Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study

Background & Objectives: Deductions applied by insurance companies on sent bills affect the income of hospitals. If hospitals do not pay attention to this issue, it is probable that they do not receive the costs that they have paid even for the provided services. Methods: In this retrospective descriptive study conducted in one of the armed forces hospitals in Tehran in 2015, 6717 medical files belonged to the admitted cases were investigated. The list of reported deductions for admitted cases was prepared using a self-made form that included deduction topics (surgery, anesthesia, services, imaging, laboratory, supplies and equipment, beds, visit and counseling). Results: The highest rate of deduction was due to the additional request for surgery and anesthesia (30% of total deduction). The highest rates of return were respectively related to request lower than tariff rate (78%) and absence of recording services related to surgical activities (17%) and operating room and anesthesia (5%). After identifying these cases, a total of 3270 million Rial was returned to the financial resources of hospital. Conclusion: Some strategies for reducing deductions are transferring affairs related to the registration and identification of outpatient services to the authorities of the units, establishing a system for collecting the experience of personnel and transferring them to the insurance organizations, creating a system for receiving the suggestions and ideas of employees, establishing interactions with the authorities of the contracting insurance companies, having physicians to record correct codes of surgery and services as well as establishing deduction committees. Key¬words: Deduction, Insurance, Armed Forces, Hospital Citation: Vali-pour N, Mosavi-nejad SM, Meshkani Z. Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study. Journal of Health Based Research 2017; 3(2): 141-150

Educational Costs of Residents in a Teaching Hospital: a case study

Background & Objectives: Residents spend much of their time at the hospitals to earn their required educational skills and although they act as a kind of human resource in the hospital, they increase hospital costs. The present study was designed to calculate the share of educational costs of different medical residents in hospitals. Methods: In this descriptive and applied study performed in one of the hospitals affiliated to Iran University of Medical Sciences, the hospital cost items of education of residents in different medical fields during the academic year of 2017-2018 were identified by use of two scenarios. Results: In short, mean educational cost of one resident in the studied academic year was about 5357$based on the first scenario and about 5404$ according to the second scenario. Based on both scenarios, salaries paid to residents accounted for more than 50% of the costs followed by the cost of consumed materials by residents. Forensic Medicine and Anesthesiology residency programs had respectively the lowest and highest share of costs in both scenarios. Conclusion: The cost of training in the hospital is different among residency fields based on the required tests and errors in each field. But, in order to save hospital costs, the culture of optimal use of materials as well as medical equipment should be taught to residents. Key­words: Education Economics, Costing, Direct Costs, Residents, Teaching hospital ­Citation: Aleboyeh MR, Reza pour A, Meshkani Z, Alipour V, Soleimani movahed M. Educational Costs of Residents in a Teaching Hospital: a case study. Journal of Health Based Research 2019; 5(2): 117-30

Inequality in Distribution of Human Resource in Health Sector: Case Study of Dentists in Fars Province

Background & Objectives: Oral and dental disorders have a significant role in the development of diseases such as respiratory and cardiovascular diseases and diabetes. So prevention of oral and dental problems should be one of the most important health system priorities. On the other hand, the fair distribution of dentists for a full coverage of the whole country is not suitable. In this study, the distribution of dentists and their density in Fars province were investigated. Methods: In this descriptive study, population statistics of Fars Province, as well as the number of active dentists in the public sector in each county in 2015 And 2016 were obtained from the Iranian Statistics Center and the Deputy of Health of Fars province. Finally, using the Gini and Robin Hood indices, the distribution of dentists was studied. Results: Gini index for dentists in 2015 and 2016 was calculated as 0.32 and 0.27, respectively, and 503 and 485 dentists had to be redistributed in order to achieve a complete equality. Accordingly, the number of dentists in the city of Shiraz should be reduced in order to be redistributed in other cities. Conclusion: Health care policy makers should distribute dentists in different parts of the country according to their needs and based on the extent of deprivation of the areas, the success rate of past interventions in maintaining human resources, and the increasing or decreasing trend of the Decay-missing-filled teeth index in recent years. Key¬words: Dentists, Equal distribution, Redistribution, Service benefits, Gini index, Robin Hood index Citation: Moalemi S, Meshkani Z, Moosavi Nejad SM, ValipourYekani N. Inequality in Distribution of Human Resource in Health Sector: Case Study of Dentists in Fars Province. Journal of Health Based Research 2018; 4(3): 261-72. [In Persian

