فهرست نشریات علمی دسترسی آزاد ایران

INTRODUCTION: Since 2013, in Iran’s health care, the contribution of direct payments for health‑careservices was estimated more than 50 % of all expenditures. In May 2014, Iran’s health‑care reform wasestablished to improve health services quality and reduce patients’ out‑of‑pocket payments <10% inurban and 5% in rural areas. Therefore, the purpose of this study is to investigate unmet costs (thosewhich are not covered either by the insurance companies nor the recent reform coverage mentionedin Sections 1.2.2 and 1.2.1, Article 6 of the Health Minister Reform Guideline) in the inpatient billingswithin the first 5 months from the reform implementation.METHODS: This study was conducted as a cross‑sectional research in the second half of 2014 onthe selected hospitals in Isfahan Province. Data were collected by investigating 97,000 inpatients’billing records issued by 28 hospitals affiliated to Isfahan University of Medical Sciences usingcensus method.RESULTS: Findings of the study showed that the average of unmet costs paid by the inpatientsconstituted 21.8% of the total billing costs in 28 hospitals, and the average unmet costs paid by eachpatient was 1,903,832 Rials.CONCLUSION: Considering the definition of unmet cost in the context of health‑care reformguideline and hospitals’ problems in providing some costly services, drugs, and medicalequipment (that were not covered by insurance organizations and the reform scheme) withinthe obligations of the reform, it is necessary to review these obligations and further interact withinsurance companies about expanding the coverage to some costly services required by thepatients.