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آرشیو :
نسخه زمستان 1400 - جلد دوم
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کد پذیرش :
12067
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موضوع :
سایر شاخه ها
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نویسنده/گان :
| نیما هنرور، عبدالخالق کشاورزی، آزیتا یزدان پناه
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زبان :
فارسی
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نوع مقاله :
پژوهشی
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چکیده مقاله به فارسی :
مقدمه : با توجه به تعرفه های پایین خدمات درمانی در بیمارستانهای دولتی و هزینه های بالای خدمات درمانی، لزوم وصول کلیه درآمدها از سازمانهای بیمه گر ضروری است. این پژوهش با هدف اصلی اولویت بندی عوامل کسورات بیمه ای به منظور مداخله هدفمند در بیمارستانهای آموزشی درمانی دانشگاه علوم پزشکی شیراز انجام گرفته است.
روش کار: این پژوهش کاربردی از نوع توصیفی-تحلیلی و مقطعی است. جامعه پژوهش شامل 4580 صورتحساب اعمال جراحی که 367 صورتحساب مشمول کسورات بیمه ای در سه ماهه چهارم سال 96 گردیده بود. با توجه به در دسترس بودن جامعه آماری در شهر شیراز لذا داده های مورد نیاز پژوهش از مستندات اسناد پزشکی سازمان بیمه تامین اجتماعی و مراکز آموزشی درمانی در شیراز استخراج گردید. سپس عوامل کسورات به روش آنتروپی شانون وزن دهی و با استفاده از نرم افزار آنتروپی رتبه بندی شد.
یافته ها: بیشترین میزان کسورات مربوط به گروه جراحی عمومی و سپس گروه جراحی مغز و اعصاب بوده است. پس از وزن دهی، مهمترین عوامل کسورات به ترتیب اولویت شامل درخواست کد اضافی- درخواست کد عدم تعهد بیمه-عدم امضا مدارک عمل توسط جراح- ایراد در شرح عمل نویسی-ایراد در سیستم HIS- عدم مهر مدارک عمل توسط جراح بوده است. نتیجه گیری: براساس نتایج بیشترین عوامل کسورات مربوط به درخواست کد اضافی و درخواست کد عمل که در تعهد بیمه نمی باشد که اکثرا ناشی از عدم آشنایی پزشکان و سایر پرسنل درگیر در فرایند درمان بیمار با قوانین بیمه ای است.
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لیست منابع :
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کلمات کلیدی به فارسی :
کسورات، بیمه، آنتروپی، شانون، حق العمل.
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چکیده مقاله به انگلیسی :
Investigating the amount and causes of social security insurance deductions in surgical fees in Shiraz teaching hospitals and prioritizing deduction factors by Shannon entropy method in the fourth quarter of 2017
Introduction: Due to the low tariffs for medical services in public hospitals and the high costs of medical services, it is necessary to collect all revenues from insurance organizations. This study was conducted with the main purpose of prioritizing the factors of insurance deductions for purposeful intervention in the teaching hospitals of Shiraz University of Medical Sciences.
Methods: in this cross-sectional applied research. The study population included 4580 invoices for surgeries, of which 367 invoices were subject to insurance deductions in the fourth quarter of 2017. Due to the availability of the statistical community in Shiraz, therefore, the data required for the study were extracted from the documents of medical documents of the Social Security Insurance Organization and educational and medical centers in Shiraz. Then the fraction factors were weighted by Shannon entropy method and ranked using entropy software.
Results: The highest rate of deductions was related to the general surgery group and then to the neurosurgery group. After weighing, the most important factors of deductions in order of priority included requesting additional code, requesting non-commitment code, non-signing of operation documents by the surgeon, defect in the description of the operation, defect in the HIS system, non-sealing of operation documents by the surgeon.
Conclusion: Based on the results, most of the deduction factors are related to requesting additional code and requesting action code, which is not in the insurance obligation, which is mostly due to unfamiliarity of physicians and other personnel involved in the patient treatment process with insurance rules.
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کلمات کلیدی به انگلیسی :
- صفحات : 49-57
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