Retrospective or Prospective Reimbursement Systems: Evaluating the Efficiency of the Global Payment System in Public Hospitals in Bushehr Province; [نظامهای بازپرداخت گذشت هنگر یا آیندهنگر: ارزیاب ی کارای ی نظام پرداخت گلوبال در مقایسه با نظام پرداخت کارانه در بیمارستا نها ی دولتی استان بوشه] Publisher



Omranikhoo H ; Shahbazifard M ; Ardaneh M ; Rezaee M
Source: Iranian South Medical Journal Published:2025

Abstract

Background: Reimbursement systems play an important role in controlling costs and improving hospital efficiency. This study aimed to compare the billing costs of procedures subject to global tariffs with the notified tariffs for the same procedures to determine the efficiency of the global reimbursement method in hospitals affiliated with Bushehr University of Medical Sciences. Materials and Methods: This cross-sectional descriptive-analytical study examines data related to 12,527 procedures covered by the global tariff in 2022 in eight government hospitals in Bushehr Province, Iran. The required information was obtained through the Hospital Information System (HIS) and then analyzed using SPSS version 26 software. Results: The results showed that the global payment system (prospective) was able to cover 93% of hospital billing costs compared to fee-for-service (retrospective). Hospital profits were significant for part-time doctors, male doctors, male patients, and in services such as, neurosurgery and ophthalmology. Meanwhile, the largest losses imposed on hospitals were, related to the obstetrics and gynecology department. Also, profitable patients usually had shorter hospital stays and imposed lower costs on the hospital for medication, paraclinical services and accommodations. Conclusion: Global payment system can effectively reduce hospital costs and increase, productivity. In addition, it seems that in some cases global tariffs are not able to cover real costs and these tariffs should be revised. The findings can be used as a basis for decision making by health policy-makers. © 2025, Bushehr University of Medical Sciences. All rights reserved.