هزينه هاي خدمات تحت پوشش نظام بازپرداخت بيمارستاني گلوبال در دانشگاه علوم پزشكي تهران

Costs of services covered by the global payment system in Tehran University of Medical Sciences

مطالعه حاضر با هدف بررسي هزينه هاي 90 خدمت نظام بازپرداخت بيمارستاني گلوبال در دانشگاه علوم پزشكي تهران انجام شده است. روش بررسي اين مطالعه توصيفي- مقطعي كاربردي بر مبناي اطلاعات بيماران مراجعه كننده به بيمارستان هاي دانشگاه علوم پزشكي تهران از ابتداي فروردين 1396 تا پايان اسفند 1397 انجام شده است. داده هاي صورتحساب و پرونده كليه بيماران از سيستم هاي اطلاعات بيمارستان ها (HIS) استخراج گرديد و با استفاده از آمارهاي توصيفي در SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) و (Excel, 2016, Microsoft, USA) تحليل شد. يافته ها طي دو سال 143.866 خدمت گلوبال در دانشگاه علوم پزشكي تهران انجام شده بود كه حدود 2.300 ميليارد ريال هزينه داشته است. 80% كل خدمات و هزينه ها مربوط به 10 خدمت بوده اند. متوسط هزينه به ازاي هر خدمت حدود 16 ميليون ريال بود اما به ازاي خدمات مختلف تفاوت بسياري داشته و از حدود 67 ميليون ريال تا 1/8 ميليون ريال نوسان داشته است. به طور متوسط براي هر خدمت سهم هر يك از زيرگروه هاي هزينه اي خدمات تشخيصي، هتلينگ و خدمات پرستاري، دارو و لوازم مصرفي، اتاق عمل و جراحي، ويزيت و مشاوره پزشك به ترتيب 3/1%، 11/6%، 21/4%، 49/9% و 13/9% بوده است. نتيجه گيري مديران بيمارستان ها براي كاهش هزينه و زيان مالي ناشي از خدمات گلوبال بايد بر خدمات با فراواني بالا و خدمات با هزينه بالا متمركز شوند. متناسب با الگوي هزينه اي ويژه هر خدمت نيز راهبردهاي اتخاذ شده براي كنترل هزينه هاي آن خدمت بايد متفاوت باشد.

In Iran, a combination of three methods of budget payment, fee for service and case-based payment (known as the global payment system) is used to reimburse the cost of hospital services. The aim of this study was to investigate the costs of 90 services of the Global Hospital Reimbursement System at Tehran University of Medical Sciences. Methods: This descriptive cross-sectional applied study was performed from March 2017 to March 2019 in the hospitals of Tehran University of Medical Sciences. The billing and record data of all patients whose services were reimbursed on a global payment system basis were extracted from hospital information systems. Data were analyzed using descriptive statistics (frequency mean. std deviation, maximum & minimum) in SPSS 21 and Excel 2016. Results: During two years in TUMS, the costs of services provided to 143,866 patients have been reimbursed based on the global payment system., which had a cost of 2300 billion rials. 80% of the total services and costs were related to 10 services. 78.46% of the cases were related to two specialized groups of ophthalmology and obstetrics and gynecology. 83.17% of the total costs of services reimbursed globally at the TUMS were related to these two specialized groups. The average cost per service was about 16 million Rials, but varied greatly for different services, ranging from about 1.8 million Rials to 67 million Rials. On average, for a global service, the share of each of the cost subgroups of diagnostic services, hoteling and nursing services, medicine and consumables, operating room and surgery, physician's visit and consultation, respectively 3.1%, 11.6%, 21.4%, 49.9% and 13.9%. Conclusion: Managers need to focus on high-frequency and high-cost services to reduce the cost and financial losses for services that are under the global payment system. Depending on the specific cost pattern of each service, the strategies adopted to control the costs of that service should also be different.