Designing a Model for Calculating and Announcing Medical Service Tariffs in Iran

Introduction: It is necessary to have a transparent and measurable mechanism for determining the medical service tariffs in order to achieve the desired outcomes of the health system. The purpose behind this study is to design a national model for the country’s tariff system.
Method: Descriptive-comparative research has been done in three stages. 1) Using the content analysis method, the challenges of the existing tariff system have been identified. 2) Using the comparative study method, the health system and tariffing processes in selected countries have been studied. 3) Using Delphi technique, the desirable and national model has been designed.
Findings: The findings of the study, while providing a general model, contain the following suggestions:
1. In the field of structure: creating a balance between the votes of the supply and demand representatives of medical services and the existence of committees to provide the necessary evidences for decision-making.
2. In the field of process:
 
- Separation of physician work and practice expenses RVUs2 for all medical services.
 
- Determining the physician work conversion factor
 
- Determining the practice expenses conversion factor or adjusting its relative value units according to the physician work conversion factor
- Calculating the average cost of physician work and practice expenses RVUs of paraclinical services
- Converting hotel costing to relative value units.
3. In the field of supervision, the formation of a committee to monitor the determination and implementation of tariffs
Discussion: Iran’s healthcare tariff system is facing serious challenges and defects, and it is expected that the proposed reforms in this study will pave the way for the desirable outcomes in the country’s health system.