Identifying and Prioritizing Cost Containment Approaches for Iran Hospitals from Health System Perspective

Trying to contain hospital costs is one of the biggest challenges facing the Iranian health system. In this study, we attempted to identify the key factors affecting hospital costs, hospital cost containment approaches, and to tailor intervention packages accordingly.

This study was conducted in three stages. In the first stage, by searching databases and expanding the total cost formula for a hospital from the health system perspective, key factors affecting hospital costs were identified. In the second stage, cost control approaches, intervention packages, and their prioritization criteria were identified in a panel of experts with the participation of 4 faculty members of the School of Management and Medical Informatics. In the third stage, the matrix scoring for intervention packages was completed and prioritized by 21 hospital managers.

By expanding the formula of the total cost (C=P×Q), three factors of technology, productivity, and inflation in the Price field (P), and three factors of covered population, Utilization and overuse in the Quantity field (Q) were identified. For these key factors, 17 components were identified, which 9 components were intervenable. Then, based on expert panel members' opinion, 10 intervention packages were defined. These packages were prioritized by five criteria including: "effectiveness, appropriateness, feasibility, efficiency, and painlessness". Finally, the five most important intervention packages were selected as: "prevention of inappropriate use of services", "production of low-cost hospital services", "reducing inpatient costs", " containing drug costs" and " containing capital medical equipment costs" respectively.

Considering financing problems of the Iran health system, attention to cost containment approaches is very important especially from the health system perspective. This study showed that by identifying key cost factors and cost control approaches, special intervention packages could be formulated that are relatively painless and in line with upstream policies.