A comparative study on the effect of the California Book and relative value of services on the costs of hospitalization for common surgeries in selected hospitals of Sanandaj, Iran

Document Type : Original Article


Bs in Nursing, Iran Health Insurance Organization of Kurdistan, Sanandaj, Iran


Introduction:Tariff determination is one of the important tools for policy making which governments use to intervene in the health market. The aim of this study was to compare California Book effect and relative value of services on the costs of hospitalization for common surgeries in selected hospitals of Sanandaj, Iran before and after the implementation of National Healthcare Reform Program (NHRP).
Methods: This semi-experimental study using before and after method was conducted on medical records of patients underwent surgeries in Tohid and Besat hospitals, Sanandaj, Iran that insured by Iran Health Insurance Organization in 2015. Data were collected from medical records of patients who underwent surgeries including; cataract, tonsillectomy-adenoidectomy, pilonidal sinus, cholecystectomy, delivery, cesarean section, curettage, abortion, appendectomy and anterior-posterior colporraphy. The data included the total cost, organization share, and patient share, the share of subsidies, out-of commitment and final payment.
Results:After the implementation of National Healthcare Reform Program the average cost of common surgical procedures showed 80.8% growth. The highest average growth rate of organization share was for abortion with 125.1% growth and the lowest average growth rate of organization share was for anterior-posterior colporraphy with 46.3% growth. In terms of the share of subsidies anterior-posterior colporraphy with 299.8% had the highest and delivery with a negative growth of 7.6% had the lowest share of the subsidies.
Conclusion: After the implementation of National Healthcare Reform Program the cost of surgery has doubled and additional burden has been inflicted on the health insurance organization to contribute the organization's share. Therefore, the organization's commitment to public and private health service providers was delayed.


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