Examining the Real Financial Risk of Global Surgical Procedures: Comparing Global Reimbursement Method and Fee-for-Service

Abstract

Background: Payment methods are essential for ensuring access, equity, and quality of care. Objectives: This study compared global tariffs for various surgical procedures with their costs under the Fee-for-Service (FFS) model to understand how different financial methods affect the hospital economy. Methods: This study is a retrospective cross-sectional analysis based on data collected from the hospital information system (HIS). The research focused on all university hospitals in Bushehr province, examining cases that fell under the global tariff in 2022. For each case, the global tariff was compared to the bill amount (FFS) to assess the profitability or loss associated with each case. All statistical analyses were performed in SPSS software using an independent t-test at the significance level of 0.05. Results: The results showed that out of 12,527 services subject to the global tariff, 5,227 cases had the tariff exceed the billing cost, benefiting the hospitals. However, in 7,300 cases (58%), the billing cost surpassed the global tariff, leading to losses. Overall, hospitals faced a total loss of 33,841,636,586 rials in 2022, averaging 2,701,495 rials per case. Profits were observed in ophthalmology, neurology, and urology, while losses occurred in gynecology, general surgery, orthopedics, and ENT. Conclusions: The results indicated that the global payment method has led to losses for hospitals overall, yet has been profitable in 42 percent of cases. To enhance its effectiveness, it's crucial to consider factors like patient age, comorbidities, disease severity, and adjust tariffs for inflation while controlling costs in drug prescriptions and consumables.