part of Iran Health Transformation Plan (HTP) in 2014, the relative value of health care and services was increased to motivate healthcare providers to deliver high quality services. This study aimed to examine the impact of HTP on health services tariffs. Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared. Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average. Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.