Analysis of Cost Price and Net Profit of Laboratory: Case Study of Iran

Diagnostic services are regarded as important hospital services, which are very costly due to the use of advanced technologies and facilities, and it seems so necessary to calculate and analyze the costs thereof. Understanding the profitability of lab services by traditional and ABC method that provided by military units is the purpose of the study. This study was an applied retrospective study that conducted in a lab of Iran in a hospital of military unit in 2015. After identifying the overhead and final centers, costs related topics were collected, and cost price of the final services was calculated using Activity-Based Costing method. Calculated cost of services had been consequently compared average tariff of common services using the principles of sharing. According to the results, there were deviations between average service tariff and per admission, and most services provided to armed forces were losing. The lab was no profitable in both methods but losses in ABC were more estimated. For Pathology, Blood Bank, Biochemistry, and Hematology tests, we were witnessing the greatest deviation from the tariff but Immunology, Serology and Microbiology tests were profitable

Comparing the Results of two Cost Sharing Approaches in Calculating the Cost of Hospital Services: a case study

Background & Objectives: Calculation of hospital services costs, especially the allocated costs, is a complicated process due to the great number of hospital services, as well as the interdependence between different centers. Considering the interrelationships between all departments in the hospital, cost analysis is possible only through the mutul sharing approach, which can provide more accurate information for researchers and managers in order to decide on a costs analysis. Methods: The present study was a descriptive study that was conducted in 2017 in a selected educational hospital affiliated to Iran University of Medical Sciences. Data collection was done through observation, interview and investigating financial documents. After identifying the active centers and the appropriate cost drivers, the cost of important services in final sectors was calculated by using two methods of one-way sharing and mutual sharing through simultaneous equations. Results: In comparison of one-way and mutaul sharing approach, all overhead, intermediate and total costs showed deviation. The greatest deviation between these two approaches was found in the parturition and ophthalmology departments and related to the cesarean with 16 million rials and the lacrimal duct cathetering with 13 million rials, respectively. Conclusion: The findings of this study showed that if hospitals managers calculate their services costs by activity-based cost and through mutual cost sharing approach, they can benefit from the correct costreportings and by having a clear image can make management decisions appropriately. Key¬words: Activity-based costing, One-way sharing, Mutual sharing, Teaching hospital Citation: Alipour V , Rezapour A , Meshkani Z, Farabi H, Mazdaki A, Hakimi N. Comparing the Results of two Cost Sharing Approaches in Calculating the Cost of Hospital Services: a case study. Journal of Health Based Research 2018; 4(3): 273-87. [In Persian

The Cost of Internal and Neurosurgery ICUs in a Selected Teaching Hospital: A Case Study

Background & Objectives: Intensive Care Unit (ICU) is the most important units in hospitals, which imposes high costs to patients. This unit is considered as one of the high-cost unit for providing End-of-Life Services. The cost analysis of the ICUs can help managers decide on how to provide the services of this unit. Methods: In this descriptive study, the total cost of Internal and Neurosurgery ICUs in a selected teaching hospital affiliated to Iran University of Medical Sciences in 2017, was evaluated using top-down approach. The financial records of the units and data on the cost drivers were collected from accounting and related units, respectively. Results: About 7% of the total hospital costs was related to the ICUs. The direct costs allocated to the internal and neurosurgery units were about $2261000 and$928000, respectively. Payments, medicines, and hospital consumables had the highest share of costs, respectively. By considering the total costs, the units as well as services studied were loss-making. Conclusion: Given that the hospital is a teaching one, teaching students about saving resources reduces the costs. Also, by providing home health care services for patients at the end-of-life stage hospitalized in the ICUs can also help the hospital achieve its financial goals. Key¬words: Activity-based costing, Overhead cost, Cost of End-of-Life services, Teaching hospital, Intensive care units Citation: Mehrinezhad S, Sarabi A, Rezapour A, Shokri A, Zahra Meshkani Z, Alipour V, et al. The Cost of Internal and Neurosurgery ICUs in a Selected Teaching Hospital: A Case Study. Journal of Health Based Research 2018; 4(3): 219-23. [In Persian

