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Arch Iran Med. 2024;27(10): 580-587.
doi: 10.34172/aim.31106
PMID: 39492565
PMCID: PMC11532652
Scopus ID: 85206828421
  Abstract View: 338
  PDF Download: 231

Original Article

The Gap Between the Actual Cost and Tariffs of Global Surgical Procedures: A Retrospective Cross-sectional Study in Qazvin Province, Iran

Ehsan Zarei 1 ORCID logo, Maedehsadat Hashemi 2, Pouria Farrokhi 3* ORCID logo

1 Department of Health Service Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Health Service Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
*Corresponding Author: Pouria Farrokhi, Email: pouriafarrokhi73@gmail.com

Abstract

Background: Iran’s healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran’s public hospitals.

Methods: This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP’s actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap.

Results: The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B=1.05, 95% CI: 0.76-1.35, P<0.001), females (B=26.7, 95% CI: 15.5-37.9, P<0.001), patients with a longer stay (B=81.2, 95% CI: 77.5-84.8, P<0.001), and procedures performed by full-time surgeons (B=67.3, 95% CI: 56.9-77.5, P<0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B=346.9, 95% CI: 214.3-479.5, P<0.001).

Conclusion: Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs.


Cite this article as: Zarei E, Hashemi M, Farrokhi P. The gap between the actual cost and tariffs of global surgical procedures: a retrospective cross-sectional study in Qazvin province, Iran. Arch Iran Med. 2024;27(10):580-587. doi: 10.34172/aim.31106
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Submitted: 01 Apr 2024
Accepted: 11 Sep 2024
ePublished: 01 Oct 2024
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