Perception of insurance organization managers on the concept of real tariff of medical services in the health system: A qualitative study

Jabbari, Alireza and Keyvan ara, Mahmood and Rahi, Fatemeh and Aziz zadeh, Mina (2015) Perception of insurance organization managers on the concept of real tariff of medical services in the health system: A qualitative study. Journal of Qualitative Research in Health Sciences, 4 (3). pp. 304-313. ISSN 2645-6109

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Abstract

Introduction: Setting tariffs is one of the most important tools of policy makers of the health system in every country for implementing their authority which is effective in justice, performance, and the quality of and accountability in offering services. Moreover, it can influence access rate and use of services. Changing medical tariffs affects the income of medical and hospital service providers, and the expenditure of financiers of medical and hospital services. This study investigated the concept of real tariff from the point of view of managers of insurance organizations. Method: This qualitative study was performed via in-depth interviews with 19 managers of health, social security, and armed forces insurance organizations who were informed of or their occupation was related to this field. Thematic analysis method was used for analyzing interviews. Results: Managers of insurance organizations expressed the concept of real tariff in two themes of definition of real tariff, and methods, elements, and principles of determining tariffs and subthemes of determination of tariffs based on collective agreement considering interests of involved groups, based on cost of services, and based on type and sensitivity. Conclusion: To amend the status of setting tariffs, characteristics of real tariff should be identified based on the concept of real tariff. Interests of involved groups (insured, service provider, and insurer) should be considered in determining tariffs. Tariffs should be determined based on collective agreement, the views of representatives of involved groups, and cost of services. Keywords: Real tariff, Insurance organizations, Managers, Medical services, Health system

Item Type: Article
Subjects: A General Works > AI Indexes (General)
Depositing User: amiri
Date Deposited: 01 Mar 2019 12:33
Last Modified: 27 Mar 2019 19:25
URI: http://eprints.kmu.ac.ir/id/eprint/30605

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