Health care pricing and tariff setting methods: A scoping review

Objective (s): 

Health services tariff is “the mandated price of health services determined by authorities and must be paid to healthcare providers in exchange of receiving services”. The pricing and tariff-setting system of healthcare services in Iran is facing challenges. This study aimed to identify and explain healthcare pricing and tariff-setting methods.

This study was conducted in 2023. Five English databases (i.e., PubMed, Web of Science, Scopus, Embase, and ProQuest) and three Persian databases (i.e., Magiran, Iranmedex and SID) and Google and Google scholar search engines were searched to find scientific sources. Finally, 45 documents related to healthcare pricing and tariff-setting methods were selected and analyzed using MAXQDA software version 10.

Overall, 20 healthcare pricing and tariff setting methods were identified, including capitation, per diem, fee-for-service, global budget, negotiation-based, resource-based relative value scale, cost-plus, value-based, pay-for-performance, best practice-based, diagnosis-related groups, bundled, reference, tiered, sliding-scale, premium, market-based, risk-adjusted, subscription and competitive bidding. Each of these pricing and tariff-setting methods has advantages and disadvantages. In general, the prospective and fixed pricing methods reduce healthcare costs and increase the efficiency of healthcare organizations. The use of complementary value and performance based methods improve the quality of health services.

Health care pricing and tariff-setting methods affect access to health services, and quality and cost of health services. The capitation method along with the value and performance based methods are suggested for the pricing of outpatient services; and diagnosis related groups, bundled and best performance-based methods are suggested for the pricing of inpatient services in Iran.