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:: Volume 4, Issue 3 (12-2015) ::
J Qual Res Health Sci 2015, 4(3): 304-313 Back to browse issues page
Perception of insurance organization managers on the concept of real tariff of medical services in the health system: A qualitative study
Alireza Jabbari , Mahmood Keyvan ara , Fatemeh Rahi * , Mina Aziz zadeh
Abstract:   (3375 Views)

Introduction: Setting tariffs is one of the most important tools of policy makers of the health system in every country for implementing their authority which is effective in justice, performance, and the quality of and accountability in offering services. Moreover, it can influence access rate and use of services. Changing medical tariffs affects the income of medical and hospital service providers, and the expenditure of financiers of medical and hospital services. This study investigated the concept of real tariff from the point of view of managers of insurance organizations. Method: This qualitative study was performed via in-depth interviews with 19 managers of health, social security, and armed forces insurance organizations who were informed of or their occupation was related to this field. Thematic analysis method was used for analyzing interviews. Results: Managers of insurance organizations expressed the concept of real tariff in two themes of definition of real tariff, and methods, elements, and principles of determining tariffs and subthemes of determination of tariffs based on collective agreement considering interests of involved groups, based on cost of services, and based on type and sensitivity. Conclusion: To amend the status of setting tariffs, characteristics of real tariff should be identified based on the concept of real tariff. Interests of involved groups (insured, service provider, and insurer) should be considered in determining tariffs. Tariffs should be determined based on collective agreement, the views of representatives of involved groups, and cost of services.

Keywords: Real tariff, Insurance organizations, Managers, Medical services, Health system
Full-Text [PDF 438 kb]   (764 Downloads)    
Type of Study: Research | Subject: Special
Received: 2015/05/5 | Accepted: 2015/09/7 | Published: 2016/01/30
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jabbari A, keyvan ara M, rahi F, aziz zadeh M. Perception of insurance organization managers on the concept of real tariff of medical services in the health system: A qualitative study. J Qual Res Health Sci. 2015; 4 (3) :304-313
URL: http://jqr.kmu.ac.ir/article-1-484-en.html

Volume 4, Issue 3 (12-2015) Back to browse issues page
مجله تحقیقات کیفی در علوم سلامت Journal of Qualitative Research in Health Sciences
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