Relationship Between Hospital Cost Based on Current Procedural Terminology and Out-of-Pocket Payment of Oil Company Retirees

This study aimed to investigate the relationship between hospital cost based on current procedural terminology and patients’ out-of-pocket payment by examining the most common surgical procedures in Oil Company retires, including cataract surgery, coronary angiography, total knee arthroplasty, and total hip replacement. This applied study utilized a descriptive - analytical design. The target population included oil company retires hospitalized in private hospitals in Tehran. The data were collected by examining the medical records archived in the Oil Industry Pension Fund from 2014 to 2015. In total, 920 samples were selected, 459 of which had been gathered before the implementation of Current Procedural Terminology and 461 after its implementation. In the end, the data were analyzed using SPSS V. 20 software by paired t-test and Wilcoxon test. The results of statistical tests showed a significant difference in the direct payment of patients undergoing angiography before and after the implementation of Current Procedural Terminology (P < 0.05). In addition, the Wilcoxon test showed a significant difference in the patient’s franchise for cataract surgery (P = 0.01; Z = -12.07). The health reform plan has increased the out-of-pocket payment in private hospitals. However, it can be reduced by proper monitoring and management.