A study of the problems between basic insurance organizations and teaching hospitals of Shiraz University of Medical Sciences as viewed by the staff of income hospitals and representative of the insurer’s organization in 2013

摘要

Introduction : In Iran health insurance is a significant tool in healthcare costs, financing health care and equal access to health services for people. Problems between hospitals and insurance organizations impose extra cost to the patient, leading to financial losses they will infringe upon the rights of patients. This study aimed to determine the issues between hospitals and basic insurance organizations and proposed practical solutions to solve problems in Shiraz University of Medical Sciences. Method :This research was a qualitative study (content analysis), which was conducted in 2013. The research population consisted of teaching hospitals of Shiraz University of Medical Sciences; Purposeful sampling was used and continued until data saturation. The representative of the insurers and staff of income hospitals were asked questions using a semi-structured interview. In this study, we used NVIVO for data analysis. Results : The results of this study showed that the most common problems between basic insurance organizations and teaching hospitals include the lack of prompt payment of hospital bills and imposing deduction on the hospitals. Conclusion : Based on the results of this study, it seems that cooperation between hospitals and insurance organizations could be improved by timely payment of hospital bills and codifying appropriate rules and regulations by basic insurance organizations and, on the other hand, with timely completion of bills and training of hospital staff by the hospital authorities. Keywords : Hospitals, Insurance, deductions.