IMPACT OF HOSPITAL DEDUCTIONS IMPOSED BY THE SOCIAL SECURITY INSURANCE ON PATIENT’S TEACHING HOSPITALS OF KASHAN

Karami, M and Moini, M and Safdari, R (2011) IMPACT OF HOSPITAL DEDUCTIONS IMPOSED BY THE SOCIAL SECURITY INSURANCE ON PATIENT’S TEACHING HOSPITALS OF KASHAN. The Journal of Urmia Nursing and Midwifery Faculty, 8 (4). pp. 220-228.

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Abstract

Deductions not only waste a large amount of hospitals revenue and reduce hospital finance but also result in financial burden on patients through increasing out of pocket expenditure. This study focused on determining the cause of deduction and the impact of deduction on patient’s expenses. Materials & Methods: This descriptive cross sectional study was conducted in the first half of 2009 in hospitals of Kashan University of Medical Sciences. Research population included 7907 medical records covered by social security insurance among which 7116 had deductions. The data were gathered by standard checklist analyzed through descriptive statistics. Results: The findings revealed that the most important causes of deduction (23648 cases observed) were as follows: request for extra cost (7537); no correct assigning of the K to consultation (318); extra request for consultation (218); request for extra K for consultation (1664); extra K (up coding) for concurrent operations on one site (898); request for extra medication (3276); extra request for anesthesia time (1121); request for extra K (up coding) for anesthesia (322); request for extra modification anesthesia (1103). All the above patients had to pay for extra medication. Conclusion: In order to reduce financial loss imposed on patients, it is crucial that hospitals control the physicians’ functions to prevent or at least to reduce request for extra cost and request for extra K.

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