بررسی علل کسورات بیمه ای از دیدگاه کارشناسان بیمه در بیمارستان های آموزشی دانشگاه علوم پزشکی مشهد

Background and Aim: The most important issues that always absorb accuracy and effort of hospital, is the mastery and control over the financial status for the hospital resources management. In all countries, the medical centers are considered as a vital community resource and must be managed in line with the interests of society. Hence, these studies aimed to investigate the causes of insurance deductions and were made to assist hospital administrators in reducing the deductions against them.  Materials and Methods: This descriptive research is retrospective study in year 2012. The study population consisted of 100 insurance experts deployed in insurance centers (including Health care’s, Social security, Armed forces, Help Committee) from which 25 experts were randomly selected from each Insurance Center. Researcher madden questionnaire was used to collect data. For validating of questionnaire justifiability, questionnaire was provided to insurance expert, professors and ambiguities were resolved. Test-retest procedure was used to ensure the Stability of the questionnaire. The collected data was analyzed and classified using Excel software. Results: These findings indicate that between all parts of surgery wards deductions are the highest (%45/55), and between surgery wards, orthopedics surgery had the highest amount of deductions (%40/75). Conclusion: Healthcare provider should be more careful and minimize documentation errors in reporting and documentation. Also the hospital administrators for reducing deductions against patient records must provide educational course for correct documentation.