Actual Costs of Residency Training in Teaching Hospitals: A Case of Iran

Background: There was a challenge for teaching hospitals to accept residents for educational goals due to their training costs. Objectives: The present study aimed to estimate the actual costs of residency training in hospitals for policymaking, budgetary impact, and negotiation. Methods: This retrospective study was performed in eight teaching hospitals affiliated with the Iran University of Medical Sciences, Tehran, Iran, in 2018. Two scenarios were designed to estimate the costs of education per resident. All of the resources used by residents in the hospitals were identified. Cost items attributed to the training goals were allocated to the internal medicine and surgical fields; however, for cost items that were used for treatment and education, such as disposables and consumables and equipment, the cost drivers were used. Therefore, the difference between the scenarios was related to the cost drivers. Results: Overall, the selected hospitals had spent $586,720.35 and$ 572,358.10 based on scenarios 1 and 2, respectively. The residency training per surgical resident in the hospitals was about 1.2 times higher than an internal medicine resident. Surgery, neurology, urology, and anesthesiology were the f ields with the highest costs in the hospitals. Conclusion: Although residency training accounts for a large proportion of hospital costs, employing residents reduces the costs of human resources. Monitoring and controlling costs, as well as resource quotas for resident training, can be a way to reduce educational course costs in hospitals. Universities can cover some parts of the educational costs to motivate hospitals to make an appropriate setting for residents. Keywords: Cost Analyses, Academic Medical Centers, Internship and Residenc

Distribution of General Practitioners in the Health System of Iran Using Equity Indices (Gini, Atkinson(

Introduction: Although equity is a key motivation for providing hospital services to the public, resource distribution in governments, rarely focus on those who need the resources more. This study was done to investigate the distribution of general practitioners in the health system of Iran using Gini and Atkinson indices. Method: In this cross-sectional study, data were gathered from the Statistics Center of Iran, Medical Council and statistics office of the Ministry of Health and Medical Education. Gini and Atkinson indices have been used to investigate the distribution of human resources. In order to find more accurate estimation of the distribution coefficients, the adjusted index was used. Stata 11 software was applied for data analysis. Results: The range of Gini and Atkinson indices before adjusting needs during 2006-2011were respectively between 0.127-0.204; and 0.018-0.038 that shows a worse status after adjusting needs. Conclusion: Appropriate supply and distribution of medical manpower is the major key for improvement of the countries’ health status. Therefore, accurate estimation of required human resources and population-based distribution help to reduce the cost of health care systems as well as households’ cost. Keywords: General Practitioners, Equity, Lorenz curve, Gini coefficient, Atkinson inde

Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study

Background & Objectives: Deductions applied by insurance companies on sent bills affect the income of hospitals. If hospitals do not pay attention to this issue, it is probable that they do not receive the costs that they have paid even for the provided services. Methods: In this retrospective descriptive study conducted in one of the armed forces hospitals in Tehran in 2015, 6717 medical files belonged to the admitted cases were investigated. The list of reported deductions for admitted cases was prepared using a selfmade form that included deduction topics (surgery, anesthesia, services, imaging, laboratory, supplies and equipment, beds, visit and counseling). Results: The highest rate of deduction was due to the additional request for surgery and anesthesia (30% of total deduction). The highest rates of return were respectively related to request lower than tariff rate (78%) and absence of recording services related to surgical activities (17%) and operating room and anesthesia (5%). After identifying these cases, a total of 3270 million Rial was returned to the financial resources of hospital. Conclusion: Some strategies for reducing deductions are transferring affairs related to the registration and identification of outpatient services to the authorities of the units, establishing a system for collecting the experience of personnel and transferring them to the insurance organizations, creating a system for receiving the suggestions and ideas of employees, establishing interactions with the authorities of the contracting insurance companies, having physicians to record correct codes of surgery and services as well as establishing deduction committees. Keywords: Deduction, Insurance, Armed Forces, Hospital Citation: Vali-pour N, Mosavi-nejad SM, Meshkani Z. Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study. Journal of Health Based Research 2017; 3(2): 141-150

Enhanced Biomass-Derived Glycerol Conversion to Syngas in the CO₂ Reforming Process: Influence of the Nickel Loading Method on Physicochemical Properties and Catalytic Performance

In the current study, renewable syngas production from glycerol has been investigated through a catalytic dry reforming process using the Ni/CaO·Al2O3 catalyst. Calcium aluminate support has been synthesized via a one-step sol–gel technique. The active metal of Ni attached to the CaO·Al2O3 is supported by wet impregnation, simultaneous sol–gel, and EDTA-assisted impregnation. Investigation of different methods’ impact on Ni species attachment onto carrier revealed that the EDTA-assisted impregnation method improves the reducibility catalytic activity (57% at 750 °C) of the catalyst in the dry reforming of glycerol (dry-RG) process. It also affects carbon formation on the catalyst surface. Besides, the impact of Ni content (5–20 wt %) in the catalyst has been evaluated. Increasing the nickel loading amount increased the active phase’s reducibility and reduced the pore size. Ni loading experiments’ results indicate that glycerol conversion improves with increasing Ni loading up to 10 wt %, impregnated by chelated Ni species [Ni (EDTA)2–] onto calcium aluminate support. Based on the characterization results, the impact of the nickel loading method and amount on the dry-RG reaction was discussed