Comparing the Billing Cost of Global Childbirth Surgeries (Natural, Cesarean Section) with the Tariff Approved by the Supreme Insurance Council: A Descriptive Study

Global reimbursement is a hospital payment method. In some global surgeries, the billing cost of treatment differs from the tariff set by the Supreme Council of Insurance, leading to financial losses for hospitals or insurance companies. This study compares the billing costs of childbirth services with the approved tariffs.

This descriptive-analytical study examined the billing costs of all childbirth cases (natural and cesarean section) covered by health insurance at three specialized maternity hospitals (A, B, C) in Tehran province in 1400. Data were sourced from health insurance company dashboards, compiled in Excel, and analyzed using SPSS software.

The study evaluated 3,742 childbirth cases, with 35% being natural births and 65% cesarean sections. The comparison between billing costs and approved tariffs showed that Hospital A's costs for both natural and cesarean childbirths exceeded the set tariffs. However, the billing costs in the other two hospitals were below the approved tariffs. Additionally, the actual hospitalization days for cesarean sections were shorter than those covered by the tariff in all three hospitals.

This study highlights variations in childbirth billing costs compared to the approved global tariffs across different hospitals. These findings underline the necessity of cost control in hospitals and suggest a need to revise the approved tariffs to align with the actual hospitalization duration for patients.