Abstract

Background and Aim: Today, most of the hospital revenue comes from insurers. The aim of this study was to investigate the amount and causes of insurance deductions of the Armed Forces Medical Services Organization (Sakhad) in a military hospital in Tehran, Iran. Methods: This cross-sectional study was performed in Tehran, Iran in 2015. All inpatient files with deductions which had contracted with the armed services medical insurance were collected using a database. Medical records and documents were screened using a checklist assessing the amount and reasons for the deduction, month, division and specialty of the physician. Data were analyzed using SPSS-19 software. Results: A total of 11,992 inpatient medical records were studied, yielding a total of 3517 medical records with insurance deductions. The total amount of insurance deductions was 2,383,423,209 Rials (79,447.4403 USD). The highest amount of deductions per month, department, physician's specialty and causes were in June (14.45), men's surgery (39.78), orthopedics (40.76), and consumables (48.30), respectively. There was a significant difference in deductions mean score and month, department, physician specialty and causes variables (p <0.0001). Conclusion: Considering the significant confirmation of the difference in the mean of deductions and the study variables, personnel familiarity with insurance laws, and using a hospital data system can help prevent insurance deductions. © 2018 Baqiyatallah University of Medical Sciences. All rights reserved.