Investigating the type, causes and amount of health insurance deductions in teaching hospitals of Ferdows city

One of the effective ways to improve the quality-of-care services is to prevent the wastage of resources in health-treatment centers and hospitals by identifying the relevant causes. This study was conducted with the aim of investigating the type, causes, and amount of health insurance deductions in the teaching hospitals of Ferdows city.

The current descriptive research is a study that was conducted in 2021 in two teaching hospitals in Ferdows city. The research population included the inpatient and outpatient medical records of these two hospitals. The data collection tool was a checklist made by the researchers, confirming its validity. The collected data were analyzed using Excel software and descriptive statistics.

Most deductions and their causes in the reviewed cases are respectively related to the laboratory (due to the absence of a technical officer), and consumables (due to the lack of insurance commitment for some equipment and price increase requests). The lowest deductions in the investigated cases are related to medicine (due to the request for an excessive amount of medicine), anesthesia (due to the demand for an additional amount of anesthesia), and prosthetics (due to the request for an additional price). Findings showed that in both hospitals, the highest number of deductions are related to inpatient cases.

Correct information in medical files and also the presence of the technical officer in different hospital departments play important roles in reducing hospital deductions. Therefore, a proper decision and policy should be made in this regard.