Causes of Deductions Insurer to Document the Treatment of Patients in one Hospital in Iran

Decreasing the deductions made by insurance companies would play a significant role in providing the sources required for providing good services to patients. This study aimed to investigate the reasons for which insurance companies make reductions in the medical documents in a hospital subordinate to Shahroud University for Medical Sciences. This is an applied research which was conducted in a cross-sectional procedure in 2011. The required data were collected through a questionnaire which included 5 general and 37 specific items on the reasons for deductions. The questionnaires were completed directly by the researchers who referred to the contracted insurance companies. The data were entered into SPSS and analyzed through one-way ANOVA and Pearson; the results were displayed in frequency tables. The highest percentage of deductions belonged to armed forces (6.24%), and the lowest belonged to East Alborz Coal Company (0.33%). The least reasons of deductions belonged to the visit fees of physicians in outpatients’ prescriptions (2.09%). Regarding the specified groups, deductions of visits in Social Security Organization’s prescriptions (64.18) were ranked first and were followed by 21.94%. The main reasons for deductions in insurance documents included not accepting day beds, nursing services and high statistics of C-section compared to natural delivery. No significant relationship was observed between the deduction amount and the months of the year. However, a significant relationship was found between the amount of deductions and the type of insurance companies, and the number of sent admission documents (p 0.05). Organizing training sessions for specialists, ward authorities, and medical documents attendants, and more interactions with insurance companies as well as using systems of hospital data management can play an important role in reducing the amount of deductions.