A trend analysis of surgical operations under a global payment system in Tehran, Iran (2005-2015)

Abstract

BackgroundGlobal 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.ObjectiveThe aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations.MethodsIn 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.ResultsSome 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).ConclusionThe varying trend of global surgeries can partly reflect the behavior of service providers in order to increase their profits and minimize their costs.

Does the approved tariff cover the actual cost of global surgical procedures?

“…For example, they do not reimburse the cost of some medicines and medical supplies or do not accept the use of some more expensive techniques, such as laparoscopy for surgery. In addition, the lack of attention to the production cost of services, the inflation rate, the type and function of the hospital, the age and gender of the patient, the disease severity, and comorbidity in tariff setting are the factors causing a difference between the tariff and the actual cost (6). The growth of tariffs for medical services should be based on the inflation rate (24).…”

“…Failure to determine the actual tariff that covers the actual costs of the service can result in incomplete treatment and early discharge, resulting in increased surgical complications, re-admission rates, and treatment costs (6).…”

“…In the global payment system, the total cost of a GSP consists of the surgeon and assistant surgeon wages and the costs of operating room, anesthesia, physician counseling, electrocardiography, laboratory tests, pathology, imaging, medicine and consumable items, and other expenses. Therefore, the purchaser, like a patient or an insurer, pays at a specified and predetermined price for each GSP, regardless of its actual costs, and the costs beyond that cannot be reimbursed (6). Factors such as age, sex, and disease severity do not affect the amount of reimbursement (5,7).…”