A trend analysis of surgical operations under a global payment system in Tehran, Iran (2005-2015)
Keywords:
Global Payment System, Time Series Analysis, Surgical Operation, IranAbstract
Background: Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran. Objective: The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations. Methods: In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005-2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed. Results: Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p<0.05) and N32, N43, N81 and N90 showed a significant downward trend (p<0.05). Similarly, all H Codes except for H18 had a significant upward trend (p<0.000). As such, K Codes including K45, K56 and K81 had an increasing movement. S Codes also experienced both increasing and decreasing trends. However, none of the O Codes changed according to time. Other global surgical codes like C61, E07, M51, L60, J98 (p<0.000), I84 (p<0.031) and I86 (p<0.000) shown upward and downward trends. Total global surgeries trend was significantly upwards (B=24.26109, p<0.000). Conclusion: The varying trend of global surgeries can partly reflect the behavior of service providers in order to increase their profits and minimize their costs.
References
Rosen B. Professional reimbursement and professional behavior: emerging issues and research challenges.Social Science & Medicine. 1989; 29(3): 455-62. doi: 10.1016/0277-9536(89)90294-3.2)Wynia MK, Cummins DS, VanGeest JB, Wilson IB. Physician manipulation of reimbursement rules forpatients: between a rock and a hard place. JAMA. 2000; 283(14): 1858-65. doi: 10.1001/jama.283.14.1858.3)Jacobs VR, Fischer T. APragmatic Guide on How Physicians Can Take Over Financial Control of TheirClinical Practice. JSLS. 2012; 16(4): 632. doi: 10.4293/108680812X13517013316438.4)Shrank W, Ettner SL, Slavin PH, Kaplan HJ. Effect of physician reimbursement methodology on the rateand cost of cataract surgery. Archives of ophthalmology. 2005; 123(12): 1733-8. doi:10.1001/archopht.123.12.1733.
Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. The Experience of Risk-Adjusted CapitationPayment for Family Physicians in Iran: A Qualitative Staudy. Iran Red Crescent Med J. 2016; 18(4):e23782. doi: 10.5812/ircmj.23782. PMID: 27340558, PMCID: PMC4916528.6)Pillay TD, Skordis-Worrall J. South African health financing reform 2000–2010: Understanding theagenda-setting process. Health policy. 2013; 109(3): 321-31. doi: 10.1016/j.healthpol.2012.12.012. PMID:23337113.7)Lagarde M, Blaauw D. Physicians’ responses to financial and social incentives: A medically framed realeffort experiment. Soc Sci Med. 2017; 179: 147-59. doi: 10.1016/j.socscimed.2017.03.002. PMID:28279924.8)McPherson E, Hedden L, Regier DA. Impact of oncologist payment method on health care outcomes, costs,quality: a rapid review. Bio Med Central (BMC). 2016; 5: 160. doi: 10.1186/s13643-016-0341-2.9)Jegers M, KestelootK, De Graeve D, Gilles W. A typology for provider payment systems in health care.Health policy. 2002; 60(3): 255-73. doi: 10.1016/S0168-8510(01)00216-0.10)Melichar L. The effect of reimbursement on medical decision making: Do physicians alter treatment inresponse to a managed care incentive? Journal of health economics. 2009; 28(4): 902-7. doi:10.1016/j.jhealeco.2009.03.004.11)Liu X, Mills A. The influence of bonus payments to doctors on hospital revenue: results of a quasi-experimental study. Applied healtheconomics and health policy. 2002; 2(2): 91-8. PMID: 14619280.12)Jang S, Nam CM, Lee SG, Kim TH, Park S, Park E. Impact of payment system change from per-case toper-diem on high severity patient’s length of stay. Medicine (Baltimore). 2016; 95(37): e4839.doi:10.1097/MD.0000000000004839. PMID: 27631239, PMCID: PMC5402582.13)Siddiqui M, Joy S, Elwell D, Anderson GF. The National Commission on Physician Payment Reform:Recalibrating Fee-for-Service and Transitioning to Fixed Payment Models. J Gen Intern Med.2014; 29(5):700–2. doi: 10.1007/s11606-014-2785-1. PMID: 24573711, PMCID: PMC4000324.14)Langenbrunner J, Cashin C, O'Dougherty S. Designing and Implementing Health Care Provider PaymentSystems How-To-Manuals. The International Bank for Reconstruction and Development/ The World Bank.2009: 130. doi: 10.1596/978-0-8213-7815-1.15)Molavi Verdkejani H, Kamyabi A, Jabarizadeh A, Haghdoust A. Methods of remuneration of generalpractitioners in the world: a Systematic Review on International Documents. Journal of medical council ofislamic republic of iran. 2012; 30(4): 379-89.16)Safdari R, Ghazi Saeidi M, Goudini A, Monajemi F. Study comparative payment mechanism healthinsurance in United states of America, Australia and Iran, 87-88. Teb. 2010; 19(2): 41-51.17)Comparingthe global average of invoicingoperations in civilian hospitals of Social Security Organizationwith approved tariff in the first six months of 2009. Department of Economics and planning of treatmentSocial Security Department. 2010.18)Robinson JC. Theoryand practice in the design of physician payment incentives. Milbank Q. 2001; 79(2):149-77. doi: 10.1111/1468-0009.00202. PMID: 11439463, PMCID: PMC2751195.19)Chen B, Fan YV. Strategic provider behavior under global budget payment with price adjustment inTaiwan. Health economics. 2015; 24(11): 1422-36. doi: 10.1002/hec.3095.20)Di Giorgio L, Filippini M, Masiero G. Implications of global budget payment system on nursing homecosts. Health policy. 2014; 115(2): 237-48. doi: 10.1016/j.healthpol.2014.01.017.21)Kantarevic J, Kralj B. Risk selection and cost shifting in a prospective physician payment system: Evidencefrom Ontario. Health policy. 2014; 115(2): 249-57. doi: 10.1016/j.healthpol.2013.10.002.22)Thompson MJ, McCue JM. Performance of freestanding inpatient rehabilitation hospitals before and afterthe rehabilitation prospective payment system. Health Care Manage Rev. 2010; 35(1): 36-45. doi:10.1097/HMR.0b013e3181b475de. PMID: 20010011.23)Herwartz H, Strumann Ch. Hospital efficiency under prospective reimbursement schemes: an empiricalassessment for the case of Germany. Eur J Health Econ. 2014; 15: 175–86. Doi: 10.1007/s10198-013-0464-5.24)Hamada H, Sekimoto M, Imanaka Y. Effects of the per diem prospective payment system with DRG-likegrouping system (DPC/PDPS) onresource usage and healthcare quality in Japan. Health Policy. 2012;107(2): 194-201. doi: 10.1016/j.healthpol.2012.01.002.25)Arab M, Zeraati H, Ravangard R, Gholinejad A, Rasooli A. Comparing global-operations reimbursementswith their actual costs in theCancer Institute, Tehran. Journal of School of Public Health and Institute ofPublic Health Research. 2008; 6(2): 59-66.
Published
Issue
Section
License
Copyright (c) 2020 Knowledge Kingdom Publishing
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
