Comparison of the Actual Cost of Global Surgeries in the Hospitals Affiliated to Birjand University of Medical Sciences With the Government-approved Tariffs in 2021

One of the constant questions of hospitals and insurance organizations is the actual tariff of global surgeries. This study aims to compare the actual costs of surgeries in the hospitals affiliated to Birjand University of Medical Sciences (BUMS) with the approved global tariffs.

This is a retrospective study that was conducted in 11 hospitals affiliated to BUMS. The study population includes all global surgery bills in 2021. The criterion for entering the study was the presence of sufficient samples (at least 10 bills) from each of the performed global surgeries. Out of 91 collected global surgical procedures, 57 surgical procedures (equivalent to 63% of all global surgical procedures) met the inclusion criteria. The actual costs of surgeries were extracted from the hospital information system and compared with the government-approved tariffs. Data were analyzed using descriptive statistics in Excel 2016 software.

Based on the results, 52% of examined global surgery procedures, the global income was less than the average actual cost, while in 48% of the cases, the hospitals benefited from the costs of surgery. In 56 surgery cases, the billing cost was 12-139% higher than the approved global tariff, and in 23 cases, the difference was more than 50%.

There is a considerable difference between the actual cost of global surgeries in hospitals affiliated to BUMS and the approved tariffs. Due to the higher actual cost of surgeries, these tariffs have resulted in losses in hospitals.